Prescribers and FP10 Prescriptions
(Last updated 30/06/2008)
Learning Objective
On completion of this package you will:
 Be able to write FP10 prescriptions to comply with legal requirements
 Be able to identify which health professionals are allowed to write prescriptions
 Know where to find out whether a product can be prescribed on FP10
 Know the extra information to include on a prescription for a controlled drug
The package is divided into the following sections:
 Who can write an NHS prescription?
 What are the Different Types of NHS Prescription Forms in England?
 What can a prescriber order on an NHS prescription?
 How should a prescriber complete the prescription form?
 FP10s for Controlled Drugs
 FP10MDA-S
 Out of Hours Service Provision
Before patients can receive a medicine paid for by the NHS they usually have to receive a
prescription. Some medicines are normally only available on prescription and not
surprisingly these are referred to as POMs or prescription only medicines. Other
medicines can be bought in pharmacies or from general retail outlets. Most of these
medicines can also be obtained through the NHS on prescription. In addition patients
receive products on prescription that are not licensed medicinal products for example
appliances or dressings.
Who can write an NHS prescription?
Identify which of the following groups of health professionals can write prescriptions that
the NHS will pay for if they are dispensed in primary care:
General practitioners
Dentists
Podiatrists
Pharmacists
Health Visitors
Physiotherapist
Veterinary Surgeons
Chiropodists
Practice Nurses
Optometrists
Hospital doctors
Radiographers
Follow this link to check your answers.
To enable the NHS to pay for medicines dispensed in primary care the correct prescription
form has to be used. Prescribers use different prescription forms in Scotland and Wales
to those in England. The bottom section of the prescription is printed with details of the
prescriber such as his or her name and with information that identifies the contract to
which the cost of the medicine will be charged. Each prescriber has his or her own
number so that ultimately the person responsible for prescribing the medicine can be
identified. Primary care organisations such as general practices and Primary Care Trusts
are allocated budgets to cover the cost of prescribing.
The following can write NHS prescriptions:
Most prescriptions are written by General Practitioners. Sometimes doctors working in
NHS hospitals write prescriptions for patients to take to community pharmacies
(Chemists). This is usually in situations where the hospital pharmacy department cannot
supply the medicine. Doctors working in hospital out-patient drug addiction clinics can
also issue special NHS prescriptions.
Dentists can prescribe for their NHS patients
Some nurse practitioners have qualified as independent prescribers. This means that
they can draw up a management plan and initiate therapy for the patients they treat unlike
supplementary prescribers. There are two groups of independent nurse prescribers: (a)
Community Practitioner Nurse Prescribers who qualified under the original arrangements
for nurse prescribing and (b) Nurse Independent Prescribers (formerly known as Extended
Formulary Nurse Prescribers). The first group have to hold either a district nursing
qualification or be registered as a health visitor and they have to have completed an
approved training course (this training is now part of the university-based specialist
practitioner programmes for new district nurses and health visitors). The second group of
nurses must be a 1st level Registered Nurse or Registered Midwife or a Registered
Specialist Community Public Health Nurse who has completed the specific programme of
preparation for Nurse Independent prescribing. For both groups of nurses, they have to
be registered in the register maintained by the Nursing and Midwifery Council (NMC) with
an appropriate annotation next to their name indicating the type of nurse prescriber.
Pharmacist Independent Prescribing was introduced from 1st May 2006. To qualify they
must be a registered pharmacist whose name is held on the membership register of the
Royal Pharmaceutical Society of Great Britain with an annotation signifying that the
pharmacist has successfully completed an education and training programme accredited
by the RPSGB and is qualified as an independent prescriber.
Optometrist Independent Prescribing was introduced from 4th June 2008. Once training is
completed practitioners will need to register their independent prescribing specialty with
the General Optical Council before they can exercise prescribing responsibilities.
