Vespasian House
Bridport Road
Dorchester
Dorset
DT1 1TS
July 2013
To all:
Community Pharmacies
Tel: 01305 213 614
Fax: 01305 213 543
www.dorsetccg.nhs.uk
Dear Colleague
RE: Patients who need repeat medication when GP practices are closed
You will be aware of the considerable media attention that has been devoted to the NHS111
service and the quality of out of hours care across the NHS. In Dorset we are fortunate that
we have an excellent service, which integrates Urgent care services, out of hours GPs and
NHS111. However the service is under considerable strain when call volumes peak. Analysis
of this service has shown that at peak times, especially Saturday mornings, upto a third of
calls are for people seeking repeat prescriptions as opposed to needing urgent medical help.
The service was never intended to be for routine repeat medicines, but for urgent care.
In order to ensure that the service is able to cope with the urgent cases, we are aiming to
remind patients that they should order their prescriptions in plenty of time and then seek
help from pharmacists and their practice if they have difficulty in ordering. These patients
may benefit from repeat dispensing, managed repeats or other support in ordering
prescriptions. We are looking to pharmacies and GP practices to work together to make
these systems work. We are auditing data from the service, and asking GPs to look at the
reasons patients had to seek repeat medicines in the out of hours period and explore
whether it was preventable.
The other group of patients that may seek medicines through calling NHS111 are holiday
makers in the area, forgetting or running out of routine medicines. For UK holiday makers
they can contact their home GP during working hours and organise a prescription to be
posted or with the agreement of the pharmacist, faxed and posted within 72 hours.
We are also reminding patients of the potential to obtain an emergency supply of medicines
and referring them to pharmacies to see if that is possible. This will result in a charge, and
we are making that clear in our communications.
In order to address the pressure on NHS111 form requests for routine medicines we are
undertaking a communications campaign, starting with holidaymakers, referring them to
the appropriate place to access medicines, and we see community pharmacy as a key first
point of access for advice when patients have run out of their medicines. When GP practices
are closed, pharmacies are the most easily accessed health professionals, and with the
increasing range of medicines available over the counter, and the minor ailment advice and
support, we hope that they are used as a first point of call when patients are accessing
medicines. This will reduce the strain on urgent care services and A&E departments,
allowing them to treat the urgent cases promptly.
From August, we will refer patients seeking repeat medicines to the nearest open pharmacy
to see if they can be helped with accessing their prescription or if necessary obtain an
emergency supply. There may be some situations where medicines can safely wait until a GP
practice re-opens. This will be up to the advice of the individual pharmacist.
There will be some occasions where the pharmacist working in the out of hours period is
presented with a difficult situation of a patient needing medication for conditions such as
diabetes, respiratory disease and epilepsy. The Out of Hours service provided by SWAST has
provided a number that pharmacists can use to access a health professional for advice. This
is …….. Please note this is not for patient access as it will not get them through to someone who can
help, but it will allow pharmacists to get through to the out of hours administration system, and then a
GP.
If you are aware of specific local or patient issues that contribute to patients not getting
their repeat medicines promptly, please liaise with your local GP practices to ensure that
repeat dispensing, managed repeats etc are used appropriately to prevent them having an
impact on the urgent care services.
A poster to highlight to holiday makers their options when they run out of repeat
medication is enclosed, and will be circulated through tourism contacts. We have produced
a signposting guide for pharmacists, along with a reminder of the Emergency supply
regulations, though pharmacists should make sure they are up to date with the most recent
Medicines Ethics and Practice. Please review your current standard operating procedures
for signposting to ensure they are aligned with these recommendations.
Following a discussion involving Dorset Clinical Commissioning Group (CCG) and South
Western Ambulance Services NHS Trust (SWAST) we are trying to ensure that a consistent
message is given to people who need to access a supply of repeat medication urgently.
Please do not refer patients to NHS111 or A&E unless they need the urgent medical
attention that these services are in place for.
Having a consistent approach should have positive effects on the wider health community.
Thank you in advance for your efforts to support this initiative.
Yours sincerely
Katherine Gough
Head of Medicines Management
Dorset Clinical Commissioning Group