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Roger Pilsbury (left) discusses a repeat prescription with local GP Dr Kenneth Megson
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Repeat dispensing schemes are slowly beginning to get off the ground.
Problems with the software used by some general practitioners have held
back the pathfinder sites (see p635), but where the difficulties have
been overcome, a positive story emerges. Pharmacists, patients and GPs
are all seeing the benefits that repeat dispensing schemes can offer.
One pathfinder site where progress has been made is in Gateshead, Tyne
and Wear. Six general practices and five community pharmacies are involved.
One pharmacist who has had several months of experience of the scheme
is Roger Pilsbury. Mr Pilsbury’s pharmacy, Trichem Ltd, is located
at Felling Health Centre in Gateshead. Within the health centre are two
GP practices, both of which are part of the repeat dispensing scheme. “We
started in August and are just beginning to have the first few patients
collecting their third month’s supply. Almost all of them are on
one-monthly cycles for a total of either six or 12 months,” explains
Mr Pilsbury.
“The scheme has been well accepted by patients,” he says. “Both
surgeries have a 48-hour turnaround for repeat prescriptions so to be
able to come to the pharmacy and, following a few questions, obtain a
supply without this wait is a huge bonus,” he explains. “In
addition, patients’ conversations about repeat prescriptions in
the past have been with medical receptionists at the surgery. Pharmacists
are more comfortable with talking about, for example, ‘blue’ or ‘brown’ inhalers.”
How it works
Repeat dispensing schemes are being piloted in 30
pathfinder sites across
England.
The GP produces a “master” repeatable prescription
and a series of “batch” issues. The master prescription
is the legal document and must be signed by the prescriber. The
prescription can last for up to a year, with supplies made at specified
intervals determined by the prescriber.
The pharmacy retains the
master prescription.
Batch prescriptions are signed on the reverse
by the patient and sent to the Prescription Pricing Authority
for payment. The master prescription follows once all the batch
prescriptions
have been dispensed. |
When patients first hand over the master prescription (see Panel), Mr
Pilsbury tells them about how the repeat prescription process works.
Next, he checks that the quantities have been optimised so that they
are all due on the same day. “We have to instil confidence so that
patients know how to get supplies, including additional supplies of ‘as
required’ medicines if they run out,” he explains. Each time
the patient requests a supply of medicines, Mr Pilsbury asks questions
about any problems they have encountered with their medicines, any side
effects and any other medicines they are taking including those purchased
over the counter. He also establishes which drugs they need.
A record sheet is kept for each patient, noting which drugs are supplied
and the date of supply. “There is also a space to record any interventions
or if a drug was refused,” he adds.
A few days before a patient is due to collect a supply, the repeat prescription
is retrieved from the filing box where it is stored and the medicines
prepared and placed in a designated area in the pharmacy for collection.
The reason for the separate storage is to ensure patients receive proper
counselling when they come to collect the supply. “Preparing the
medicines in advance helps us to manage workload but the important thing
is the interaction between the pharmacist and patient,” Mr Pilsbury
stresses.
At the moment, repeat dispensing is a paper-based system. It would be
easier if it were electronic but Mr Pilsbury is positive. “The
paperwork hasn’t proved too onerous yet. It is counterbalanced
by the ability to manage workload better,” he comments. However,
this might not be the case if more patients were involved. There are
only 38 patients in the scheme now, but Mr Pilsbury says that the pharmacy
could offer the service to 100–150 patients. “We would need
to make a judgement not just on the paperwork and workload balance but
also on the storage of medicines once they had been prepared,” he
notes.
At the pathfinder site in West Sheffield, one surgery issued its first
repeat prescriptions under the scheme last week and a second surgery
hopes to follow suit this week. Altogether, 15 community pharmacies have
been trained to offer the repeat dispensing service. Annette Farrow,
lead for repeat dispensing at Sheffield West Primary Care Trust, explains
that the GP practices are initially identifying groups of patients that
are straightforward to manage. “The notes of patients on thyroxine
have been tagged and the next time they come to the surgery will be asked
if they want to join,” she says. Another group of patients is those
on insulin whose diabetes is stable. A practice pharmacist is being used
to identify suitable patients — including older patients by means
of medication reviews. All the prescriptions are for six months of repeats,
to be dispensed at monthly intervals.
Meanwhile in east London, Karen Samuel-Smith, repeat dispensing pathfinder
site lead for Newham PCT, reports that 30 pharmacists have been trained
to offer repeat dispensing. Of these, seven are actively dispensing at
the moment. Between 40 and 50 patients across the PCT are now using the
scheme.
One of the pharmacists involved, Shailesh Badiani, of Blakeberry Ltd
in East Ham, explains that he has 15–20 patients involved in the
pilot that come from a nearby doctors’ surgery which started the
scheme two weeks’ ago. He says that most patients are given an
annual master prescription, with repeat batch prescriptions to be supplied
every two months. Mr Badiani has recruited patients to the scheme by
identifying those who come to the pharmacy regularly with repeat prescriptions.
They are then reviewed by the GP before joining the scheme. He highlights
the fact that good communication between the pharmacist and doctor is
essential. “It is early days but I can see it working so hopefully
it will take off,” he comments.
In Blackburn with Darwen PCT, eight GP practices and 28 community pharmacies
are involved in a pathfinder site.
Sharuna Reddy, pharmaceutical adviser, says that there have been difficulties
with software used by GPs. “We have encouraged GPs only to recruit
10–15 patients to test their systems. Six of the practices have
recruited patients and are getting experience in using the software,” she
says. “Anecdotally, we have had some positive feedback from patients.” Pharmacists
have already started making interventions to improve compliance. Doctors’ surgeries
have also been positive, with one practice manager describing it as “brilliant”,
she adds.
Valerie Fairwood, a pharmacist in Roe Lee, Lancashire, comments: “I
am pleased with the scheme. It’s going fine but slow.”
This theme of positive response to repeat dispensing schemes but frustration
at the slow rate of progress, seemingly as a result of GP software problems,
is a recurrent one. |