The Department of Health has introduced supplementary prescribing, which is “A
voluntary prescribing partnership between an independent prescriber and a
supplementary prescriber, to implement an agreed patient-specific clinical management
plan with the patient’s agreement”. Supplementary prescribers are able to prescribe from
a range of medicines for a broad range of medical conditions under the terms of a clinical
management plan. The plan will be drawn up, with the patient’s agreement, in
consultation with an independent prescriber. The independent prescriber is a doctor or a
dentist. The supplementary prescriber is either a Registered Nurse, Registered Midwife or
Registered Pharmacist. Nurses can hold more than one qualification e.g. as a Nurse
Independent Prescriber and also as a supplementary prescriber. In May 2004, the DH
proposed that allied health professionals, including physiotherapists, radiographers,
chiropodists and optometrists, should be able to prescribe medicines, as supplementary
prescribers in partnership with a doctor. The introduction of supplementary prescribing by
these health professionals was implemented in April 2005 to allow AHP’s to train as
supplementary prescribers.
These changes in who can prescribe result from the implementation of the Crown Report .
Follow this link for more information about nurse prescribing, pharmacist prescribing and
supplementary prescribing click here.
What are the Different Types of NHS Prescription Forms
in England?
Different types of prescribers use different versions of the standard NHS FP10
prescription form. Each version is a different colour, which helps the dispenser and the
NHS Prescription Services to identify the prescriber. The different versions of the FP10
also have different codes.
For the following codes, name the prescriber who uses the form: -
FP10P
FP10MDA-SS
FP10NC
FP10D
FP10SS
FP10HNC
FP10MDA-S
FP10HMDA-S
FP10MDA-SP
FP10PCD
Follow this link to check your answers.
The FP10 form has been redesigned in the last few years to make counterfeiting of the
form more difficult, for example special dyes are used. Other measures introduced to
reduce patient charge evasion have resulted in the back of the form being changed as
well. The back of the form specifies exemption categories for patients who don't pay the
prescription charge and these have been updated following the introduction of new types
of social benefits. An example of an FP10 form is shown below.
enlarge
Front FP10 form
Back FP10 form
The following groups of prescribers use these various forms:
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GPs – FP10NC, FP10SS, FP10MDA-SS, FP10MDA-S
Hospital-based prescribers - FP10SS, FP10MDA-SS, FP10HNC, FP10HMDA-S
Dentists - FP10D
Nurses - FP10P, FP10SS, FP10 MDA-SS
Supplementary prescribers – FP10P, FP10SS, FP10 MDA-SS, FP10MDA-SP
OOH - FP10P-REC
Private prescribers - FP10PCD
Form FP10MDA-S is used for prescribing controlled drugs (mainly methadone) to addicts.
It is twice the size of the standard FP10 because it contains space for the pharmacist to
record each time an instalment is supplied.
FP10SS forms are designed for use with the prescriber’s computer system. Many
prescriptions are produced in this way and they are usually easier to read than
hand-written prescriptions. FP10NC are for hand-written prescriptions.
The FP10P is printed with information to indicate the type of prescriber:
 COMMUNITY PRACTITIONER NURSE PRESCRIBER - the original group of nurse
prescribers
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NURSE INDEPENDENT PRESCRIBER - nurses formerly known as Extended
Formulary Nurse Prescribers
SUPPLEMENTARY PRESCRIBERS
OUT OF HOURS CENTRES
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The FP10PCD was introduced to support the DH project for safer management of CDs
and is used for any private prescriptions for schedule 2 & 3 controlled drugs dispensed by
community pharmacists. It is printed with information to indicate the type of private
prescriber:
PRIVATE DOCTOR
PRIVATE NURSE PRESCRIBER
PRIVATE PHARMACIST PRESCRIBER
PRIVATE OPTOMETRIST PRESCRIBER
PRIVATE PHYSIOTHERAPIST PRESCRIBER
PRIVATE RADIOGRAPHER PRESCRIBER
PRIVATE PODIATRIST PRESCRIBER
What can a prescriber order on an NHS prescription?
