Repeat Dispensing Services Resource Pack

Repeat Dispensing Services Resource Pack

This pack has been produced to support Local Health Boards in establishing Repeat Dispensing Services, an Essential Service under the New Pharmacy Contract. NHS Repeat Dispensing Services allow patients to obtain prescriptions from their GPs that can be dispensed in instalments. These arrangements may benefit the patient, GP practice and the pharmacy. Potential gains include Reduced workload for GP surgeries in processing repeat prescription forms under the current arrangements Could act as a trigger opportunity to link to medication review. Reduced GP burden with less prescription form signing An opportunity to help patients to better manage their medicines and reduce waste Repeat Dispensing is a voluntary arrangement and patients do not have to agree to the service if they would prefer to continue with the repeat prescription arrangements that currently apply. Repeat dispensing is not suitable for all patients and careful selection of individuals is essential for the arrangements to work. Repeat Dispensing is suitable for patients who Have a medical condition that is stable on current medication and whose medication regimen is unlikely to change for the duration of a repeat dispensing prescription. Have a reasonably simple regime Regularly use the same pharmacy Repeat Dispensing is not suitable for patients who Have frequent changes to drug therapy Multiple drug regimes Unstable medical conditions e.g. frequent admissions to hospital Training Issues A distance learning pack will be available to all pharmacists in Wales from WCPPE. Completion of this pack will fulfil the requirement in the new contract that a contractor should have received adequate training before commencing the service. A training package for local practices (GP and community pharmacy) will also be available from WCPPE for those who wish to commission it. The National Prescribing Centre has also produced guidance on repeat dispensing; http://www.npc.co.uk/mms/extras/dispensing_with_repeats.pdf 2

Repeat Dispensing Services - GP Key Points GPs should Notify the Local Health Board in writing of their intention to provide Repeat Dispensing Services Have access to appropriate computer systems and software as Repeat Dispensing prescriptions cannot be handwritten. (Special prescription forms are not required as the repeat dispensing software generates the appropriate wording on WP10 NHS prescription forms to create the repeat dispensing format). Be in a position to contact a pharmacist providing Repeat Dispensing Services to a patient if changes are made to that patient s repeatable prescription Repeat Dispensing Services Pharmacist Key Points Pharmacists should Notify the Local Health Board in writing of their intention to provide Repeat Dispensing Services and that is satisfies the requirements for all essential services in the new contact. Have completed appropriate training (e.g. a WCPPE Repeat Dispensing Course). Have the facility to store securely the repeatable prescription and any batch issues if requested to do so by the patient. Make sure that the patient is taking or using medicines / devices / appliances appropriately Ensure that the patient is not suffering from any side effects which may necessitate a review of the repeatable prescription Contact the doctor in certain circumstances e.g. if concerned about the patient s safety Refuse to supply medicines / devices / appliances if not deemed appropriate Endorse prescription issues appropriately according to what was supplied Sort Repeat Dispensing Issue forms in accordance with the instructions issued by the pricing division Health Solution Wales 3

Destroy any batch issues that have been cancelled, are not required or have expired. The Scheme In Detail Adapted from the arrangements detailed by the Department of Health. http://www.dh.gov.uk/policyandguidance/medicinespharmacyandindustry/prescript ions/prescriptionsarticle/fs/en?content_id=4000157&chk=uynzdf The regulations should be referred to for further and definitive detail; http://www.wales-legislation.hmso.gov.uk/legislation/wales/wsi2004/20041018e.htm The Arrangements The use of the arrangements is voluntary. The prescriber and patient can choose to use acute prescriptions, repeat prescriptions (as now) or repeat dispensing. Patients will need to be aware that if they wish to use repeat dispensing, information on their use of the arrangements and medication dispensed may be passed between the pharmacist and prescriber and vice versa. At this stage, repeatable prescriptions will be generated from computer prescribing systems: i.e. not hand-written or electronic. Where repeat dispensing is required, prescribers software systems will produce a repeatable prescription on a WP10 and a further series of batch issues (also printed on WP10s) of up to a year s duration. The repeatable prescription contains all the usual details i.e. name and address of patient, age, date of birth, prescriber details, signature and date. The prescriber is required to specify the number of issues he/she wishes to permit from this prescription and, if appropriate, the dispensing interval (e.g. weekly, monthly, quarterly). The prescriber signs the repeatable prescription as this is the legal prescription, as defined by the Medicines Act, needed by the dispenser at each dispensing episode. The batch issues are not signed by the prescriber as they are not prescriptions but are used for reimbursement purposes. The computer system needs to print the required number of batch issues depending on how many issues the prescriber has requested. The computer system needs to annotate the WP10 form (as set out in the regulations) so that the dispenser can distinguish when an WP10 is being used for repeat dispensing rather than for a normal single-event WP10. Systems also generate and link the designated number of batch issues by overwriting the prescriber signature box on each batch issue form with text "Repeat dispensing: [example] 6 of 12". The date on which the repeats were authorised is printed on all the batch issues. 4

