Prescribing & Medicines
Management
Issue no 1, p6-7
January/February 2003
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Prescribing & Medicines
Management |
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Features |
Repeat dispensing projects due to take off in Scotland
Patients suffering from chronic conditions receive regular repeat prescriptions. Approximately 75 per cent of prescription items are dispensed on a repeat basis, which often require a number of visits by patients to their GPs' surgeries and require GPs to spend time each day signing numerous prescriptions. Repeat prescribing systems have evolved rather than been designed and are, therefore, subject to local variations. They normally rely on the patient prompting the continuity of supply and this has serious drawbacks if the patient is non-compliant. They do not, usually, include any provision for regular medication review or checks on the patient's understanding of their medicines or instructions. In many cases the number of days supply for each repeat item differs, placing additional demands on the GP practice and often leading to an accumulation of unused medicines. In Northern Ireland, for example, a repeat dispensing project conducted from a community pharmacy demonstrated cost savings of £10 a patient a month. The Scottish health plan, "Our national health", is committed to improving the provision of repeat medication and supporting this by developing electronic transmission of prescriptions and better information exchange. Further to that, "The right medicine: a strategy for pharmaceutical care in Scotland" describes developing and rolling out a repeat dispensing model as a shared care package between GPs, pharmacists and patients. In 2001, the Scottish Executive commissioned a report on the options available to introduce a model for repeat dispensing and prescribing to improve the patient's journey and assist GPs and community pharmacists in managing chronic conditions. After a thorough literature review, it proposed three potential options; a master and slave option, a three-monthly instalment option or a carbon copy option. Preferred option The first of these was the preferred option and it is currently being piloted between a GP practice and community pharmacy in Elie, north east Fife. The model consists of a master prescription for a six-month quantity which is signed by the GP and either two 56-day or five 28-day slave prescriptions which are unsigned. This allows for local agreements between GPs, pharmacists and patients on the time interval for repeat prescriptions. The master is the legal authorising prescription and the slaves act as the triggers for the pharmacist's reimbursement. The slave prescriptions are dispensed in sequential order, with the master prescription as the final instalment of the transaction. The GP has the option to repeat a six-month instalment before seeing the patient for a formal review. How it works in practice Work has been undertaken with GPASS, the Scottish GPs software system used in 85 per cent of practices, to develop a module for the repeat dispensing programme. It allows for the system to request information on patient consent regarding participating in the repeat dispensing service and on sharing the agreed read codes to enable the sharing of some core clinical information on the patient's condition. The programme offers the GP the option of producing a master prescription and either five 28-day or two 56- day slave prescriptions. The master prescription is pre-printed with the final instalment quantity in the endorsement area. This is included to prevent any confusion arising from the six-month quantity appearing on the prescription form in the quantity area when, in fact, the pharmacist is only dispensing a 28- or 56-day instalment from that prescription. There is also a patient held order record which serves two main purposes: it indicates which repeat items are required by the patient that they can take to the pharmacy, and it records information on the collection of repeat prescriptions, which the patient can share with their GP during a review. The repeat dispensing module has been designed to view each six-month period as a "horizon". If a new medicine is introduced or a dosage quantity adjusted during a six-month period and included in the repeat list, the programme will automatically calculate the required number of days' treatment until the end of that horizon. It will then produce the required number of prescriptions. Currently, if a patient stops taking a medicine for any reason this relies on verbal communication from the GP or patient. However as NHSNet connections are rolled out across Scotland, it is planned to include an e-mail option to allow the GP to notify the pharmacist automatically if a medicine is stopped. Work is currently underway as part of the electronic transfer of prescriptions (ETP) programme to include repeat dispensing in its development stages. Benefits There are many benefits as a result of repeat dispensing apparent to patients, GPs, practice staff and pharmacists. From a patient perspective their journey is simplified and access is improved. They receive the medicine they want when they want it, the risk of owed medicines is minimised and they retain the ongoing contact and advice from their pharmacist on a regular basis. This improves the quality of care a patient receives and helps identify problems with compliance. GPs are freed of the need to sign repeat prescriptions on such a regular basis and their workload is reduced. As a result, this allows them to spend more time with patients during appointments and improves the quality of the review they offer patients on a six-monthly or annual basis. It also reduces drug wastage, yielding potential savings in the drugs bill. Again, for practice staff workload is streamlined because they have to deal with fewer daily repeat prescription requests. Repeat dispensing positions the pharmacist in an important role in terms of improving the patient's journey. It makes better use of pharmacists' skills and integrates them into the primary care team. It allows pharmacists to organise their workload and staff profiles to suit more predictable workflow patterns. It makes it easier to effectively manage stock control and stock owed to patients is minimised. The impact of initiatives such as protected time for training, which often means GP surgeries close in an area for a half day, is minimised as the pharmacist has a patient's prescription available for dispensing if required. Next steps The pilot has produced encouraging results and it is planned to extend it to include the other pharmacies and GP practices within the LHCC area over the coming months. Work is currently been undertaken jointly with the Director of Pharmaceutical Care Model Schemes to integrate the future model schemes for chronic disease with the repeat dispensing model. The Electronic Transmission of Prescrip-tions future stages are to include repeat dispensing as a core function. |
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