The Pharmaceutical Journal
Vol 272 No 7298 p567
8 May 2004

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Questions arise over repeat dispensing

One year ago this week the regulations that allow repeat dispensing schemes in England came into force. Since then, questions have arisen over just how widely repeat dispensing can be used and how quickly it can be rolled out. Clare Bellingham (on the staff of The Journal) reports

Repeat dispensing had a shaky start. Technological problems held back most of the pilot sites so, despite repeat dispensing being theoretically possible from last May, not much happened until the autumn. Perhaps not surprisingly this resulted in a feeling of lost momentum in some of the pilot “pathfinder” sites, that in some senses still prevails.

Although things have picked up, repeat dispensing has yet to prove itself. This is concerning since repeat dispensing is likely to be an essential service in the new pharmacy contract, and is supported by the Department of Health and the Pharmaceutical Services Negotiating Committee (see p559). And a further 57 primary care trusts were told last month that they could join the 30 pathfinder sites in implementing repeat dispensing.

Among those that know the most about repeat dispensing, in the initial pathfinder sites, concerns are plentiful. The repeat dispensing lead at one primary care trust who asked not to be named said that an evaluation is urgently needed along with guidance from the DoH over how repeat dispensing is expected to be used in the future. Until this becomes clear, enthusiasm for the initiative is difficult to find, she says.

However, the news is not all bad. Where repeat dispensing works, be it across an entire pathfinder site or just a patch, the scheme gets resounding support from all parties involved — the patients, doctors, pharmacists and primary care trust. One site that is particularly positive is Coventry PCT, where Mark Galloway, the head of medicines management, says: “Repeat dispensing is an integral part of what we in the PCT want community pharmacists to do in the future.”

But of the pathfinder sites that The Journal spoke to, the overall picture was more reserved. Perhaps Karen Samuel-Smith, repeat dispensing lead at Newham PCT in East London, sums up the general feeling best: “It is a useful tool but that is all it is — an adjunct. It is not the great answer to the repeat prescribing problem.” She adds: “We have offered repeat dispensing in Newham for 10 months now and not many patients are choosing to use it.”

Considering Newham has got a comparatively large number of patients involved — 400 — this is worrying. Although the number of items dispensed through repeat dispensing schemes has risen steadily since they were first introduced last summer (see Table below), uptake of the scheme has been far from uniform across the 30 pathfinder sites.

One of the difficulties has been recruiting GP practices. Only a small number of GP practices are involved, so the number of pharmacies is restricted to those in close proximity to the surgeries. In Newham, only eight out of 57 trained pharmacists are regularly involved in repeat dispensing. Similarly in Erewash PCT, in Derbyshire, two practices and the surrounding 13 pharmacies in one area of the PCT are involved in the scheme. “Progress has been relatively slow, mainly because of the software problems, which did put some practices off,” comments Nuala Hampson, repeat dispensing lead.

In addition, Ms Samuel-Smith says that reasons practices gave for not participating included the fact that they already had good repeat prescribing arrangements in place so had little incentive to change. Others said they were unable to see a patient benefit or that the pressure of implementing the new contract for GPs meant they had little time to become involved in other initiatives.

However, one interesting observation has been made. “Our experience shows that practices are not using repeat dispensing to reduce their repeat prescription workload. Instead they are using it to manage certain groups of patients differently,” explains Ms Samuel-Smith. “For example, one practice plans to use repeat dispensing in conjunction with medication review clinics for patients aged over 75. The patients will be given six months worth of monthly repeats and the end of the repeat dispensings should act as a trigger to come back for their six-monthly review.”

Positive success

Processing about 1,000 items a month through repeat dispensing, Coventry PCT is handling about a sixth of the total across the 30 pathfinder sites. “Where it is working, it has been an unmitigated success,” says Mr Galloway. “The scheme has increased communication between pharmacists and doctors and it is already having an impact on waste through pharmacists identifying items that patients do not need.”

Parvesh Patel is a pharmacist participating in the scheme at Manson’s Chemist in Forest Gate, London. “We know when patients should be coming in for repeat medicines so we can ensure they pick up monthly and check they are not over- or under-ordering,” he says. “If we identify a problem we try to find out the reasons for it and feed it back to the doctor. We just ask patients how things are going, it seems like idle chat but we are ascertaining important information.”

One of the benefits repeat dispensing offers patients is saving time: they only have to visit the pharmacy to get a repeat supply of medicine. But this has a negative side too. “Elderly people like coming into the surgery regularly, it is a point of social contact for them,” explains Mrs Hampson. “Having said that, younger patients who are working think that only having to go to the pharmacy is great. We are currently writing to patients with hay fever to see if they want to join the scheme over the summer.”

Ms Samuel-Smith comments: “We also found that some older patients had concerns about sharing of information between the pharmacist and doctor. Their concern was that the pharmacist was more likely to check up on how they used their medicine and might report it to the doctor which could result in them being removed from the doctor’s list.” But she adds: “An unexpected knock-on benefit we have found is that pharmacists are having far less requests for emergency supplies for patients involved in the repeat dispensing scheme.”

Opinion is divided over how widely repeat dispensing will be used in the future. A DoH spokesman comments: “In the Cabinet Office publication ‘Making a difference: reducing the burdens on GPs’ it was estimated that up to 80 per cent of all repeat prescriptions could be replaced with repeat dispensing over time.” The pathfinder sites are more reserved. Ms Samuel-Smith expects every pharmacist will have some patients choosing to use repeat dispensing in the next five years but she thinks it is unlikely to be more than about a quarter of patients. And Mrs Hampson comments: “Repeat dispensing is definitely worth persisting with, but it is only for a group of patients, not 80 per cent.”