What do you think prescribers should be allowed to order on prescriptions - anything they
think the patient needs? How about a regular session of exercise or a daily helping of fruit
for a patient who requires vitamins? These suggestions are not as daft as you might
suppose. There have to be limitations on what can be prescribed at NHS expense and it
is important that prescribers only prescribe within their own competencies. How do you
think this might affect prescribing by dentists or nurses? Why not discuss these issues
with your colleagues or tutor.
Follow the links to find out more.
General Medical Services (GMS) contract
Drugs and other substances not to be prescribed under the NHS Pharmaceutical Services
Drugs and other substances to be prescribed in certain circumstances under the NHS
Pharmaceutical Services
Appliances
Borderline substances
Dental Practitioners Formulary
Nurse Prescribers Formularies
Supplementary Prescribing
Pharmacist Independent Prescribing
Optometrist Independent Prescribing
General Medical Services (GMS) Contract
The Standard General Medical Services Contract states that:
"A prescriber shall order any drugs, medicines or appliances which are needed for the
treatment of any patient who is receiving treatment under the contract by issuing to that
patient a prescription form or a repeatable prescription and such a prescription form or
repeatable prescription shall not be used in any other circumstances."
This means that the prescriber can't use the FP10 form to prescribe exercise sessions.
The General Medical Services (GMS) contract was introduced in April 2004. The contract
is between the primary care organisation (PCO) and the primary care practice as opposed
to a contract with each GP. The contract includes proposals to help GPs to manage their
workload by enabling practices to transfer responsibility for providing some services,
including out-of-hours care, to their PCO. Under the terms of the contract a practice can
decide which additional and enhanced services they wish to provide, for example,
contraceptive services, childhood vaccinations and minor surgery. If the practice opts out
the PCO becomes responsible for the service provision.
Drugs and other substances not to be prescribed under the NHS Pharmaceutical
Services
In practice there are some restrictions on what a GP can prescribe on FP10. Schedule 1
to the NHS (General Medical Services Contract) (Prescription of Drugs etc) Regulations
2004 lists drugs and other substances not to be prescribed under the NHS pharmaceutical
services. This list can be found in Part XVIIIA of the Drug Tariff. If an FP10 prescription is
dispensed for an item on this list, no reimbursement is made to the contractor for that
item.
Drugs and other substances to be prescribed in certain circumstances under the
NHS Pharmaceutical Services
Schedule 2 to the NHS (General Medical Services Contract) (Prescription of Drugs etc)
Regulations 2004 lists drugs to be prescribed in certain circumstances under the NHS
pharmaceutical services. It specifies groups of patients who may receive specific drugs
for specific purposes. These drugs can not be prescribed to other types of patient or for
different purposes. The list of drugs covered by Schedule 2 is usually referred to as
theSelected List and it can be found in Part XVIIIB of the Drug Tariff. If one of these drugs
is prescribed, the GP must endorse the face of the FP10 with the reference “SLS”.
Appliances
Unlike drugs where a GP can prescribe any drug that is not in Schedule 1, only the
appliances listed in Part IX of the Drug Tariff can be supplied on FP10. If an appliance not
listed in the Drug Tariff is dispensed or an appliance that does not conform to the Drug
Tariff specification, no reimbursement will be made to the dispensing contractor for that
appliance.
Borderline substances
The products that GPs prescribe on FP10 do not have to have marketing authorisations
(product licences) to be considered as drugs. Some patients will require unlicensed
medicines. There are also patients who need products where it is borderline whether the
product is a drug or something else such as a food or cosmetic.
Whether a product is allowed as a drug on an FP10 may depend on the particular
circumstances in which the product is used e.g. it may be considered a drug when used
for treating a specific condition. The Advisory Committee on Borderline Substances
advises as to the circumstances in which some foods and toilet preparations may be
regarded as drugs. The ACBS recommendations can be found in Part XV of the Drug
Tariff. If a GP prescribes one of these substances, he or she should endorse the FP10
with "ACBS".
Dental Practitioners Formulary
Unlike GPs, dentists are restricted to a specific list of products that they can prescribe on
FP10D. The NHS Prescription Services will only reimburse the dispensing contractor if
the products are in the formulary. You can find the list of preparations which may be
prescribed on form FP10D as Part XVIIA of the Drug Tariff.
