Policy on the use of Hospital Based Prescriptions in NHS Lothian

Policy on the use of Hospital Based Prescriptions in NHS Lothian Unique ID: NHSL Author (s): HBP Policy Short Life Working Group Category/Level/Type: Version: 3 Status: FINAL Authorised by: Area Drugs and Therapeutics Committee Date of Authorisation: 03 June 2016 Review Date: June 2018 Date added to Intranet: Key Words: hospital based prescriptions; medicines governance; policy

CONTENTS Page 1. Purpose of Policy 1 2. Scope of Policy 1 3. Introduction and Background 1 4. Procedure for the use of HBPs 2 5. Prescribing 3 6. Dispensing (Community Pharmacy) 4 7. Budgetary and Tracking aspects 4 8. Risk management 5 9. Monitoring and Audit 5 10. References 5 Appendices 1 Members of the HBP Policy Short Life Working Group 2 Procedure for the use of HBPs 3 HBP Application Form for Drug and Therapeutics Sub Committee 4 HBP Prescriber Application Form ISD (HBP) 1 5 HBP order form Unique ID: NHSL Author (s): HBP Policy Short Life Working Group Category/Level/Type: Version: 3 Status: FINAL Authorised by: Area Drugs and Therapeutics Committee Date of Authorisation: 03 June 2016 Review Date: June 2018 Date added to Intranet: Key Words: hospital based prescriptions; medicines governance; policy

1. Purpose of Policy NHS Lothian Policy on the use of Hospital Based Prescriptions (HBPs) The aim of this policy is to set out procedures for the use of HBPs by specialist clinicians within the hospital setting for dispensing at a community pharmacy that reflect current best practice. The key objectives of this policy are: to enable safe systems for the use of HBPs the application process for using HBPs to facilitate initiation of therapy to improve patient access to medicines to ensure adequate monitoring is in place 2. Scope of Policy This policy applies to clinicians and pharmacists involved in the prescribing and dispensing of medicines prescribed on HBPs. 3. Introduction and Background The term Hospital Based Prescriptions (HBP) applies to prescriptions written for individual patients by hospital specialists, and dispensed by community pharmacists. HBPs have been operational in The Royal Edinburgh Hospital and Associated Services since 2002. HBPs are also utilised within the Infectious Diseases Unit, University Hospital Division. Changes of service delivery models and optimisation of patient care now necessitates an expansion of use to other clinical areas. Appropriate controls and guidance is required to underpin this process. 1 P a g e

4. Procedure for the request of new indication/clinical area to use HBPs (see also Appendix 2) 4.1 Prescribers wishing to prescribe via an HBP should seek approval from relevant Drug and Therapeutic Sub Committee in the first instance. (Appendix 3). 4.2 The clinical pharmacist for that area wishing to use HBP forms is required to liaise with the management accountant for the service to obtain a cost code. Prescribers wishing to prescribe on HBPs are required to complete the ISD (HBP) 1 application form http://www.isdscotland.org/health-topics/prescribingand-medicines/community-dispensing/prescriber-codes/index.asp?co=y (see Appendix 4), and submit it to the appropriate Pharmacy Medicines Management department. The Medicines Management department will send the ISD (HBP) 1 application form to the appropriate Associate Director of Pharmacy (an authorised Health Board signatory) to authorise the request. Once authorised, Medicines Management will then send the request to Information Services Division (ISD) to enable an HBP prescriber code to be allocated. Once a HBP prescriber code is allocated the clinical pharmacist is required to inform the relevant Pharmacy Medicines Management Team of the HBP prescriber code. For all nurse prescribers please contact Jennifer Houliston, Practice Nursing/Nurse Prescribing (Jennifer.houliston@nhslothian.scot.nhs.uk) to obtain an ISD prescriber code. Once a prescribing code is obtained the relevant Pharmacy Medicines Management Team should be informed of the HBP prescriber code. Once a HBP prescriber code is allocated the clinical pharmacist is required to complete the HBP order form (Appendix 5) http://www.psd.scot.nhs.uk/professionals/pharmacy/prescription-order-forms.html Completed forms are to be sent to Medicines Management Team to obtain authorisation from the Associate Director of Pharmacy. Copies of the HBP order form are required to be sent by the clinical pharmacist to Procurement department, Central Stores, NRIE (fax number 0131 242 7047), to enable the HBP pads to be issued directly to the prescriber. A copy of the form should also be sent to the Finance department, Pentland House, for information. For nurse prescribers the HBP order from is completed by Practice Nursing/Nurse Prescribing (Jennifer.houliston@nhslothian.scot.nhs.uk) 4.3 A list of prescribers and associated codes will be held by the Pharmacy, Procurement and Finance departments. 4.4 HBP prescription pads will be issued to prescribers direct from the Procurement department. A maximum of four pads will be issued at a time. 2 P a g e

4.5 The duplicate copy of the prescription should be filed in the patient s notes. 4.6 The medicines are dispensed by community pharmacists and the HBPs forwarded to the Practitioner Services Division (PSD), NHS National Services Scotland, for processing. They are charged, as are GP10s, back to the prescriber as per the details/code stamped on the prescription. 4.7 Re-ordering of HBP pads should be requested through the Procurement department, Central Stores, NRIE (fax number 0131 242 7047).The time frame from ordering to delivery of HBP pads is usually eight weeks. For nurse prescribers re-ordering of HBP pads should be requested through Practice Nurse Prescribing (Jennifer.houliston@nhslothian.scot.nhs.uk) 5. Prescribing 5.1 Prescriber codes for HBPs will be issued for named Consultants/Independent Prescribers, linked to clinical location. There may be instances where Associate Specialists and Staff Grade doctors are allocated an HBP code. The accountability for prescribing lies with the individual prescriber and overall with the Clinical Lead/Consultant for the relevant speciality/cost centre. 5.2 Prescribed medicines should, where possible, be those recommended in the Lothian Joint Formulary (www.ljf.scot.nhs.uk). The main aim of the LJF is to promote safe, effective, and economic prescribing in both hospital and general practice. The medicines included provide appropriate treatment for the vast majority of patients. Use of the formulary will ensure seamless prescribing for patients between general practice and hospital, and minimise supply problems. A common sense approach is advised for those occasions when nonformulary drugs are required for patients. Non-formulary drugs are both appropriate and justifiable when there are contra-indications to formulary drugs or when patients require further medicines in addition to the recommended first and second choice drugs. The key to agreement in these cases is clear communication between primary and secondary care and explanation of the reasons why this is necessary. Prescribers wishing to prescribe medicines that are not recommended by the Scottish Medicines Consortium must first obtain approval by the IPTR Panel, in line with the NHS Lothian Individual Patient Treatment Request (IPTR) Policy. The Scottish Government has advised that the IPTR process will shortly be replaced by a Peer Approved Clinical System (PACS). 5.3 The need for immediate supply must be considered, i.e. should the patient receive a prescription from the specialist (treatment is required within 48 hours), or can supply wait until the patient can obtain a prescription from their GP (greater than 48 hours). 3 P a g e

5.4 Prescribers must restrict the prescribing of medicines on HBPs to their own specialist therapeutic area. The names of medicines to be prescribed on HBPs must be specified, depending on the specialist service being provided. 5.5 Length of prescription supply is governed by sensible patient management, and should fit in with review by the specialist. Specific examples are: Short course of treatment, e.g. antibiotics Initiation of a newly prescribed medicine, which the GP can continue immediately thereafter Newly prescribed medicine which the specialist will review and the GP will continue in the longer term. Treatment which the specialist wants to review, e.g. antipsychotic or antidepressant therapy prescribed by a psychiatrist. 5.6 Prescribers must communicate details of the prescribed medicines to the patient s GP, and a clear statement indicating when prescribing is likely to be transferred to the GP (in line with Shared Care Protocol if one exists). 6. Dispensing (Community Pharmacy) 6.1 The need for a compliance aid to be issued will be considered on an individual patient basis. 6.2 See also 7.3 and 7.4 below. 7. Budgetary and Tracking aspects 7.1 Specific budgets for HBP use, associated with the consultant-led service, should be established. The specific budget code can be obtained from the management accountant for that service. 7.2 The cost of HBPs is charged to the relevant specialist service budget, secondary care. 7.3 Drug costs may be different when dispensed in community pharmacy, but named prescriber/named patient prescriptions, e.g. GP10s, HBPs are exempt from VAT thus opposing cost factors may balance each other out. 7.4 Prescriptions dispensed by community pharmacists incur a dispensing fee. 7.5 ISD produces monthly total cost reports on the use of HBPs. These are sent to NHSL Finance departments and in some cases to individual prescribers. Level 2 reports detailing drug items prescribed are also available. PSD also maintain a database of valid HBP codes to enable validation of HBP codes. Specific information may be able to be extracted from the database on request. 4 P a g e

7.6 Prescriber feedback on the use of HBPs is required, quarterly reports by prescriber code, linked to location, items and expenditure will be co-ordinated by the primary and secondary care Medicines Management Teams. The designated clinical pharmacist is responsible for assuring appropriate use of HBP and is required to report any anomalies. HBP expenditure is reported to MURG and subsequently to ADTC. Drug and Therapeutic Sub Committees should also be informed of HBP expenditure. 8. Risk management 8.1 Risk management issues which must be considered include: ensuring the safe and secure storage of the prescription pads, a robust procedure for the issuing and tracking of prescriptions, and the addressing of issues to ensure effective communication to prescribers and community pharmacists on the use of HBPs. 8.2 Prescribers are responsible for the safekeeping of HBPs in their possession. 8.3 Any anomalies in prescribing identified by the clinical pharmacist should be reported as appropriate to the Medical Director and Associate Director of Pharmacy for discussion and action. 8.4 Medicine Management Pharmacy should be informed immediately of any HBP codes which are no longer in use. Old and redundant HBP prescription pads should be returned to Medicines Management Pharmacy for destruction. 8.5 Medicines Management Pharmacy should inform e-vadis of old and redundant HBP prescribing codes. 9. Monitoring and Audit 9.1 An audit of the use of HBPs is desirable, to track how they are being used and to identify patterns of prescribing. 9.2 Monitoring of the expenditure and prescribing trends related to HBP prescribing are monitored continuously by Pharmacy and finance. 10. References 1. Lothian Primary Care NHS Trust, Policy on the use of Hospital Based Prescriptions (HBPs) 17 June 2003 2. The NHS Information Authority www.nhsia.nhs.uk. 5 P a g e

Appendix 1 Members of the HBP Policy Short Life Working Group Dr Louise Bath, Consultant Paediatrician, NHSL Iain Bishop, Principal Pharmacist-Prescribing, ISD, NHS National Services Scotland Melinda Cuthbert, Lead Pharmacist Lothian Medicines Information Service/ Yellow Card Centre Scotland Karen Drury, Medicines Management Technician, REAS Dr Adam Hill, Respiratory Consultant, NHSL Joan Kelly, Principal Pharmacist, Medicines Management, REAS Rhoda Morgan, Specialist Pharmacist, Infectious Diseases, NHSL Tina Robertson, Business Change Manager, Practitioner Services, NHS National Services Scotland Jenny Scott, Specialist Pharmacist, Respiratory, NHSL Cathy Sedgeworth, Lead Directorate Pharmacist, NHSL Joanna Skwarski, Specialist Pharmacist - Clinical Trials Gastrointestinal medicine, NHSL Zena Trendell, Prescribing Accountant Analyst, NHSL

Appendix 2 Procedure for the use of HBPs Approval for new HBP form obtained from relevant Drug and Therapeutics Sub Committee Prescribers wishing to prescribe on HBPs complete ISD (HBP) 1 http://www.isdscotland.org/health-topics/prescribing-and-medicines/community- Dispensing/Prescriber-Codes/index.asp?Co=Y and submit to the appropriate Pharmacy Department, NHSL. Clinical Pharmacist obtains cost code from service management accountant. Associate Director of Pharmacy authorises request. ISD (HBP)1 is sent to ISD to enable HBP prescriber code to be allocated. ISD allocates HBP prescriber code. Clinical Pharmacist informs MMT of prescriber code and completes HBP Order Formhttp://www.psd.scot.nhs.uk/professionals/pharmacy/Prescription-Order-Forms.html Associate Director of Pharmacy authorises request. Nurse prescribers contact Practice Nurse Prescribing Jennifer.houliston@nhslothian.scot.nhs.uk) Clinical Pharmacist forwards copies of HBP Order Form to Procurement Department, Central Stores, NRIE and Finance Department, Pentland House. Pharmacy Department holds list of prescribers and associated codes. Finance Department receives copy of form for information, and holds list of prescribers and associated codes. Procurement Department receives HBP order form and issues HBP prescription pads directly to prescriber. Procurement Department holds list of prescribers and associated codes. Prescribers prescribe medicines for the patient. Duplicate copy of prescription filed in patient s notes. Community Pharmacists dispense the medicines and forward HBPs to the Prescription Pricing Department, ISD for processing. HBP medicines charged to prescriber code. Clinical pharmacist monitors and reports on prescribing quarterly.

Appendix 3 HBP Application Form Drug and Therapeutics Sub Committee HOSPITAL BASED PRESCRIPTION (HBP) APPLICATION FORM This form should be completed to provide the Drug and Therapeutics Sub Committee with information to allow consideration for approval of prescribing the named medicine via a Hospital Based Prescription. For information regarding Hospital Based Prescription please read NHS Lothian Policy on the use of Hospital Based Prescriptions (HBPs). Section 1: Background Information Generic name of medicine: Brand name: Manufacturer (if appropriate): Completed by: GP/Consultant - Name, full postal address and email address: Clinical Pharmacist - Name, full postal address and email address: Approved by: Clinical Director - NAME, SIGNATURE, DATE: By signing this form, it is confirmation that this medicine in Lothian is clinically appropriate to be prescribed and supplied via a HBP form and that the necessary budget provision is in place and available if Drug and Therapeutics Committee approve the application. Site Lead Pharmacist - NAME, SIGNATURE, DATE:

Section 2: Place of medicine in Lothian and the Lothian Joint Formulary (LJF) (www.ljf.scot.nhs.uk) a) Please estimate for ALL Lothian use: Prevalence (number of patients with condition): Incidence (number of new patients per annum): Is this medicine currently supplied by primary care or secondary care, please specify:. If secondary care, the number of patients currently prescribed this medicine and supplied from hospital pharmacies per annum: If primary care, is a shared care agreement in place? Yes No Number of patients to be prescribed treatment with the medicine on HBP per annum: b) Please summarise in the boxes below how it is proposed that the medicine will be prescribed using HBPs in Lothian. Please specify the criteria for patient selection: Please specify therapy, quantity supplied and course length to be prescribed on HBP: Reasons of using HBP: Benefits and risks of supply via HBP: c) Area(s) that will prescribe Hospital site(s) that will prescribe on HBP:. Outpatient area/speciality:.. Responsible consultants(s):... Current formulary status of medicine (Please note that only medicines approved for use in NHS Lothian can be prescribed via HBP) - Medicine is first or second choice in LJF first second - Medicine is on the Additional List of LJF

Section 3: Financial Information for the use of [insert generic (and Brand) name of medicine here] in Lothian No. of patients in Lothian eligible for treatment per annum Cost per annum ( ) per patient Cost per annum ( ) ALL patients Secondary Care Lothian Non-Lothian Primary Care TOTAL NET COST: Other Cost Implications if supplied via HBP and not supplied by hospital pharmacy e.g. VAT

Approved by: Chair of Paediatric Drug and Therapeutics Committee (if applicable) - By signing this form, it is confirmation that this medicine in Lothian is clinically appropriate to be prescribed and supplied via a Hospital Based Prescription Form. NAME: SIGNATURE: DATE: Chair of UHD Drug and Therapeutics Committee (if applicable) - By signing this form, it is confirmation that this medicine in Lothian is clinically appropriate to be prescribed and supplied via a Hospital Based Prescription Form. NAME: SIGNATURE: DATE: Chair of HSSMC Drug and Therapeutics Committee (if applicable) - By signing this form, it is confirmation that this medicine in Lothian is clinically appropriate to be prescribed and supplied via a Hospital Based Prescription Form. NAME: SIGNATURE: DATE:

Section 4: Declaration of Interests A declaration of interest should be completed by each applicant as detailed in section 1 of this form. A common form is used by ADTC and all its subcommittees, as detailed in the ADTC policy Declarations of Interest: Applying the Principles of Good Business Conduct. Definitions of Declared Interests The following is intended as a guide to the kinds of interest which should be declared. It should be noted that if individuals have interests not specified in these notes but which they believe could be regarded as influencing their advice they should declare them. Individual interests should be declared and examples are detailed below. It should also be noted with that, in line with the Standing Financial Instructions, the interests of a spouse/partner/cohabittee or close relative should also be declared, if known. Personal Interests A personal interest involves payment to the individual personally, for example: Consultancies - any consultancy, directorship, position in or work which attracts regular or occasional payments in cash or kind. Fee-Paid Work - any work commissioned by the pharmaceutical industry for which the member is paid in cash or kind. Shareholdings - any shareholding in or other beneficial interest in shares of the pharmaceutical industry. This does not include shareholdings through unit trusts or similar arrangements where the member has no influence or financial management. Personal specific interests A personal specific interest involves payments to an individual who has worked at any time on the product under consideration, or a direct comparator, and has personally received payment for that work, in any form, from the pharmaceutical industry. Personal non-specific interests A personal non-specific interest involves a payment to an individual from the pharmaceutical company concerned which does not relate specifically to the product under discussion. Non-personal interests A non-personal interest involves payment which benefits a department for which an individual is responsible, but is not received by the individual personally, for example: Fellowships the holding of a fellowship endowed by a pharmaceutical industry. Support by the pharmaceutical industry any payment, other support or sponsorship by the pharmaceutical industry which does not convey any pecuniary or material benefit to a member personally but which does benefit his/her position or department. Individuals are under no obligation to seek out knowledge of work done for or on behalf of the pharmaceutical industry within departments for which they are responsible if they would not normally expect to be informed. Non-personal specific interests A non-personal specific interest refers to payments to the individual s department, which has at any time worked on the product.

Non-personal non-specific interests A non-personal non-specific interest refers to a department which is currently receiving payments from a pharmaceutical company concerned which does not relate specifically to the product under discussion. CLINICIAN Register of Interests Form for Use by ADTC and all its subcommittees Committee members are required to complete this on an annual basis. It should also be updated throughout the year if required, if, and as soon as circumstances change. Name of the individual and the position held in NHS Lothian What is the nature of the interest being declared? Please refer to Appendix 3 (Declaration of Interests) of the NHS Lothian Procedures and Guidance for Applying the Principles of Good Business Conduct under Corporate Policies on NHS Lothian Intranet and also to the definitions provided above. Why is this declaration being made? I declare that the information I have given is correct and complete. I understand that if I knowingly provide false information this may result in disciplinary action and I may be liable for prosecution and civil recovery proceedings. I understand this form is a public record, and it will be made available for audit or other inspection, or disclosure under the Freedom of Information Act. Clinician Name and Signature: Date: PHARMACIST

