Prescribing & Medicines Management
page PM3
December 2004

Features

Training receptionists on repeat prescribing designed to improve safety

It is common knowledge that repeat prescriptions typically account for the majority of primary care prescribing. Therefore, it is of paramount importance that the repeat prescribing process in each GP surgery is both safe and efficient. Receptionists and prescription clerks play a significant role in this process yet the training they receive is often unsatisfactory. The more they understand about repeat prescribing, and current issues in medicines management, the better they can respond to patient needs and help to provide a safe and efficient service. With this in mind, the pharmacy team at Kingston Primary Care Trust created repeat prescribing training workshops specifically designed to suit the requirements of receptionists and prescription clerks.

Creating the workshops

The idea was to develop workshops that reflected the specific interests and needs of our local GP practices, relating every issue back to the two central themes: patient safety and practice efficiency.

We formed a multidisciplinary working group which included local receptionists and prescription clerks, practice managers, community pharmacists and PCT pharmacists. The group was tasked with determining the content and style of training. Our discussions resulted in a preliminary list of repeat prescribing topics to be covered. In the guise of an informal training needs analysis, we surveyed GPs, practice managers and receptionists from every GP surgery within our PCT area, using a short, simple questionnaire. We asked them to indicate which of the proposed topics they deemed desirable for inclusion in the training. They also fed back on the format and duration of the workshops.

We obtained a return rate of 36 per cent, mainly consisting of replies from receptionists and practice managers. The feedback was analysed and two distinct half-day workshops were created.

Flexibility and variation

The working group recognised that the challenge was to balance the needs of experienced and less experienced receptionists, while maintaining the interest and active participation of all parties. It was, therefore, critical to create a flexible programme and learning environment that catered to different learning styles and, similarly, to vary the content and delivery depending on the needs and level of each group. Without being dogmatic or authoritative, we intended to raise awareness and stimulate reflection and discussion about the chosen repeat prescribing issues, while illustrating at all times how they relate to safety and efficiency.

We hoped that a friendly, open environment would encourage receptionists to participate freely and learn as much from each other as they would from us. It would also provide the PCT pharmacy team with an insider’s view of current local issues in repeat prescribing, allowing us to target prescribing advice and to provide more relevant support to practices in this area.

Workshops included group work, an interactive question-and-answer game, open discussion and flipchart notes, a medicines management video, props and displays of items commonly supplied on repeat prescriptions, along with a slideshow presentation. As medicines management project facilitator, I hosted the workshops with help from a local community pharmacist and members of the Kingston PCT pharmacy team to answer clinical questions.

Raising GP practice interest

Creating carefully balanced and locally relevant workshops was one challenge; drawing in adequate numbers of participants was certainly another. We needed to identify ways of sparking interest in these workshops and remove the practical barriers which prevented GP practices from sending their staff.

Within Kingston PCT, this training initiative was viewed as a major contributor to improving safety and efficiency within local practice and, as such, was included in the trust’s 2004–05 prescribing incentive scheme. This removed any financial barriers which can often limit the willingness of GP practices to release their staff for training purposes. Also, the PCT would be assured that any money spent on this part of the scheme would be tied into explicit improvements in repeat prescribing.

More specifically, one-third of this year’s prescribing incentive scheme payment was based on practices sending staff to the training workshops and then drawing up and implementing agreed action plans for improvements in both safety and efficience in their repeat prescribing process. A payment will be made to GP practices to help offset the costs incurred for locum cover and the working time spent writing and implementing the action plans. Implementation will be verified by PCT prescribing advisers at the end of the current financial year during their general medical services medicines management visits. GP practices will not be eligible for any of the partial payment unless they have implemented their safety and efficiency action plans by that time.

Results and outcomes

Three sessions of each workshop were held with 75 per cent of local GP practices taking part. Attendance stood at 117, including three practice managers and one GP. A short quiz given at the end of the second workshop revealed that the main topics covered were well understood, as the average mark for the quiz was 83 per cent. Complete speaker notes and handouts for both workshops were sent to all GP practices as a training package, both for reference and to be used in training new staff.

Currently, GP practices across Kingston are busy producing and submitting their action plans. By the end of the fiscal year, we expect to see many improvements in safety and efficiency within repeat prescribing across the majority of GP practices in the Kingston PCT area.