Nurse Prescribers Formularies
There are two groups of independent nurse prescribers.
Community Practitioner Nurse prescribers who have completed the necessary training can
only prescribe the preparations listed in Part XVIIB(i) of the Drug Tariff. The list includes
almost all appliances (including wound management products) and reagents listed in Part
IX. The second group, Nurse Independent Prescribers, can prescribe any licensed
medicine for any medical condition, including some Controlled Drugs listed in Part
XVIIB(ii) and must work within their own level of professional competence and expertise.
Supplementary Prescribing
Supplementary prescribers can prescribe the following, provided they are included within
the patient-specific clinical management plan:
 All General Sales List medicines, Pharmacy medicines, appliances and devices,
foods and other borderline substances approved by the Advisory Committee on
Borderline Substances.
 All POMs.
 Controlled Drugs (except those listed in Schedule 1 of 'The Misuse of Drugs
Regulations 2001' - that are not intended for medicinal use). (The current
exception is when an AHP is the supplementary prescriber)
 Medicines for use outside their licence indications.
 Unlicensed drugs (a product not licensed in the UK).
Pharmacist Independent Prescribing
Pharmacist Independent prescribers, as stated in Part XVIIB(ii) of the Drug Tariff, are able
to prescribe any licensed medicine for any medical condition but cannot prescribe
Controlled Drugs.
Optometrist Independent Prescribing
Optometrist Independent prescribers can prescribe any ophthalmic medication for any eye
condition and must work within their own level of professional competence.
How should a prescriber complete the prescription form?
FP10 forms have to be completed in accordance with legal requirements such as the
Medicines Act (if the drug is a POM) and the Misuse of Drugs Act (if the product contains
a controlled drug). The NHS (General Medical Services Contract) Regulation 2004 also
contains some requirements for writing prescriptions: these apply to all prescriptions
regardless of whether the item prescribed is a drug or an appliance.
Which of the following pieces of information does a prescriber have to include on
an FP10
prescription to meet legal requirements?
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Patient's date of birth
Patient's name
Patient's title e.g. Mr
Quantity of the product to be supplied
Prescriber's qualifications
The date the prescription was signed
Instructions to the patient on how to use the product
Prescriber's signature
Follow this link to check your answers.
Which of the following statements about prescriptions are true?
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Carbon paper can be used to write FP10 prescriptions
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provided the prescriber signs each copy of the prescription in indelible ink
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FP10 prescriptions can contain an instruction to allow repeat dispensing of the
same prescription
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A doctor can write a single prescription for a POM to treat more than one patient
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An FP10 prescription is normally valid for 6 months from the date on the
prescription
Follow this link to check your answers.
A prescriber should include the following on an FP10 prescription:
The prescriber's signature - this should include his or her initials, or forenames, and
surname. Electronic signatures or stamps are not currently permitted on paper
prescriptions. To allow the pilots for electronic transmission of prescriptions to go ahead
in England, the Prescription Only Medicines Order was amended to allow authorised
prescribers who were participating in the pilot schemes to sign prescriptions digitally in
place of ink signatures.
The prescriber's address - this is usually the practice address for a GP or dentist and it is
already printed on the FP10. For a nurse employed by a Primary Care Trust, the trust's
address is printed on the form and the nurse has to add a code that identifies the patient's
GP practice.
Particulars to indicate whether the prescriber is a doctor, dentist, nurse or pharmacist this does not have to be the prescriber's qualifications. FP10s contain a number to
identify the prescriber.
A date must appear on the FP10 next to the prescriber's signature. For most prescriptions
this is the date the prescriber signed the prescription but the prescriber is also allowed to
put a date before which the prescription should not be dispensed.
Patient's details - name and address must be given but the format for this information is
not specified. It's not essential to give the patient's title but it can be helpful. For patients
under 12 years, the age or date of birth must be stated but this is not required for older
patients. GP computer systems should print the age or date of birth on the FP10 for all
patients and this information is very useful for the pharmacist.