Register of Interests Form for Use by ADTC and all its subcommittees Committee members are required to complete this on an annual basis. It should also be updated throughout the year if required, if, and as soon as circumstances change. Name of the individual and the position held in NHS Lothian What is the nature of the interest being declared? Please refer to Appendix 3 (Declaration of Interests) of the NHS Lothian Procedures and Guidance for Applying the Principles of Good Business Conduct under Corporate Policies on NHS Lothian Intranet and also to the definitions provided above. Why is this declaration being made? I declare that the information I have given is correct and complete. I understand that if I knowingly provide false information this may result in disciplinary action and I may be liable for prosecution and civil recovery proceedings. I understand this form is a public record, and it will be made available for audit or other inspection, or disclosure under the Freedom of Information Act. Pharmacist Name and Signature: Date: Please post the completed form and signed declaration of interests to relevant Professional Secretary of Drug and Therapeutics Sub Committee.

Appendix 4 ISD (HBP) 1 Application Form HOSPITAL PRESCRIBING REGISTRATION OR CHANGE OF CIRCUMSTANCES Return form to: Note Healthcare Information Group, Area 114c, 1 st Floor, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB Mail to nss.evadis@nhs.net This document is regularly reviewed with the aim of ensuring that it is as user- friendly as possible. Please email any comments on the documentation to prescribing@nhslothian.scot.nhs.uk Please tick appropriate box: New HBP Code Required HBP Prescribing activity ends Change of HBP Code Name Change of HBP Code Address Prescribers requiring more than one HBP Code must fill in one form for each location/service. SECTION A: Prescriber Details New Prescriber Registration Change of Circumstances 1 Health Board Name NHS Lothian 2 Hospital / Clinic / Service Name 3 Individual Prescriber Name (if appropriate) 4 Individual Professional No. eg GMC, NMC RPSGB (if appropriate) 5 Address (inc postcode) 6 Tel. No. 7 Existing HBP Code 8 HBP Prescribing Planned Start Date 9 HBP Prescribing End Date SECTION B: NHS Organisation Details 1 NHS Organisation 2 Address 3 Contact Telephone Number SECTION C: To be completed by Health Board Official responsible for notifying registration: Name (capital letters please) : Telephone number: Address: Signature: Date:........ HIG use only Prescriber code: Date issued: FINANCE CODE FOR CHARGING =

Appendix 5 PSD HBP Order Form HOSPITAL BASED PRESCRIBERS PRESCRIPTION PAD ORDER FORM (HBP) TO BE COMPLETED BY AUTHORISED SIGNATORY AND RETURNED TO: Practitioner Services Kirkton Campus, 3 Bain Square, Livingston, EH54 7DQ Tel: 01506 705 100 Fax: 01506 705 191 e-mail: NSS.psd-pscriber-statnry@nhs.net Hospital/Clinic Code Hospital Name Personal Details (only to be completed by Nurse, Pharmacist & Non-Medical Prescribers) Surname. Forename Initial... Professional Code NMC - Nurse GPhC - Pharmacist Prof Reg - Other Non Medical Prescriber, e.g. Physiotherapist, Radiographer, Podiatrist etc Tick as appropriate Insert Professional Code Address (Address to be printed on prescription) (Clinic Name)... (Town of Hospital) (Post Code) Contact Telephone Number:... No. of Pads 4 Address for delivery of pads: (NHS organisation stores or pharmacy department/ or direct to the prescriber s address where agreed with PSD by NHS Board s Finance Manager): Health Board Details Post Code:.. Signed: Authorised Signatory Print Name: Date: Telephone Number:..

Guidance Notes: All prescription pads will be delivered directly to the NHS Board at the address specified on this form prior to the NHS Board distribution to the nurse prescriber. Number of Pads A maximum of FOUR pads will be automatically ordered.