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Reducing waste associated with repeat prescribing

1. Why is this being done?

 

The CCG has asked the practice to adopt this approach to repeat prescription requests, believing that overall it will reduce waste and save a worthwhile amount of money for the NHS.  They believe that patients should be in control of requesting their repeat medicine(s). Pharmacies requesting repeat prescriptions on patients’ behalf can result in waste, when medicines are requested that the patient will not take or is not running out of. The person who knows best about which medicines are required or running out is the person taking the medicines (or their carer). We think that if people request their own repeat prescriptions, it will help to reduce waste.

 

2. What’s the evidence that there is more waste when patients do not request their repeat prescriptions direct from their general practice?

 

Luton practices limited third party requests for repeat medicines and improved repeat prescribing systems. Estimated savings were 7% of the primary care prescribing budget, albeit over 2 years. An equivalent impact in NWL would be a considerable cost saving.

Haringey CCG used Luton’s audit methodology in late 2016. Results from 10 practices showed that patients had over-ordered by 6-17% (average 12%) and community pharmacies had over-ordered by 7-40% (average 19%).

 

North West London Collaboration of CCGs - Prescribing Wisely FAQs

The 2015 BMJ awards shortlisted a general practice in Cardiff which asks patients to confirm the prescription by countersigning and dating it. Prescribing costs fell by 7.5% in the first quarter after the change was made

Initial work in Coventry reduced two practices’ overall costs for medicines by 8.9%.

3. What if I cannot request my own repeat prescriptions and do not have a family member or friend who can request it for me?

 

Options may include:

  • Repeat prescriptions requested by another health professional who works with the patient;

  • The prescriber agreeing that the patient’s community pharmacy can request the prescription on the patient’s behalf (patients who do not have a Carer or are disabled);

  • If the practice has a clinical pharmacist, him or her managing generation of the patient’s repeat prescriptions.

4. How will the pharmacy know that I am now requesting my own repeat prescriptions?

 

Please inform your community pharmacy that from now on you will be requesting your repeat prescriptions direct from the general practice.

5. Can I ask the pharmacist to order my repeat medicines ?

 

It is easy for the vast majority of patients to request their own repeat prescription, or to do so with help from a relation or friend. The CCG have advice that the convenience of ordering medication direct from a pharmacist is likely to come at a high price to the NHS in wasted medicines. Some patients are given medicines that they don’t intend to take or are not running out of. It is quick and easy for patients who use a computer, tablet computer or smartphone to request their own repeat prescriptions, at a time that suits them. It should not be unreasonably onerous for other patients to request their repeat prescriptions using repeat prescription request slips.

 

6. What about online pharmacies?

Online pharmacies should be treated identically to other community pharmacies. The vast majority of patients should request their own repeat prescriptions; most who can’t will have a friend or relative who can request the prescription for them.

7. What if the patient runs out of his or her medicines?

If a prescription cannot be issued in time:

  • The patient can request an ‘emergency supply’ of the medicines from their community pharmacist. The pharmacist will need to interview the patient and be satisfied there is an immediate need for the prescription only medicine and that it is not practical for the patient to obtain a prescription. Any medicines supplied will be a private transaction and the pharmacist may charge for the cost of the medicines and a dispensing fee. Emergency supplies cannot be made for controlled drugs Schedule 1, 2 and 3 (except phenobarbitone or phenobarbitone sodium for epilepsy).

  • The prescriber can request a pharmacy to make an ‘emergency supply’ to a patient. The pharmacist will need to be satisfied that the prescriber is unable to provide a prescription immediately due to an emergency (e.g. patient cannot collect the prescription from the prescriber, the prescriber is unable to get the prescription to the pharmacy, and the patient urgently needs the medicine). The prescriber will need to agree to provide the pharmacy with a prescription within 72 hours. Emergency supplies cannot be requested for controlled drugs Schedule 1, 2 and 3 (except phenobarbitone or phenobarbitone sodium for epilepsy).

  • The patient can phone NHS 111 which should direct them to a pharmacy that is able to issue an urgent supply of the medicines free of charge on the NHS under the NHS Urgent Medicines Supply Advanced Service (NUMSAS). NHS Prescription charges will apply to any medicines supplied.

8. If I have a complaint?

There should be little cause for a complaint, but if you disagree and want to complain, please direct communications to the CCGs’ complaints team: