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Chris Howland-Harris: repeat dispensing is the beginning
of a new way of working with patients and practices |
Repeat dispensing is a major Government target. As of 1 October 2005,
all pharmacies in England must have been ready to dispense repeatable
prescriptions and each month contractors are being paid £125 for
this service under the pharmacy contract. In December 2005, however,
items dispensed on repeatable prescriptions made up only 0.3 per cent
of the total number of items dispensed in England. In stark contrast,
Bristol North Primary Care Trust was way ahead with 11 per cent of its
items coming from repeat
dispensing. The difference could be due to the fact that the PCT is offering
its 42
pharmacies and 32 GP practices extra money to provide the service.
Since 2003, Bristol North has operated a community pharmacy development
incentive scheme. This rewards pharmacies that undertake activities which
improve services. For example, in 2004, pharmacies that had personal
development plans and annual appraisals in place for their staff, among
other criteria, were rewarded. In 2005, the incentive scheme focused
on repeat dispensing and pharmacies that can show they have met nine
set criteria (see Panel) will get a share of £15,000, which the
PCT has set aside, in addition to the
payment for repeat dispensing they
receive under the pharmacy contract.
Andrew Evans, community pharmacy
facilitator for Bristol North PCT, told The Journal that the PCT believes
repeat dispensing is more convenient for patients, reduces the administrative
workload for GP practices and makes the dispensing of repeat medicines
easier for pharmacies (by helping with stock management and workload
planning).
Panel: Pharmacy criteria
· The pharmacy has an identified lead for repeat
dispensing
· The pharmacist has met the local practice(s) to discuss an action
plan for promoting repeat dispensing
· As a result of the meeting, the practice has agreed the action
plan and has submitted a copy to the PCT
· Between months 3 and 6 the pharmacist has met the local practice(s)
to review the action plan
· The practice has agreed any changes to the action plan and submitted
a copy to the PCT
· At month 6 the pharmacy has referred a number of patients to
the practice such that 2 per cent of prescriptions dispensed can
be done
so using repeat dispensing (as calculated by the PCT and agreed
with the contractor)
· During February 2006 the pharmacist has met the local practice(s)
to review the action plan
· The practice has agreed an action plan for 2006–07
· At year end the pharmacy has referred a number of patients to
the practice so that
5 per cent of prescriptions dispensed can be done so using repeat
dispensing (as calculated by the PCT and agreed with the contractor) |
Encouraging GP practices
Repeat dispensing in the rest of the country has rolled out at a slower
rate than predicted. According to a recent update on growth in prescription
volume from the Prescription Pricing Authority, in September 2005 repeat
dispensing items were submitted from only about half of the PCTs in
England. Software problems have been blamed for the low
uptake, but a study conducted by the University of Manchester also suggests
that the willingness of GPs to offer patients repeat dispensing is likely
to depend on effective local working arrangements with pharmacists, as
well as the recognition of benefits to patients.
Like other PCTs, Bristol North operates a prescribing incentive scheme
for GP practices. However, in addition to the usual
requirements, such as keeping within prescribing budgets, the Bristol
North scheme includes repeat dispensing as a measure of quality improvement.
Practices need to meet criteria similar to those applied to pharmacies
in order to earn a share of £27,500 that has been ring-fenced for
them for repeat dispensing. “The incentive scheme was intended
to get all practices involved in repeat dispensing so that they could
see the advantages for the practice and for their patients. Practices
would also see the benefits of closer working with pharmacists,” Mr
Evans said.
The PCT repeat dispensing criteria
requires contractors and practices to meet
initially to discuss an action plan and at least twice more to review
it. “By its very nature repeat dispensing requires greater communication
and co-operation between pharmacists and GPs,” Mr Evans explained.
This
view is corroborated by the University
of Manchester study. Qualitative semi-structured interviews with GPs
and practice managers at pathfinder pilots indicated that effective working
relationships and communication with
local pharmacies were key to successful repeat dispensing schemes.
Ashgrove Pharmacy is taking part in the Bristol North PCT incentive.
Chris Howland-Harris, proprietor of Ashgrove,
co-ordinated an initial repeat dispensing meeting with other local pharmacies
and three practices. “This definitely smoothed the way,” he
said.
Mr Evans added: “Co-operation between pharmacists and GPs was something
we were keen to see happen as a step to integrating community pharmacy
in the NHS.” This
integration seems to be prominent in the Bristol North mindset. For example,
grants to add NHS signs to premises are also available to contractors. “We
feel it is important to
support pharmacies to feel part of the NHS,” Mr Evans pointed out.
Mr Howland-Harris describes himself as an “early adopter” of
initiatives where he can see a real benefit for patients. In his opinion,
the PCT incentive schemes have definitely helped. “We are all busy
and under pressure. Incentives like these make it worth getting things
going because there are costs in initially setting up. Time is spent
meeting with surgeries, training surgery staff and training your own
staff,” he said.
Commenting on the PCT repeat dispensing criteria, Mr Howland-Harris said
that these were all good practices and “no more than what we, as
professionals, should be doing”. He added: “We had a relationship
with practices before, but [repeat dispensing] has helped to improve
it and has demonstrated that strengthening relationships is
mutually beneficial.”
A good argument for practices to take up repeat dispensing is that it
is a precursor to electronic transfer of prescriptions. “Repeat
dispensing and ETP work together, and GP surgeries will find that being
well advanced with repeat dispensing will really bring benefits with
ETP,” Mr Howland-Harris said. Finding the money
Some years ago, the PCT decided to stop its pharmacy rota arrangement.
This liberated £20,000, which was put into a protected pot to
start the community pharmacy development incentive scheme. This funding
has been maintained in subsequent years.
The money for GP practices was already available: “Funds were always
going to
be allocated to the prescribing incentive scheme,” Mr Evans said.
It was just a question of finding a subtly different way of using the
funds allocated to quality improvement activities, he added. Results and benefits
Although Bristol North PCT hosted a repeat dispensing pathfinder site
in 2003, this
involved only a handful of GP practices. The latest figures speak for
themselves. Before the repeat dispensing incentive (March 2005), 34 per
cent of the PCT’s practices were involved in repeat dispensing
and 1.5 per cent of all items were from repeatable prescriptions. By
December 2005, 93 per cent of the practices were involved. One practice
is unable to participate because of problems with its
software. The number of repeatable items in the nine months that the
scheme has been running has increased 12-fold compared with the same
period in the year before.
According to Mr Evans, benefits to the PCT include improved use of the
pharmacists skills, particularly in reducing waste of
unwanted medicines and reducing the risks associated with unnecessary
supply of repeat medicines. Although in some cases practices have been
concerned that they receive little or no feedback from pharmacies about
problems with medication, on the whole, patients find the the repeat
dispensing system more convenient than normal dispensing. “We
believe that repeat dispensing will continue to be used,” he said.
How easy would it be for other PCTs to put a similar scheme into practice? “PCTs
would need to convince their professional executive committees that providing
the
incentives to deliver service changes is in the interest of patients
and the PCT by improving access, reducing waste and developing some of
the changes needed in practice thinking to support the full implementation
of essential pharmacy services,” Mr Evans said. |
The
Pharmaceutical Journal