1
Policy Number, REPEAT PRESCRIPTION, MEDICATION REVIEW and
MEDICINES RECONCILIATION POLICY June 2010
Date approved and name of approving body. Replaces [ref or date of
previous policy]
Review Date 1st June 2012
1
1.1
Summary
The aim is to provide a safe and efficient repeat prescribing and
medication review system, for use in general practice, which ensures
effective appropriate treatment, provides monitoring for long term
conditions and minimizes patient harm, inappropriate requests, drug
wastage and prescribing errors. Systems should be in place to ensure
that changes to a patient’s medication made by a practitioner outside the
practice e.g. Community Nurse or hospital doctor, are updated on the
patient’s medical record and reviewed appropriately.
The policy should be implemented by practice managers with support
from all practice staff.
2.
The policy
2.1
Ordering repeat prescriptions
Repeat prescriptions should ideally be requested by the patient. The
patient should only order items that they need between now and when
the next repeat request is due. Where a third party is responsible for
the ordering of repeat prescriptions they should have the authority to do
so from the patient and should obtain clear instructions, at the time the
request is made as to which items are required. Repeat requests should
be made on the tear off section of the previous prescription. Other
arrangements may be in place. (See appendix 1 Information for Patients)
2.2
Who can issue a repeat prescription
The practice manager should only allow competent staff to be responsible
for issuing repeat medication. Staff authorized to print off a repeat
2
prescription should be members of practice staff that have been
specifically trained and accredited in the repeat prescribing process or a
doctor or a competent nurse or pharmacist working in the practice
2.3
The repeat prescription process
The competent person should check the repeat prescription request
to make sure the patient’s intention is clear and, if unsure, confirm the
items required with the patient or their authorized representative directly.
If a medication review is due or individual items appear to be over or
under used or have reached the end of their repeat authorization period,
the competent person should contact the prescriber. (See Appendix2 and
Appendix 3)
2.4
The prescriber
The prescriber is responsible for ensuring that medication reviews and
repeat authorizations are completed in a timely fashion. They should
check that the drugs are still required clinically and that monitoring is up
to date. Wherever possible, the length of supply of each of the repeat
medications should be aligned to the number of days specified in the
practice repeat prescription policy and should also take account of
patient’s current stockholding. Any changes to medication made by
external prescribers should be reconciled. Repeat prescriptions should be
signed in protected time with minimal interruptions. (See appendix 4)
2.5
Storage of signed prescriptions
Signed repeat prescriptions should be stored in a way that prevents
unauthorized access. They should be stored in a locked cupboard or
draw when the surgery is closed.
2.6
Issuing signed prescriptions to patients and their authorized representatives
To ensure that prescriptions are only collected by patients or their
authorized representative, practice staff should request further details e.g.
confirmation of address before issuing the prescription. If controlled drugs,
or any drug liable to misuse, is included on the prescription then further
identification should be sought.
3
Drivers or other pharmacy staff collecting prescriptions, as the patients
authorized representative, should sign for each prescription form recording
details of the patient name, number of items, and date collected. This
serves as an audit trail if prescriptions are lost. Non-practice staff should
not be allowed to retrieve signed prescriptions from where they are stored as
this may breach the confidentiality of other patients.
2.7
Repeat Dispensing Arrangements
Practices should consider taking part in the scheme in order to reduce
the number of repeat prescriptions requiring signature, improve medicines
compliance and the monitoring of repeat drug use via the feedback from
community pharmacists. (See appendix 5)
3.
Implementation
3.1
The policy should be implemented by practice managers with support
from all practice staff. (See Appendix 6)
3.2
Practice staff, patients, patient’s authorized representatives and community
pharmacists should be informed of any changes in the existing repeat
prescribing system. Arrangements for Bank Holidays, any half days and
weekends should be clearly stated.
4
This policy has was forwarded to the Healthcare Commission for the Medicines
Management Post Discharge Pilot Survey November 2008
Appendices
Appendix 1
Information for patients
What is a Medication Review?