The pharmacy retains the repeatable prescription. The patient keeps the remaining batch issues or asks the pharmacist to keep them on his/her behalf, until he/she requires another issue of medication. Consideration needs to be given to whether putting regular medication on the same prescription to those that are taken on an as required basis is suitable. The patient is not asked to sign the repeatable prescription. Instead, the patient signs each batch issue at the time it is dispensed and completes the relevant declarations on the reverse of the form. The dispenser processes batch issues and forwards the forms to HSW at the end of the month dispensed, as now. The repeatable prescription is sent to HSW once all batch issues have been dispensed or, if the patient does not collect all instalments, on expiry. While the system is paper based, patient "mobility" is limited. If the patient wishes to change dispenser mid-episode (e.g. because of moving house), we require them to contact their prescriber for a further prescription to take to a new pharmacy. Drugs, Medicines And Appliances To Be Included To begin with all Schedule 2 and 3 Controlled Drugs are excluded. Patients And Their Medical Conditions Whether a prescription is suitable to be dispensed under repeat dispensing arrangements is a matter for the prescriber s clinical judgement and mutual agreement between the prescriber, the patient and, ideally, the pharmacist. Our expectation is that the arrangements will only apply to patients with chronic conditions who are considered likely to remain stable for the duration of the repeat dispensing. No group of patient or medical condition are currently excluded from the arrangements. Instalment Intervals It is not intended to stipulate how long one instalment or episode from a prescription should last. This is left to the clinical judgement of the prescriber There are no controls around dispensing intervals, as this will allow leeway for unusual situations such as when the patient goes away on holiday. The dispenser should use his/her professional judgement to dispense instalments at an appropriate time. However, good practice expects both prescriber and dispenser to take account of the balance that needs to be struck between maximising patient convenience and the risk of oversupply and possible diversion because the intervals between instalments are too long or inadequately controlled. 5

Maximum Duration Of Each Repeatable Prescription The maximum treatment time that one repeatable prescription should cover is one year. Dispensing Discretions There is no discretion for dispensers to change the frequency, formulation, total strength, chemical entity or dosage. In all those circumstances where a patient seeks these changes, he/she should be advised to go back to the prescriber. Communication Between Professionals Participating In The Scheme At the beginning, LHBs may wish to publicise the arrangements to practices, community pharmacists and patients in order to gain wide interest in operating the arrangements. Alternatively, they may wish to start slowly with a few participants and build up. LHBs need to act on notifications that contractors wish to participate in the arrangements: for example, they will need to notify HSW. Whilst two of the main reasons for the repeat dispensing are reducing the workload for GPs and practices and increasing patient convenience, this must not be at the expense of over-burdening pharmacies or patient safety. Pharmacists and prescribers must fulfil the duties of communication placed on them in the regulations. LHBs may have a role in facilitating this. Prescription Charges Unlike instalment dispensing on an FP10(MDA-S), a prescription charge is due for each issue. The patient needs to complete the relevant declaration (the amount of prescription charge(s) paid or reason for exemption from charges) on the reverse of the form as it would be at that time for each prescription. 6