Information about the product supplied - apart from some controlled drugs (see next
section) there is no legal requirement to provide particular information about the product.
The Terms of Service require a doctor to insert particulars of the order on the form but do
not specify what these particulars include. The NHS Prescription Services obviously
needs sufficient information about the product to price the prescription and pay the
dispensing contractor accurately. If there is insufficient information on the FP10, it has to
be returned to the dispensing contractor who then has to make sure the information is
added. The form is then returned to the NHS Prescription Services and this will delay the
payment to the dispensing contractor for that FP10.
To be sure that the product meets the prescriber's requirements, information missing from
the FP10 such as the quantity of the product can not be written on the main body of the
FP10 by a pharmacist. When information is missing the pharmacist usually returns the
FP10 to the prescriber. In some circumstances the pharmacist can use his or her
discretion as to what to supply so that the patient is not deprived of a product that he or
she requires immediately. Follow this link to find out how a dispenser can endorse a
prescription form when information is missing: How to prevent common endorsing errors
The instructions for how to take or use the product do not have to appear on the
prescription. If this information is missing, the pharmacist will usually check the patient
understands the prescriber's intentions and advise the patient using the pharmacist's
professional knowledge.
The British National Formulary contains advice for prescribers on how to write
prescriptions clearly. This covers hand-written prescriptions and computer issued
prescriptions. The advice for writing prescriptions by hand can be found on our website in
the NHS Prescription Services section under Prescription Form.
Prescribers and dispensers also need to know the following about FP10
prescriptions:
FP10 prescriptions can be written using carbon paper or similar material providing they
are not for a Schedule 2 or Schedule 3 controlled drug. Carbon copies of the prescription
can be useful if the prescriber wants only a small quantity of a drug to be dispensed and
the identical prescription is being given two or three times. The prescriber must sign and
date each carbon copy.
Repeat dispensing of an FP10 prescription allows patients to obtain a prescription from
their GP which they can have dispensed in several episodes, rather than having to go
back to the surgery each time for a new prescription. For repeat dispensing the
prescriber’s software system produces a repeatable prescription on an FP10 and a further
series of ‘batch issues’ (also printed on FP10s) 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. The prescriber signs the
repeatable prescription because 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 since they are not prescriptions but are used for reimbursement
purposes. The computer system annotates the FP10 form so that the dispenser can
distinguish when an FP10 is being used for repeat dispensing rather than for a normal
single-event FP10.
Systems also link the 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. The pharmacy will
retain the repeatable prescription and the patient can keep the remaining batch issues or
ask the pharmacist to retain them on his/her behalf until the next issue of medication. The
patient signs each batch issue form at the time it is dispensed. The dispenser processes
batch issues and forwards the forms to the NHS Prescription Services at the end of the
month dispensed. The repeatable prescription is sent to the NHS Prescription Services
once all batch issues have been dispensed or, if the patient does not collect all
instalments, on expiry. When the patient collects their medicine the pharmacist has an
opportunity to confirm that the prescription still meets their needs and to answer any
questions they may have.
Follow this link for more information: Repeat dispensing
A separate prescription form has to be used for each patient, except where a doctor is
prescribing in bulk for a school or institution. POMs can not be prescribed on "bulk
prescriptions". The Drug Tariff specifies the requirements that have to be met before a
"bulk prescription" can be issued. This information can be found in Part VIII, Notes,
Paragraph 9 of the Drug Tariff, and can be viewed online at:
www.nhsbsa.nhs.uk/prescriptionservices/PaymentsandPricing/DrugTariff
An FP10 prescription can be dispensed up to 6 months from the date on the prescription
except :
 if the FP10 is for a Schedule 2 or Schedule 3 controlled drug or
 if the FP10 is a repeatable prescription.
