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Medicines Management
Issue no 4, p5
July/August 2002

Features

How to be a repeat dispensing pilot

Who is most likely to be successful when making a bid to become a repeat dispensing pilot? Sam Crowe reports

Sam Crowe is a freelance writer

PCTs that can demonstrate strong team working between community pharmacies, general practices and their patients are likely to be among the more successful bids to take part in the NHS repeat dispensing scheme, pharmacists believe.

The Department of Health published details of the proposed scheme in June, and the first PCTs are expected to apply to become a pathfinder site by the end of July, once GP software suppliers have confirmed that they will be able to make the required changes to primary care computer systems.

"Although repeat dispensing has been around in a limited form for some time, this is the first important step towards establishing a national system," says Clive Jackson, chairman of the board of the Faculty of Prescribing and Medicines Management, College of Pharmacy Practice.

Practicalities need to be addressed

Mr Jackson believes, many of the initial issues likely to be addressed in the first bids to become a pathfinder site will involve tackling the practicalities of establishing the system. "The DoH is likely to be looking for sites that can demonstrate ownership and team working between all of the players in the primary care team," he says.

Mr Jackson adds that PCTs must be able to show that community pharmacists are fully on board with the proposals and that patients in the locality are also keen to take part in the project and understand the implications: "It is a voluntary project, so clearly everyone involved needs to be signed up to the plans."

The first step will involve developing a team approach to repeat dispensing, and Mr Jackson says that sites that can already demonstrate positive relationships between GPs and pharmacists will be in a better position to carry out the work.

And he advises PCTs to bear in mind the importance of conveying the potential benefits of repeat dispensing to patients, such as improved patient care and better compliance with medicines use, and where there might be opportunities to practise pharmaceutical care. Among the more practical issues that bids must address will include whether or not GP computer systems can be modified to produce repeat dispensing prescriptions in batch form. But another important factor will be how patients are informed of the changes.

Mr Jackson points out that any changes must be talked through with patients, and obtaining consent to take part in the scheme is vital. Repeat dispensing will also involve a greater sharing of information between the GP and pharmacist, and the patient will have to understand that they must use the same pharmacy for the entire repeat dispensing period.

"So part of the bid might show how patients will be involved, and about how to get the messages across to patients," explains Mr Jackson.

However, he cautions against making the scheme too bureaucratic. Although the repeat dispensing proposals stem from the Cabinet Office's initiative to reduce the amount of paperwork in general practice, there will also be an impact on pharmacists' time. Mr Jackson says that one of the pathfinder sites' tasks will be to identify any changes in pharmacist's working patterns and scrip volumes and to record these accurately.

"If the workload for pharmacists is huge then that might have to be taken account of by any future schemes that are rolled out," he says.

Mr Jackson also says that the issue of payment still needs to be worked out, as where pharmacists make decisions that reduce the overall workload for GPs then it would count as an intervention that would need to be reimbursed. He adds that at this stage, negotiations with the PSNC are ongoing on the matter.

Mr Jackson comments that the final form of any national repeat dispensing system will be subject to an ongoing review of what the pathfinder sites find. But eventually, Mr Jackson sees no reason why all pharmacists should not be able to repeat dispense.

"Overall it seems to be a positive development for community pharmacy, and it should help them to integrate with primary care teams even more. It is another step in a process that is starting to bring pharmacists much greater job satisfaction."

Successful bids must demonstrate:

• Good teamwork between pharmacies, primary care and patients

• Technical competence to change the GP computer prescribing system

• Evidence of patient involvement, explaining benefits of RD and issues around consent to share information between GP and pharmacist

• Systematic recording of impact on workload, scrip volume, pharmacist time etc

Full details of the NHS repeat dispensing proposals can be found here