It is a talk you can have with a doctor, nurse or pharmacist to ensure that
you are comfortable taking your medication.
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

It is an opportunity to confirm that you are taking the right medicines in
the right way, in the right amounts and that you are getting the right
effects.
It is also your opportunity to learn more about your medications and a
chance to discuss any questions or concerns you might have
What are repeat prescriptions?



They are prescriptions for your medication that you can order from the
GP practice without having to see a prescriber each time.
Repeat prescriptions regularly need to be checked by a prescriber to
make sure that your medication is working correctly. Thus, you might
only be able to order a certain number of repeat prescriptions before
you have to see the prescriber
On occasions the prescriber may request that you attend a medication
review. It is important that you do attend.
How to order a repeat prescription







Order you repeat prescription in plenty of time – allow at least [no of
days stated in your repeat prescribing policy] working days.
If you use the repeat prescription form counterfoil please tick the items
carefully. You will only be able to order items that are on your repeat
slip; for anything else you may need to make an appointment with a
prescriber
If you order by e-mail fax or telephone, please order the items carefully
and give the practice full details of the prescribed medicines.
Order only those items that you need
If you do not need a particular medication this time, please do not
order it.
You will still be able to order it at a later date when you do need it.
When you collect your prescription from the surgery, please check that it
is only for the medications that you have ordered. Please inform the
receptionist if there are any errors.
Repeat prescriptions should only be ordered in writing; however you may
be able to order by e-mail, telephone or fax depending on your
circumstances or practice
6



If you agree that a community pharmacy can collect and/or deliver your
prescriptions then you must make it clear to your doctor which pharmacy
you have chosen
If you agree that a carer or community pharmacist can order your
prescriptions on your behalf, please make sure you only allow them to
order the items you need. If you receive any medicines that you did not
request please inform your doctor
When you receive or collect your medicines from the pharmacy please
check that you only receive items that you requested. Inform the practice
if there are any unexpected items.
Taking Care of Your Medication





Know the names of all your medicines (these includes tablets, capsules,
inhalers, liquid medicines, testing strips and so on) and what they are
used for
If you cannot remember what medicine is for then you can book a free
medicines use review (MUR) with your regular dispensing pharmacist
If you stop taking a prescribed medication for any reason, please make
an appointment to discuss how you feel about the medicine with a with
a doctor, nurse or practice pharmacist
If you need to take more or less of a medication than the pharmacy
label allows, please make an appointment to discuss how you feel about
the medicine with a with a doctor, nurse or practice pharmacist
Do not take non-prescribed medication (e.g. over the counter, health
foods or herbal or Chinese medicines) without checking with your
prescriber or pharmacist. It may interfere with your regular medication
and may be harmful.
Medicines and Wastage


A large amount of medication is wasted every year. Some of this is
due to people ordering medication that they do not need or do not take.
If you have decided not to take a medicine (you should take advice
from a doctor, nurse or pharmacist before stopping any medication)
please do not re-order it. Make an appointment with a doctor, nurse of
pharmacist to discuss why you have made this decision.
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

Medicines that have been ordered and returned to the pharmacy cannot
be reused even if they are unopened and must be destroyed.
You can help to reduce the amount of wastage by ordering only those
items that you use and need.
Safe Disposal of Unwanted Medicines


Do not throw away unwanted medication and do not flush any down the
toilet
Always return expired, unused and unwanted medication to your local
pharmacy. They will dispose of it safely.
Repeat Dispensing Arrangements





