The Pharmaceutical Journal
Vol 268 No 7189 p380
16 March 2002

An occasional feature, prepared in the Royal Pharmaceutical Society's Professional Standards Directorate, to highlight problems and inquiries currently being handled

Endorsement of prescriptions

A pharmacy contractor's National Health Service terms of service includes a requirement that the pharmacist shall, with reasonable promptness, provide the medicines and/or appliances as ordered on an NHS prescription form.

Circumstances are defined within the Drug Tariff where the quantity of medicine supplied by the pharmacist contractor can differ from the quantity ordered on the prescription. Examples are manufacturers' calendar packs or drugs and chemical reagents in special containers. The prescriptions must be appropriately endorsed to reflect the quantity of medicine or chemical reagent supplied.

Outside these defined circumstances, pharmacists are required to supply the exact quantity ordered on the prescription. Clearly if, for example, there is some local agreement with the relevant prescribers that only 28 days' supply would be made against prescriptions ordering in excess of 28 days, then it would be allowable for the pharmacist to supply 28 days' worth of medicine. The pharmacist must ensure that prescriptions are appropriately endorsed with the actual quantity supplied. Claims in excess of the amount actually supplied could lead to allegations of fraud against the contractor.

In the absence of any agreement from the prescriber or any other overriding circumstances, such as acting in the best interests of the patient, the pharmacist should supply what the doctor has ordered. Failure to do so could result in the contractor being liable for breach of terms of service. The local health authority currently deals with such breaches.

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Instalment dispensing of buprenorphine

Some confusion may arise over instalment dispensing of buprenorphine because of different arrangements across Britain. The current position is as follows.

In Scotland, any drug, including buprenorphine, can be dispensed in instalments on form GP10.

In England, changes occurred on 1 April 2001 to permit the supply of buprenorphine for the treatment of addiction on both FP10HP(AD) and FP10MDA prescription forms.

In Wales, legislation currently does not permit GPs to prescribe buprenorphine by instalment on FP10MDA forms. However, legislation does allow buprenorphine to be prescribed on FP10HP(AD) forms. These forms are hospital outpatient forms that are invariably used by doctors in drug treatment centres.

See Welsh GPs able to prescribe more CDs by instalments (February 2003)

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Labelling of medicines in care homes

Pharmacists are reminded that all dispensed medicinal products, including those supplied to care homes, must be labelled in accordance with the labelling regulations. A Royal Pharmaceutical Society booklet, "The administration and control of medicines in care homes", provides guidance for pharmacists where a GP changes the dose of a medicine between prescriptions. The booklet costs £6 and can be ordered by telephoning the Society on 020 7572 2409. The guidance states that the GP must provide written authorisation to the home regarding the change in dosage and the container must be clearly relabelled by the pharmacist or GP in line with any agreed local protocols. A prescriber who wishes to change a dose should endorse the new dose on the medicines chart or supply a new prescription.