Mark Galloway: repeat dispensing will form a pivotal role for pharmacists |
Repeat dispensing has been a huge success, according to Mark Galloway,
head of medicines management at Coventry Primary Care Trust, one of
the pilot sites for repeat dispensing. “We see it as a pivotal
role for pharmacists under the new contract in Coventry.”
Mr Galloway reported that the pilot has been generating prescriptions
for a year. Nearly 18,000 items have been dispensed through the repeat
dispensing scheme. “We are now at 3,000–3,500 items per month,” he
said.
Coventry PCT serves a population of 325,000 people, has 63 GP practices
and 80 pharmacies. Mr Galloway explained that the reason the PCT had
wanted to become a pathfinder site is because it had identified repeat
prescribing as a source of wasted time, effort and resources. Initially
42 of the pharmacies in the area were involved but the initiative had
been extended and 78 have been trained.
“One of the keys to success has been communication between the practice
and the pharmacy, the PCT and the pharmacy, and the PCT and the practice,” explained
Mr Galloway. “Early on, we developed a communication form to allow this.
In particular, good communication between the practice and the pharmacy is essential
to making the scheme work.”
Feedback has been positive. “Patients, practices and pharmacies have all
been enthusiastic about the scheme,” he reported. In particular, it improved
the links between community pharmacists and GPs, and enhanced the role of the
pharmacist. “It has also reduced waste,” he added.
However, there have been some issues to overcome. It is well known that repeat
dispensing has been held back by difficulties with the computer software used
at GP practices and these problems were experienced in Coventry. “These
networking problems mean that GPs can only use one computer to produce the repeat
prescriptions for the scheme,” said Mr Galloway. Other issues include slow
uptake of the scheme at some practices, poor cascading of training in pharmacy
and problems with patients’ interpretation of the scheme. “Not all
drugs are suitable for repeat dispensing,” he explained.
But Mr Galloway concluded that he is convinced of the value of repeat dispensing. “It
is here to stay,” he said. “The roll-out will continue in Coventry
to as many pharmacies and practices as we practically can.” He also has
innovative ideas to improve the scheme. “For example, we will attach a
request form for blood tests to the last repeat prescription. When the patient
gets this supply from the pharmacy, the pharmacist can give the person the form
so that the tests can be carried out before the patient’s review appointment,” he
explained.
Scottish pilot of serial dispensing
Alison Strath: repeat dispensing is a process to support other initiatives |
Alison Strath, principal pharmaceutical officer at the Scottish Executive,
spoke about her experience of a repeat dispensing pilot — called
serial dispensing in Scotland — at her pharmacy in Elie, Fife.
The service operates between one pharmacy and one GP practice. She
explained that the original purpose of the pilot had been to find a
way to introduce
a model of serial dispensing within the current financial model of a
fixed global sum.
Under the system, six months of treatment is prescribed on a “master” prescription
plus either two two-month or five one-month “slave” prescriptions
(the master acts as the final prescription in either case). The prescriptions
are submitted to Practitioner Services Division (the Scottish equivalent
of the Prescription Pricing Authority) as normal, with the master prescription
closing the repeat dispensing period.
“Repeat dispensing is a means to an end,” Ms Strath commented. “It
is just a process.” The important part is how it could be used
to support other initiatives. “Right now repeat dispensing is working
for stable, chronic patients,” she explained. But this is just
the beginning. Ms Strath’s second pharmacist should qualify as
a supplementary prescriber soon and will then be able to manage less
stable patients too. The idea is that repeat dispensing will be used
within the pharmaceutical care model schemes through which medication
review, monitoring and targeting interventions takes place.
“Under the new contract in Scotland, repeat dispensing will become
part of the chronic medication service,” she said. “But the
chronic medication service will include a lot more clinical input than
just repeat
dispensing.”
Among the lessons learnt from the pilot were a need to engage patients
in the scheme, to provide incentives for GPs to register and to realise
that IT developments never go as planned. “Waiting for IT can be
frustrating,” she said. In particular, there is a lot of paper
in the current pilot much of which would go with the introduction of
an electronic system. “Once NHSnet is in place we will be able
to communicate more quickly,” she added.
Few GPs in Scotland use the computer software that has caused the problems
for the repeat dispensing pilots in England. Nearly all of GPs in Scotland
(85 per cent) use a type of computer software called GPASS which is owned
by the NHS.
“We are working with GPASS to develop serial dispensing functionality,” Ms
Strath commented. Although it is an add-on to the current system, it
is hoped that serial dispensing will become a core function in the next
version of GPASS.
The service has improved workload management in the pharmacy. “With
the introduction of the new GP contract, the practice is closed on Saturdays
so we now do most of the repeat dispensing work on Saturdays and Mondays.” Skill
mix could also be used better. Ms Strath suggested that once the pharmacist
has clinically assessed the prescription at the start of the six months,
a clinical check for each dispensing might not be needed so, providing
proper standard operating procedures are in place, a checking technician
could take over.
Asked what she would do for a patient who was non-compliant, Ms Strath
said: “We would work with the patient first and foremost. If we
just report it to GPs it takes away the patient’s confidence in
dealing with us.” She concluded: “The important message is
that this is a patient-centred model.” It helps improve patients’ care,
it promotes multidisciplinary working and it prevents problems from happening. |
The
Pharmaceutical Journal