Key points
1. Dispensing and repeat dispensing are two of the essential services
that all community pharmacists will be expected to offer
2. The aims of the dispensing service are that both a safe supply
is made and the patient knows how to use the dispensed item
3. The repeat dispensing service will allow patients to collect repeat
medicines direct from the pharmacy
4. For each repeat supply, the pharmacist must check the patient
is taking the medicine and that it is still appropriate. If it is
not, the pharmacist must inform the prescriber
5. Records of all items dispensed through either service must be
kept. Records must also be made of any clinically important advice
given |
Dispensing and repeat dispensing are two of the essential services that
all community pharmacists in England and Wales will be expected to offer
under the new contract.
The contract will place new requirements on the dispensing process, some
of which might mean that pharmacists’ future practice will be different
from the way they practise now. All community pharmacists therefore will
need to review their practice against the
service specification for dispensing.
Repeat dispensing, however, will be a new service for the majority of community
pharmacists. Pilots of repeat dispensing have been ongoing for over a year
and experience from these pilots has helped to inform the service specification
in the new contract.
It is worth bearing in mind that both the dispensing and repeat dispensing
services will change substantially when electronic transmission of prescriptions
(ETP) is introduced. When this will be is unclear; certainly a paper-based
system will be in place when the new contract is first implemented.
Dispensing
Under the new contract, the dispensing service is defined as the supply
of both medicines and appliances on NHS prescription forms. The aims
of this service can be roughly
divided into two — first, to dispense safely and, second, to ensure
that the patient knows how to use the dispensed item. The specific jobs
to fulfil these aims could be allocated to the pharmacist or other members
of staff, so the term “pharmacy staff” is used to cover both
in this article. This will present an opportunity to make better use of
skill mix within the pharmacy.
Within the supply function, the first requirement is that pharmacy staff
perform the appropriate legal, clinical and accuracy checks required when
a prescription is presented. Next, the pharmacy will be required to have
specific systems in place so that it operates its dispensing process safely
and so that it can guarantee the integrity of the products supplied. When
a prescription is presented,
pharmacy staff will be required to dispense it on demand.
To ensure that the patient can use the
dispensed medicine or appliance safely, pharmacy staff will have to provide
appropriate advice. They will also be required to provide broader advice
when appropriate, eg, about potential side effects or interactions.
Record-keeping requirements are also part of the service specification.
All supplies of medicines and appliances will have to be recorded. In addition,
when the pharmacist considers it is clinically appropriate, a record of
any advice given should be made. On top of this, if a pharmacist needs
to make an
intervention or refer the patient to another professional, then this, too,
should be recorded. Repeat dispensing
Case study: repeat dispensing
One community pharmacy that has had experience
of repeat dispensing is Trichem Ltd, located in Felling Health
Centre, Gateshead. Pharmacist
Roger Pilsbury comments: “It is working well and we haven’t
had any big
problems at all.”
Trichem Ltd started offering the repeat dispensing scheme in August
2003 and it is currently being used by 50 to 60 patients. Overall,
Mr Pilsbury says that GPs, patients and the pharmacy have benefited
from repeat dispensing. It means that pharmacy staff can prepare
patients’ medicines in advance which helps manage workload. “The
local surgeries have a 48-hour turnaround for repeat prescriptions
so the scheme means patients can avoid this wait,” he adds.
“There is no reason why it couldn’t be introduced in any community
pharmacy,” Mr Pilsbury says. His only concern is about information
being communicated to pharmacists, particularly changes made by GPs
to patients’ medicines that are managed through repeat dispensing.
So good communication is needed. |
Repeat dispensing forms the second essential service in the new contract.
All the requirements within the dispensing service apply to the repeat
dispensing service with additional specifications on top.
The repeat dispensing service will allow patients to collect regular
repeat prescription medicines and appliances direct from the pharmacy
for a certain
length of time agreed with the prescriber. The prescriber writes a “master” prescription
which is copied onto a specified number of “batch” prescriptions.
The aims of this service are to increase
patient choice and convenience, to reduce workload at GPs’ surgeries
and to minimise wastage.
Before providing this service, it is envisaged that all pharmacists will
be required to complete a national open-learning package. The exact details
of this training are yet to be finalised but more information should be
available later in the autumn. There is likely to be a requirement for
contractors to ensure that all pharmacists working at a pharmacy have completed
the training but, again, this has yet to be confirmed.
What is known is how the repeat dispensing service will work.
The first task will be to educate patients about the repeat dispensing
system and how it works. Once a patient has decided to use the service,
the master prescription will be stored at the pharmacy. If requested by
the patient, the batch prescriptions will also be stored at the pharmacy
although patients can choose to keep the batches.
Repeat supplies will be dispensed against the batch prescriptions. The
timing of supplies will be determined by the directions on the master prescription
unless no specific
instructions are given in which case the pharmacist should use professional
judgement to determine when an item should be dispensed. However, batch
prescriptions will be valid for a maximum of one year (or less if specified
by the prescriber).
For each repeat supply, the pharmacist must ensure that the patient is
taking or using the medicine or appliance appropriately and is likely to
continue to do so.
The pharmacist should also ensure that the
patient is not suffering any side effects caused by the treatment. Finally,
the pharmacist should ensure that the medicine or appliance is still appropriate — this
will include checking that any changes to the patient’s medication
regimen or changes to the patient’s health since the repeat was authorised
by the prescriber. If any problems are identified, the pharmacist can refuse
to dispense an item and can contact or refer the patient to the prescriber.
If it is safe to make a supply, then the item should be dispensed and a
record of supply should be made so that it is clear which batch issues
have been dispensed. There will also be a requirement to inform the prescriber
of
any clinically significant issues that occur in relation to the repeatable
items. |
The
Pharmaceutical Journal