Repeat Dispensing Service Frequently Asked Questions What Is Repeat Dispensing? Currently repeat prescription arrangements require patients to order a new prescription form for each new supply of medication and each form must be signed by the GP. Repeat dispensing allows a pharmacist to dispense an agreed number of instalments of repeat medication at appropriate intervals, without the need to request a new prescription form each time. The GP signs a repeat authorisation prescription form that enables the pharmacist to dispense a number of repeat batch forms (not signed) thereby reducing the workload of the GP. Patients also benefit from not having to go to the surgery, post a request or ask the pharmacy to collect a prescription form each time a new supply is needed. How Many Instalments Are Allowed? The GP will decide on the number of instalments to be issued. The total treatment period must not exceed 12-months and the repeat dispensing prescription must be presented for dispensing within 6 months of being generated. How Often Can A Repeat Dispensing Prescription Be Dispensed? Where a repeat dispensing prescription states a dispensing interval the pharmacist can only dispense the items at the intervals specified on that prescription. Where no interval is stated then the pharmacist can use his/her discretion to determine an appropriate interval. Is Repeat Dispensing Suitable For All Patients? No. Repeat dispensing arrangements will not be suitable for all patients. Repeat dispensing is recommended for patients with a stable medical condition, whose regular medication needs are unlikely to alter for the duration of a repeat dispensing prescription issue. Following careful selection identified patients will receive an agreed number of repeat instalments of selected medicines from the pharmacist without having to order prescription forms from the surgery each time. 7

Can All Medicines Be Prescribed On A Repeatable Prescription? No. Scheduled or controlled drugs as defined in the Misuse of Drugs At 1971 cannot be dispensed on a repeat dispensing prescription. All other medicines and appliances that can be prescribed on an WP10 are allowed. It is recommended that when required medicines be prescribed on a separate repeat dispensing prescription to medicines taken regularly. Does A Patient Have A Choice In Whether Or Not To Sign Up To Repeat Dispensing Services? Yes. Use of repeat dispensing arrangements is voluntary. Patients identified as being suitable for repeat dispensing services do not have to agree to this and can choose to continue with existing repeat prescribing arrangements. Does The Patient Pay For Each Instalment? Normal prescription charges will apply to each instalment. Any levy payment or exemption category is confirmed in the usual manner by filling in the appropriate section on the reverse of the batch form. Does Every Item On A Batch Prescription Have To Be Dispensed Each Time? No. The pharmacist will check whether all the medication is required at each instalment dispensing. If an item is not dispensed it will be marked as such on the batch prescription form. The patient will be asked to confirm the number of items received by filling in the appropriate section of the batch form. Will The Same Pharmacy Have To Dispense All The Batch Forms? Yes. The pharmacist holding the repeat authorisation prescription has to dispense the associated batch issues. This requirement may determine whether repeat dispensing is the right thing for individual patients e.g. if a person works away from home and doesn t always use the same pharmacy, then repeat dispensing in its present form would not be suitable. Who Holds The Batch Forms? The patient can keep the batch forms and present them for each instalment dispensing or may ask to leave them at the pharmacy. Leaving the forms with the pharmacist allows the patient to contact the pharmacy and ask for the next instalment to be prepared in advance, ready for collection or delivery. * The pharmacist should advise the patient how and when to order their repeat medicines and at what time they will be ready for collection or delivery*. Normally a request for the next batch issue with should be made to the pharmacy at least 48 hours before collection/delivery*. Unless such 8

arrangements are followed the patient will have to wait while the medicines are prepared on each occasion. (*Where such services are available). How Will The Process Work? Once a GP has identified that a repeat dispensing arrangements are suitable for a patient the GP will arrange for an agreement form to be completed. This form confirms that the patient is in agreement with repeat dispensing arrangements and identifies the pharmacy providing the repeat dispensing service. This information will be kept in the patient s notes, so that the GP is aware of the pharmacy providing repeat dispensing. What Happens If The Patient Wants To Change Pharmacy? If for any reason the patient wishes to alter the repeat dispensing arrangements, then the surgery will need to be informed in order to issue a new repeat dispensing prescription. The surgery should make every effort to contact the current pharmacy to cancel any remaining instalments on the previous repeat dispensing prescription. The patient will be asked to fill in another repeat dispensing form indicating which pharmacy they will be using in future. What If The Patient Needs To See Their GP During The Repeat Dispensing Period For An Acute Condition? Normal arrangements apply with regard to GP appointments. Also, if any concerns arise regarding repeat dispensing medication the patient should discuss this with the pharmacist in the first instance. The pharmacist will advise on what course of action if any is required, including making an appointment to see the GP where appropriate. What Happens When The Repeat Dispensing Prescription Runs Out? The pharmacist will remind the patient to contact the surgery for a new repeat dispensing prescription. The GP may ask the patient to make an appointment for a review before deciding whether or not to continue the repeat dispensing arrangements. What Happens If The Treatment Changes e.g. after a hospital treatment? The GP should contact the pharmacist to cancel any remaining batch issues and provide a new prescription for the updated treatment as indicated by the discharge information provided by the hospital. In this way any new medication prescribed should be synchronised with existing treatment. 9

