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NHS repeat dispensing schemes in England

  • Last modified date:
    1 June 2007

Repeat dispensing means patients having medicines dispensed in several episodes direct from the pharmacy, rather than going back to their GP each time. Originally announced as part of the NHS Plan, repeat dispensing is included in the new Community Pharmacy Contractual Framework as an essential service. As of 1st October 2005 therefore, all NHS community pharmacies will be able to dispense a repeatable prescription if one is presented to them.

The following is a description of the paper-based repeat dispensing service which currently operates. Release two of the Electronic Prescription Service (EPS) will enable electronic repeatable prescribing. This service will be broadly the same as the service which operates currently, with the added advantage that patients will be able to collect their prescriptions from more than one pharmacy. The only other major change will be that paper repeatable prescriptions and batch issues will no longer be required.

Repeat dispensing - for patients

Repeat dispensing is an optional service, but anyone can use it. Whether a prescription is suitable to be dispensed under the repeat dispensing arrangements is a matter for the prescriber's clinical judgement and mutual agreement between the prescriber, the patient and, ideally, the pharmacist. The expectation is that the arrangements will be best suited to patients with chronic conditions which are considered likely to remain stable for the duration of the repeatable prescription. Currently however, no group of patients or medical conditions is excluded from the arrangements. The service may not be used for the dispensing of schedule 2 and 3 controlled drugs.

The patient receives a repeatable prescription, which gives details of how many instalments the prescription contains. This is accompanied by the correct number of 'batch issues', one for each time the medicine is to be dispensed. Both the repeatable prescription and the batch issues are required for medicines to be dispensed.

The patient declaration on the back of the batch issue must be completed for each instalment as if for a normal, acute prescription. Patients required to pay the prescription charge will have to pay this each time a batch of medicine is dispensed.

When dispensing an instalment of medicine, the pharmacist may ask the patient questions about their medication. This is to ensure that the patient is still taking their medicine and that they are not having any problems. If there are any problems the pharmacist will refer the patient back to the prescriber.

The pharmacy needs to retain the repeatable prescription for the duration of the prescription. The patient keeps the remaining batch issues or asks the pharmacist to keep them on their behalf, until they require another issue of medication. The patient must therefore use the same pharmacy for every batch of medicine. If the patient wishes to use a different pharmacy, they must return to their GP for another prescription. The Electronic Prescription Service will change this however, allowing patients to pick up their repeatable prescription from any pharmacy in England. Patients should also return to their GP if any of their batch issues are lost or stolen.

Patients will need to be aware that if they wish to use repeat dispensing, information on their use of the arrangements and medication dispensed may be passed between the pharmacist and prescriber and vice versa.

Repeat dispensing - for prescribers

The following is a description of the repeat dispensing service, the specification of which is set out in the terms of service contained in The National Health Service (General Medical Services Contracts) Regulations 2004 , with similar provisions for practitioners operating under PMS and other contracts. For further information, please refer to the relevant legislation.

Use of the repeat dispensing arrangements is a matter for the prescriber's clinical judgement and mutual agreement between the prescriber, the patient and, ideally, the pharmacist.

Where repeat dispensing is required, prescribers' software systems will need to produce a repeatable prescription on an FP10 and a further series of 'batch issues' (also printed on FP10s). GP systems suppliers will need to ensure their products are capable of producing repeatable prescriptions and batch issues. GPs should contact their suppliers about IT upgrades to allow them to operate the service

The repeatable prescription contains all the usual details i.e. name and address of patient, age, date of birth, prescriber details, signature and date. The prescriber is required to specify the number of issues he/she wishes to permit from the prescription and, if appropriate, the dispensing interval (e.g., monthly, quarterly).

Whether to indicate a dispensing interval is at the clinical discretion of the prescriber. However, it is important to note that the specification of a dispensing interval by the prescriber will restrict the pharmacist as to when they can dispense. Not giving a dispensing interval allows the dispenser to use their professional judgement to dispense instalments at an appropriate time. This will allow leeway for unusual situations such as when the patient goes on holiday.

However, good practice expects both prescriber and dispenser to take account of the balance that needs to be struck between maximising patient convenience and the risk of oversupply and possible diversion because the intervals between instalments are too long or inadequately controlled.

The FP10 form is annotated such that the dispenser can distinguish when an FP10 is being used for repeat dispensing rather than as a normal single-event prescription. The prescriber needs to sign the repeatable prescription (prescription authorisation). This is needed by the dispenser at each dispensing episode. The 'batch issues' are not signed by the prescriber as they are not prescriptions but are used for reimbursement purposes.

Batch issues are created by overwriting the prescriber signature box with the text "Repeat dispensing: [example] 6 of 12". The date on which the repeats were authorised is printed on all batch issues. Further information about repeat describing forms has been produced by:

If a change in medication is required, the patient must be issued with another prescription. If this is the case, or if the prescriber feels that a repeatable prescription they have issued is no longer appropriate, they should inform the patient and make every effort to contact the pharmacy. For this reason it is good practice for the prescriber to document which pharmacy the patient is using, if this information is known.

Current regulations do not allow for the provision of repeat dispensing services by dispensing doctors to their dispensing patients. They may, however, issue a repeatable prescription to a non-dispensing patient, to be dispensed by a pharmacist.

Repeat dispensing - for pharmacists

This is a guide to the repeat dispensing service, the specification of which is set out in the terms of service for pharmacists.

Repeat dispensing is specified as an essential service under the new Community Pharmacy Contractual Framework. As of 1st October 2005 therefore, all pharmacies must be in a position to dispense a repeatable prescription if presented with one.

There is a requirement to undertake appropriate training before providing repeat dispensing services. Training requirements are set out in paragraph 4.2 of part VIA of the drug tariff.

When dispensing a repeatable prescription, the pharmacist should check that the medication remains appropriate for the patient and their condition, and that there are no problems. If they believe that the current course of medication is no longer appropriate, they should not dispense the prescription. Rather, they should refer the patient back to the prescriber.

Unlike the dispensing of an acute prescription, the patient is not asked to sign the repeatable prescription. Instead, the declaration on the back of the batch issue is filled in when that batch of medicine is dispensed, including patient signature if necessary. Unlike instalment dispensing on an FP10(MDA-S), a prescription charge is due for each issue. Patients with exemption from the charge must declare this separately each time a batch of medicine is dispensed.

The dispenser processes batch issues and forwards the forms to the BSA at the end of each month, along with all normal, non-repeatable FP10s. The repeatable prescription is sent to the BSA once all batch issues have been dispensed or, if the patient does not collect all instalments, on expiry.

Repeat dispensing requires pharmacists to have secure storage for prescription authorisations and batch issues. There is also a requirement to ensure there is a clear audit trail for each prescription, allowing the pharmacist to see exactly what has been dispensed against each prescription. It is particularly important that locums are made aware of pharmacy-based procedures to support delivery of the service, such as the mechanism for storing batch issues.

In addition to the professional fee payable under Part IIIA of the Drug Tariff for each item dispensed, contractors who are repeat dispensing chemists will receive an annual repeat dispensing payment of £1500, received as £125 monthly. Prescriptions dispensed in accordance with repeatable prescriptions will be taken into account when considering payment for additional services and payments for the essential small pharmacy scheme.

Despite the inclusion of appliances among items suitable for repeat dispensing, current regulations do not allow for repeat dispensing by appliance contractors.

Research on repeat dispensing

An evaluation of the repeat dispensing service in community pharmacies has recently been carried out by the University of Manchester. A copy of this research can be found at the link below.

Michael West
Medicines, Pharmacy and Industry Group
Department of Health

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