repeat dispensing

Question 1

what is repeat dispensing?

Answer 1

• Essential service in the community pharmacy contract
• Most prescriptions issued in the UK are for the management of
  long-term conditions

Question 2

what are the benefits of repeat dispensing?

Answer 2

• Flexibility and easier access to medicines for patients
• Reduces workload and time for the prescriber and their staff
• A single authorising repeatable prescription for review and
  signature
• Enhances the role of the pharmacist - more than dispensing
  the Rx – also a compliance check with the patient
• Pharmacist essentially ‘manages’ the repeat Rx
• Helps to reduce waste of medicines
• Drug safety - should encourage regular clinical reviews at
  surgery – monitoring of drug therapy and safe prescribing
• Uses standard FP10s – no new prescription forms needed (but
  Rx are printed in two slightly different formats)

Question 3

what are the two different types of paper prescription?

Answer 3

repeatable prescription
batch prescription

Question 4

what is the repeatable prescription?

Answer 4

• Legal authority and clinical authority to supply medication
• Only 1 is needed per batch
• Has letters ‘RA’ on the Rx – Repeat Authorisation
• Think of it as the ‘master’ prescription

Question 5

what is the batch part of the prescription?

Answer 5

• The dispensing prescription
• Usually have more than one
• Has letters ‘RD’ on the Rx – Repeat Dispensing
• Think of it as the ‘invoice for payment’

Question 6

which paper prescription is the dispensing prescription?

Answer 6

batch

Question 7

what are rx printed on?

Answer 7

FP10 form

Question 8

can prescriptions be ammended by hand?

Answer 8

no

Question 9

which patients are suitable for repeat dispensing?

Answer 9

• Patients with long-term conditions who are stabilised on
  medication (i.e. no changes for a while)
• Patients who use one regular pharmacy
• Newly diagnosed patients, those on acute medicines (for
  short term treatment) or those who have an unstable
  medical conditions are not suitable
• GP has the final decision of the suitability of the patient
• Note that the patient must give initial consent to the
  sharing of information between the GP and pharmacist. If
  they are unwilling to do this they cannot utilise the service

Question 10

what medicines cannot be repeated?

Answer 10

• Controlled drugs in schedules 2 and 3 are not legally allowed to be prescribed in this way – ordinary FP10s should be issued in the normal way

Question 11

can prn medicines be included on a repeat?

Answer 11

‘When required’ (‘prn’) medication and non-oral
medication (e.g. inhalers, creams, drops etc) CAN be included but they should be issued on separate RD prescriptions because these are more difficult to ‘fit in’ with the ‘regular’ items

Question 12

how does repeat dispensing work in GP practice?

Answer 12

Surgery staff generate a ‘batch’ of repeat prescriptions for a patient
* Up to 12 month’s worth of medicines can be issued
* All the issues are dated with the date when the Rx was generated
* One repeatable prescription is issued (RA) and signed by the GP
* Batch prescriptions are produced next (RD), these do not have to be signed by the GP

Question 13

what are the checks needed to be done when dispensing a repeat prescription?

Answer 13

secure storage
check legality
if its safe to dispense
is it still valid to dispense
to inform the prescriber of any signifigant changes
records of interventions

Question 14

what questions must the patient be asked before each batch is dispensed?

Answer 14

• Are they taking/using the medicine appropriately (i.e. do they have any problems taking/using their medication)?
• Do they have any side-effects from the medication?
• Has there been any change in their condition?
• Are they are taking any new medicines – OTC or on Rx?
• Is there anything they do not need or, if applicable, whether they need any ‘prn’ meds?
• Also inform them of the date they should collect their next supply of medicine

Question 15

what should happen when the last batch is dispensed?

Answer 15

• In addition to the usual questions you also need to inform them that this is their last issue
• They will need to contact the surgery and may be required to attend for some clinical check
• It is good practice to give then a written reminder that this is their last batch
• If their prescription is only for 1 months supply, it may be advisable to inform them of their penultimate issue to allow time for them to arrange a review

Question 16

what are the common problems with prn medications ?

Answer 16

• May be issued on an acute Rx (as a ‘one off’)
• May be issued on a separate batch Rx
• Should not be added to the regular RD Rx as this limits flexibility when dispensing

Question 17

what are the problems with new medicines?

Answer 17

the GP will need ‘fitting in’ to the current batches

Question 18

what are the problems with discontinued medicines?

Answer 18

which are discontinued mid-batch –pharmacy should be notified

Question 19

what are the problems with changes in medicines?

Answer 19

e.g. patients admitted to hospital and
any subsequent changes in their medication since the last batch was issued

Question 20

why is it important to have good communication between surgery and pharmacy?

Answer 20

• When a prescriber starts/stops a medication
• When a strength of medication changes
• When a patient is in hospital or has medication changed by secondary care
• When a patient is not collecting medicines regularly
• When a patient consistently does not request an item/refuses an item which should be used/taken regularly

Question 21

why is keeping good records of dispensing important?

Answer 21

• Legally, pharmacies are required to keep a clear audit trail of dispensing for the repeat dispensing service
• The date and quantity of each item dispensed should be recorded
• Records of interventions made by the pharmacist, considered to be clinically significant, should be kept in the patient’s
  record
• The pharmacy should inform the prescriber of any issues which are deemed to be clinically significant which occur in relation to the repeat dispensing prescription

Question 22

how should you charge someone for a repeat prescription?

Answer 22

Apply to the batch prescription just like any ordinary FP10
* Patients who are exempt must sign each batch prescription
* No charge is payable on the repeatable prescription (RA) since it is not actually ‘dispensed’

Question 23

how does electronic repeat dispensing work?

Answer 23

GP issues prescription which can be repeated X times
EPS repeat dispensing used to prescribe
X repeat Rx for the medication to the spine
spine sends Rx to patients nominated pharmacy, or is pulled from spine by pharmacy
pharmacy dispenses

Question 24

where are RD prescriptions held?

Answer 24

RD prescriptions are held on the NHS Spine until they are ready to be dispensed
* Prescriptions are automatically sent to the nominated pharmacy from the spine 7 days prior to when the medication is needed
* Pharmacies can ‘pull down’ RDs from the spine in advance of when they are needed if they need to be dispensed early

Question 25

can the GP surgery cancel Rx?

Answer 25

yes if sitting on spine and can replace it with amended Rx, if necessary

Question 26

can EPS repeat dispensing batches be changed to another pharmacy?

Answer 26

yes if sitting on spine