What the Patient Needs To Know About Repeat Dispensing Services I understand that by agreeing to Repeat Dispensing Services My doctor will give me a repeat dispensing prescription form authorising a number of repeat dispensing issue forms. The authorising prescription will have RA printed on it and will be signed by the doctor. This prescription is valid for up to one year. The associated repeat dispensing issue forms will be marked RD and are only valid for the period indicated on the repeat authorisation prescription. I need to take the authorising repeat dispensing prescription to my pharmacy along with the first repeat dispensing issue form. My pharmacist will keep the authorising form and the first repeat issue form after dispensing my medicine. I can look after the remaining repeat issue forms or ask my pharmacist to do this for me. I have to use the same pharmacy for my repeat dispensing. If I want to change to another pharmacy I understand that I will need to go back to my doctor to get another set of repeat dispensing forms. I will be asked to complete a form confirming my new repeat dispensing pharmacy arrangements. If I pay prescription charges I understand that I must pay a prescription charge for each item dispensed each time the prescription is repeated, if those items are subject to a prescription charge. I should only complete Part 1 or Part 2 and sign in Part 3 on the reverse of the repeat issue forms each time I collect a repeat from the pharmacy. I shouldn t sign the forms in advance of collection, although I may authorise a representative to sign the forms as above on my behalf if I am unable to do so. I should return to the pharmacy for each repeat dispensing issue at intervals agreed with the pharmacy until all the repeat dispensing forms are used up. My pharmacist will inform me of any ordering arrangements that apply to repeat issues. My pharmacist will remind me when the last repeat prescription form is dispensed that I need to go back to my doctor for another set of repeat dispensing forms. I understand that no further issues are possible without a new repeat authorisation and new repeat issue forms from my GP. My pharmacist does not have to give me every item listed on the repeat dispensing issue e.g. if I already have sufficient supply of a particular item. I should tell my pharmacist if I stop taking my medicines for any reason. 10

Patient Agreement To Sharing Information (As Part Of The Repeat Dispensing Arrangements) Patient name and address I am the patient named above. My doctor or a member of the practice staff has explained repeat dispensing to me. I have also been given a leaflet about this. I have read What the Patient Needs to Know about Repeat Dispensing Services and I understand what I have to do. I agree to the exchange of information about my medication or treatment between my GP and my pharmacist as part of the repeat dispensing arrangements. Patient s Signature: Date: Date of Birth: Patient s Telephone Number: Nominated Repeat Dispensing Pharmacy name, address and tel. no. Doctor s name, Surgery name and address and telephone number 11

Repeat Dispensing - GP Referral Form Doctor s name and address Date Practice Stamp Referral Form ref. no. Patient name and address Pharmacist s name and address Please action the following for the repeat dispensing patient named above, Action Required Do not issue any further repeats of (drug name/s) GP to tick action required or write instruction as appropriate * Ask the patient to return to the surgery for review Provide simple administration advice for (drug name) Ask the patient to return to the surgery for blood monitoring test If none of the above applies please write in specific action required* GP signature 12

Repeat Dispensing - Pharmacist Referral Form Doctor s name and address Date Pharmacy Stamp Referral Form ref.no. Patient name and address The following issue/s relating to the patient named above have been identified, Issue A tick denotes that this has been identified as an issue for your patient Erratic collection of repeat medication Compliance problems Side effects of medication Potential adverse drug reaction Medication no longer required Query dose regimen Query benefit of treatment Distressing symptoms Requires Monitoring Batch issues lost The following action is recommended (write details below) Action Tick as appropriate YES NO Recommended action accepted Patient records amended Pharmacist informed Pharmacist signature 13

You Have Collected Your Last Repeat Dispensing Supply. No further issues can be made until you provide a new Repeat Dispensing Prescription. DON T RUN OUT OF YOUR MEDICINES! REQUEST A NEW REPEAT DISPENSING PRESCRIPTION FROM YOUR SURGERY IN PLENTY OF TIME. You may be asked to make an appointment with the doctor so that he/she can review your condition and decide whether or not to continue with your Repeat Dispensing Arrangements. 14