This is a system whereby your doctor or nurse can provide you with a
series of repeat prescriptions which you can either keep or give to your
dispensing pharmacist to keep for you. You can then have these
dispensed at appropriate times without the need to see your doctor in
between.
You may be able to take part providing that you medication and health
problems are unlikely to change in the near future.
The system reduces the number of prescriptions your doctor or nurse
needs to sign and involves your dispensing pharmacist more closely in
your health care.
The system can be arranged to allow you to control when you collect
you repeat prescriptions, for example in advance of going on holiday.
Each patient must give their consent before the arrangements can start.
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Appendix 2
Authorized Members of Practice Staff Responsibilities
Is the request for a patient at this surgery?
It is important that the prescriptions request form is one that was generated by
your practice. Those that were generated by a new patients’ previous surgery
should be interpreted very carefully and reviewed by a doctor or competent
nurse or pharmacist within your practice before being processed.
Is this a patient that the practice has particular concerns about?
There may be a handful of named patients who should not to have medications
on repeat without direct contact with their prescriber.
Is it clear which medicines the patient requires?
If the patient has left the form blank and it is not obvious from their computer
record which medication is needed then preferably the patient, or failing this,
their authorized representative should be contacted.
Are the requested medicines allowable on repeat?
Confirm that items requested are allowed on repeat and are within their
authorized period and that the prescriber specified that the item should be
repeated and it was not a one-off supply.
The practice’s repeat prescribing policy should list all of the items are not allowed
on repeat prescription
The following drugs or drug classes are generally less suitable for repeat
prescribing although this will depend on individual practice policy (if you are
unsure please contact the Medicines Management Team):
Antibiotics-some exceptions
The contraceptive pill
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HRT
Benzodiazepines
Antidepressants
Schedule 2 and 3 controlled drugs with the exception of phenobarbital Drugs
that require regular monitoring.
Any drug that has an abuse potential-may be appropriate for certain patients
only.
Any new drugs, until effectiveness and tolerability have been established
Are there any repeats left for each requested item?
Check the number of repeats left before the patient’s next review. If there are
no repeats left for the item, the prescriber and patient should be notified and a
review arranged.
Is the medicine being used too frequently?
Check the period since the last request. The computer should normally alert
the user if the medication appears to be over used. If problems are
suspected the prescriber should be alerted, preferably before the prescription is
produced. Prescriptions should not be printed at less than the time intervals
that have been authorized without agreeing the reason for this (e.g. holiday).
The reason should be documented in the patient’s notes
Is the medicine being used too infrequently?
Are there repeat items on the patient’s computer record that have not been
requested? Check the period since the last request. The computer should
normally alert the user if the medication appears to be underused. If
problems of non-compliance are suspected the prescriber should be alerted,
preferably before the prescription is produced. Note some medicines may be
seasonal e.g. antihistamines, or have a long shelf life but may be used
infrequently e.g. GTN spray
Does the request form contain any notes or alterations from the prescriber?
The prescriber may have indicated on the previous occasion that the patient
needs to be seen for a review, or may have requested a monitoring
test/measurement (e.g. liver function test). The receptionist should confirm
that the request has been fulfilled.
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If the patient is overdue for review, this should be brought to the attention of
the prescriber. A mechanism should be in place for dealing with patients who
fail to make appointments when they are due for a review. This process
should be explained in the practice repeat prescribing policy. If the presciber
has amended the dosage instructions on the repeat prescription, the patient’s
medical records should be amended accordingly once any change has been
confirmed by the prescriber.
Does the request form contain any manual alterations from the patient?
Any manual alterations to the request form by the patient/or their authorized
representative are to be brought to the attention of the prescriber (e.g. “I no
longer take this medication”). Any manual additions by the patient should be
referred to the prescriber before being added on to the list of repeatable
medications.
Any request to alter the strength or dosage of a repeat item (other than in
writing from an official source e.g. hospital doctor) MUST be referred to the
patient’s prescriber. Only when authorization has been give by the prescriber,
can the prescriptions details be changed.
Are full dosage instructions included?
Check that full instructions are provided for each requested item, e.g. name of
drug, form of drug (e.g. tablets capsules), strength of the drug, the dosage,
the frequency of dosage and the quantity to be supplied. Less information
may be appropriate in the case of prescriptions for dressings, appliances (e.g.
catheters) and chemical reagents (e.g. blood glucose testing strips). If in
doubt, refer to the prescriber.
Is the quantity of each medicine being requested excessive?
Verify that quantity of each item equates to the maximum prescription length
(e.g. 28 days supply) allowed by the practice as stated in the practice policy
Are there any discontinued therapies?
If the patient has not requested a particular item for a specified amount of time
(e.g. 3 months) then this may indicate poor compliance. The prescriber
should be alerted and the patient called in for a medication review. The items
11
can be removed from the repeat request form if the prescriber agrees that they
are no longer needed.
Note some medicines may be seasonal e.g. antihistamines, or have a long
shelf life but may be used infrequently e.g. GTN spray
Are you in any way concerned or uncertain about the patient or the items being
requested?
Any prescription requests about which staff are uncertain or concerned should
be referred to the prescriber
Is the prescription legible?
The printed or handwritten prescription should be legible and contain the name
and address of the patient, the patents date of birth, the full names of all the
drugs prescribed and the detail as above.
Has a record of the prescription been made?
All repeat prescriptions issued are automatically recorded in the patient’s
computer medical records. There should be a process for adding the detail of
handwritten prescriptions written by members of the practice, secondary care,
Out of Hours or by community practitioners.
Can the prescription be altered?
Handwritten prescriptions should state the number of items on the prescriptions.
Particular attention should be paid to certain drugs (e.g. where the quantity
may be altered); if the prescriber has concerns then they can specify the
quantity in words and figures.
To prevent the addition of further items, the spare space on the prescription
should be crossed through by the prescriber. Where the computer has failed to
cancel out unused space t his should be done manually to prevent any
unauthorized additions.
Is the patient suitable for the Repeat Dispensing Arrangements?
If the patient’s medication requirements and disease(s) are stable they may be
suitable for the repeat dispensing arrangements. (See appendix 5)
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See http://www.nhsbsa.nhs.uk/PrescriptionServices/1856.aspx
on prescription writing.
Appendix 3
Repeat Prescribing Process
for more details
13
Patient/carer puts request in at
practice for repeat medication
Request collected by appropriate member of staff for
processing
Does prescription request require clarification or reauthorization; is there any
medication that have not been collected for some time or that appears to be
overused or has medication been recently changed by a practice member or
external prescriber?
Yes
No
Clarify medication with patient
Obtain authority to re-authorize
Book a medication review or medicines
reconciliation with a doctor or a competent
nurse or practice pharmacist
Do the patient’s medication
quantities need to be
changed so that they all run
out at the same time
No
Process prescription
request
Yes
Consider booking patient for a review
with the practice pharmacist.
If necessary issue a “one off”
prescription and align the patient’s
medication to equalize quantities
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Pass to doctor
for signing
Appendix 4
Safe storage
Signing Repeat Prescriptions and Medication Review/Reconciliation
Signing Repeat prescriptions

