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Repeat prescribing systems

Repeat prescribing accounts for 60-70% of prescription costs and 80% of prescription items in primary care.

'Fundamental to this is a system for the continuing assessment of the condition being treated, and of the treatment ... taking into account whether the treatment is being delivered in the most appropriate manner, in appropriate quantities, and being used by the patient as intended.' National Prescribing Centre 2004

As well as affecting ease of accessing medicines for patients, repeat prescribing systems have an important role in ensuring the review of patients' medicines, patient safety and in minimising wastage of medicines. A good repeat prescribing system would provide a trigger for a full review of patients' medicines by a doctor after a specified number of repeats. The review provides an opportunity to change, continue or stop treatment.

Ordering prescriptions

Patients order their repeat prescription from the surgery, usually by posting a repeat order slip or by calling at the surgery and handing the slip to reception staff. Some patients order all the medicines on their repeat list every time, even if they are not always needed. They may worry that if a medicine is thought not to be used, the surgery will remove it from their repeat list and they will not be able to order it again, or it becomes too complicated to remember when to order which item.

Prescription frequency, patient safety and convenience

Repeat prescriptions are generally given for periods of between one and three months, sometimes longer. Some patients would prefer to have a prescription that covers the longest period so they do not have to visit the surgery so often.

'I've been on insulin for ten years now. My diabetes is under control. I won't be stopping the insulin and I go to the hospital to see the specialist. So why does my GP insist on only giving one month's supply of insulin at a time? I could easily manage six months' worth. It's a waste of time.'  (Woman aged 24 with diabetes)

The frequency of repeat prescriptions should balance patient convenience with clinical appropriateness, cost-effectiveness and patient safety. For example, where a patient's condition is stable, it may be appropriate to issue prescriptions for longer periods and this should be discussed and agreed with the patient. Long repeats can lead to waste if treatment is changed or stopped or is not tolerated because of side-effects. It also means that patients may not be reviewed for long periods.

Repeat dispensing makes it possible for patients to get their repeat medicines for up to a year from their community pharmacy without having to contact their GP surgery. On each occasion, the community pharmacist checks that the medicines are still needed and are being used appropriately, to avoid dispensing medicines that will not be used. Evidence from previous pilot studies has shown that repeat dispensing helps reduce waste.

Repeat dispensing can also make it easier for patients with chronic conditions to obtain repeat prescriptions, speeding up services and relieving pressure on GP surgeries. It is also an opportunity to make better use of pharmacists' skills by helping patients get the most out of their medicines. The new proposed pharmacy contractual framework that is being negotiated is expected to include repeat dispensing within the essential service component provided by all pharmacies.

Medicines wastage

It is estimated that up to 10% of all medicines prescribed are wasted. Patients are sometimes blamed for causing waste when in fact there are several reasons why medicines are wasted.

Reason for unused medicine

Underlying cause

Treatment changed

GP
Hospital after admission
Hospital at outpatient clinic
Hospital discharge
Medicine not tolerated by the patient
Prescription quantities not synchronised Repeat prescribing system

Patient died

 

Patient decides to use medicine intermittently or not at all

Patient - side-effects; perceived lack of intermittently or not at all efficacy and need; medicine does not fit with daily activities; medicine dose not fit with patient's beliefs.

Medicines returned to pharmacies cannot be used again. The Royal Pharmaceutical Society's Code of Ethics for pharmacists states that 'medicines returned to a pharmacy from a patient's home, a nursing or residential home must not be supplied to any other patient'. These medicines cannot be used again and have to be destroyed. The reason is that once the medicine has left the pharmacy, storage conditions cannot be guaranteed. Some medicines are sensitive to heat, light or moisture and can become less effective if not stored properly. It is also not possible to guarantee the quality of medicines on physical inspection alone.

Pharmacy prescription collection schemes

Many pharmacies have a system for collecting repeat prescriptions from local surgeries for their regular patients. Although community pharmacies have practice leaflets outlining available services, not all patients know this service is available.

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