Repeat Dispensing Patient Information Leaflet What Is Repeat Dispensing? It s a new way that patients taking regular medicines can get them without asking their doctor for a prescription each time. How Does Repeat Dispensing Work? Your doctor will give you an authorising repeat prescription form and a number of repeat dispensing issue forms. The authorising form will be marked RA and will be signed by your doctor. This form will authorise a number of repeat dispensing issues and may specify the intervals at which those repeats are to be dispensed. The repeat dispensing forms will be marked RD, will not signed, but will indicate that they are one of a number of issues associated with the authorised repeat prescription form. Do I Have To Agree To A Repeat Dispensing Service? No. Although your GP has identified that you may safely receive an agreed number of repeat instalments from your pharmacist without having to order forms from the surgery each time, you don t have to agree to this. Will The Same Pharmacy Have To Dispense All The Forms? Yes. You should consider whether repeat dispensing is the right thing for you, e.g. if you work away from home and don t always use the same pharmacy, then repeat dispensing in its present form would not be suitable for you. You will need to decide which pharmacy is most convenient for you, as the chosen pharmacy must dispense all the repeat dispensing issues once you ve handed in the repeat authorisation prescription form and first repeat dispensing issue form. Your doctor will ask you to complete an agreement form confirming which pharmacy you have chosen and this will be recorded in your notes, so that the pharmacy can be contacted if it is necessary to cancel your repeat dispensing prescription for any reason. What Do I Do With The Rest Of The forms? You may choose to keep the remaining repeat dispensing issue forms and present each in turn for future supplies or you may ask your pharmacist to look after them for you and request repeat dispensing issues as you need them. If you lose any of the forms you will have to go back to your doctor. 15

What Happens When My Repeat Dispensing Prescription Runs Out? Your pharmacist will remind you when you need to contact the surgery for a new repeat dispensing prescription. Your GP may ask you to make an appointment to review your condition before deciding whether or not to continue the repeat dispensing arrangements. Will I Still Be Able To See My GP If I Become Ill? Yes. You can make a GP appointment as usual or you may wish to discuss your condition with your pharmacist in the first instance. What Happens If I Want To Change Pharmacy? If for any reason you want to change dispensing arrangements, e.g. if you move house, then you will need to inform your surgery to make arrangements for a new repeat dispensing prescription to be produced. Your surgery will confirm with your previous pharmacy that any remaining instalments on your old prescription are cancelled. You will be asked to fill in another form indicating which pharmacy you will be using in future. What Happens If At Any Stage My Medicines Are Changed Or New Medicines Are Added To My Current Treatment? If necessary your GP will contact your pharmacist to cancel any remaining batch issues and provide you with a new prescription for your updated treatment. In this way all your medication should be in quantities that make sense for re-ordering purposes. Will I Have To Pay For Each Instalment? Normal prescription charges will apply when you collect each instalment, unless you are covered by an exemption category as listed on the reverse of the prescription forms. You will be asked to confirm the amount of payment made at the pharmacy or the reason that you don t pay, by filling in the appropriate section of he batch form. What If I Don t Need Every Item Each Issue? Your pharmacist will check with you whether all the medication is required at each instalment dispensing. If an item is not dispensed it will be marked as such on the batch prescription form. You will be asked to confirm the number of items received by filling in the appropriate section of the batch form. 16

ACKNOWLEDGEMENTS This work derived from the work of the Welsh Assembly Government Repeat Dispensing Working Group. Carolyn Poulter, Carwen Wynne-Howells, Gemma Nye, Karen Morgan WAG Catherine Stanley, Peter Haydn-Jones CPW Gwyn Phillips BSC Andrea Matthews CHC Cath O Brien RPSGB David Hopkins HSW Dr David Bailey GPC(W) Nuala Brennan NPHS Judith Vincent Swansea LHB Dr Andrew Morris Merthyr Tydfil LHB This resource pack is based on support material used by the English Repeat Dispensing pathfinder sites and from guidance on the DH website. It has been approved for use by the Project Implementaion Board of the new pharmacy contract at WAG. Further details can be found at; http://www.wales.nhs.uk/pharmacycontract 17