FP10s for Controlled Drugs
When a doctor or dentist writes a prescription for a controlled drug, he or she also has to
comply with the requirements of the Misuse of Drugs Act. In practice there are only extra
requirements for Schedule 2 and Schedule 3 controlled drugs. Prescriptions for Schedule
4 and Schedule 5 controlled drugs just have to meet the requirements for writing
prescriptions for POMs. The prescriber must ensure the FP10 contains the following
additional information:
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The prescriber's usual signature and the date
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If issued by a dentist, "for dental treatment only"
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The name and address of the patient
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The dose of the drug to be taken
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In the case of preparations, the form and, where appropriate, the strength of the
preparation
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Either the total quantity of the preparation or the number of dose units in both
words and figures, with a strong recommendation that the maximum quantity is
limited to 30 days for schedule 2, 3 & 4 controlled drugs.
FP10s for temazepam do not have to comply with the above requirements.
Validity of prescriptions for schedule 2, 3 & 4 controlled drugs is now restricted to 28 days.
FP10MDA-S
The FP10MDA-S prescription form is used to order Schedule 2 controlled drugs and
buprenorphine for supply by instalments for treatment of addiction. When a GP
writes an FP10MDA-S, he or she must specify the number of instalments to be dispensed
and the interval between each instalment. The GP can only order a sufficient quantity of
the drugs as will provide treatment for not more than 14 days. A starting date for
dispensing the instalments does not have to be specified but if such a date is given, it
must be complied with and the instalment directions run from that date. Other drugs the
patient might require (besides those for treating addiction) can not be ordered on an
FP10MDA-S.
Out of Hours (OOH) service provision
Non FP10 Supply Forms (which are sometimes referred to as FP10P-REC forms) were
introduced in 2005 for use specifically within Out of Hours Centres. However, other FP10
prescriptions also remain available for use in the more traditional OOH prescribing
scenario, where the patient is visited by a prescriber outside of normal
working hours. This overview is intended to clarify the circumstances in which each type
of form should be used.
PCTs (or their Prescription Form Purchasing & Distribution Unit / Agency) will need to
supply the different types of form to OOH service providers (all form types are obtainable
from the usual suppliers). These are:
Non FP10 Supply Forms - FP10P-REC
The Non-FP10 Supply Form was designed for a specific purpose - to support the
introduction of Out of Hours Centres in February 2005. These OOH Centres provide
patients with an opportunity to receive any urgently required medication at the same time
and place as the out of hours consultation.
The FP10P-REC forms should only be used by the OOH provider to record items supplied
directly to a patient on-site (i.e. an item not dispensed through a community pharmacy).
These forms should be submitted by the OOH provider to the NHS Prescription Services
of the NHS Business Services Authority on a monthly basis (by the 5th working day). This
will enable the NHS Prescription Services to provide monitoring and reporting information.
FP10P-REC forms should not be dispensed through traditional community pharmacies, as
they are not intended for patients to take away from the OOH Centre and exchange for
medication.
Standard FP10 Prescriptions
These are the standard FP10 prescription forms that will be dispensed by a community
pharmacy. They can either be computer-generated type (FP10SS) or hand-written
prescriptions (FP10NC). Or alternatively, FP10P forms for any qualified nurse or
pharmacist prescribers. In an OOH setting these forms should continue to be used where
prescribing takes place outside of normal working hours, but where there is no immediate
treatment required (i.e. where it is not detrimental to the patient to wait until the
prescription can be dispensed at a later point by a community pharmacy).
Click here for a copy of the original letter communicating the creation of the Out of Hours
Centre initiative. This describes the initiative in more detail and also explains the steps
that PCTs need to take in order to set up these sites.
Further reading
Drug Tariff. The Stationery Office, London
Electronic Drug Tariff
The NPA Guide to the Drug Tariff and NHS Dispensing for England and Wales. The
National Pharmaceutical Association, St Albans.
Medicines, Ethics and Practice A Guide for Pharmacists, Royal Pharmaceutical Society of
Great Britain, London
Crown Report - Review of Prescribing, Supply and Administration of Medicines, NHS
Executive
Department of Health
General Medical Services (GMS) contract
NHS repeat dispensing schemes in England
Nurse prescribing
Pharmacist Prescribing
Supplementary prescribing