Any medical and non-medical prescriber can sign a prescription provided
that they are satisfied with the request, are competent to prescribe all the
drugs on the prescription and are satisfied with the way the drugs have
been prescribed.

Repeat prescriptions should be checked and signed in protected time with
minimal interruptions.

Prescribers should be aware of their responsibilities regarding signing of
repeat prescriptions for patients not familiar to them especially if there are
queries or incomplete patient records

If a prescriber is concerned about a patient’s compliance then they should
arrange to see the patient as soon as possible; however if this would delay
the patient’s access to medicines or otherwise affect patient care then the
issue may be resolved on a temporary basis by speaking with the patient
on the phone.

Prescriptions that have the following instructions ‘As directed’ or ‘When
required should be amended to include the normal dose, frequency,
indication and maximum dose/over time e.g. “Two tablets to be taken four
times a day as directed/required, for pain, up to a maximum of eight
tablets in 24 hours”
Reporting Adverse Drug Reactions
15
Prescribers are responsible for reporting all suspected adverse drug reactions
involving new drugs, (so called black triangle drugs-annotated ) and any novel
adverse drug reactions for all other drugs, to the MHRA using the yellow card
scheme
https://yellowcard.mhra.gov.uk/hcp/
Reviewing Medicines
Patients may use medicines long term. The initial decision to prescribe
medicines, the patient’s experience of using the medicines and the patient’s
needs for support to adhere to the prescribed medicine regimen may change
over time and should be reviewed regularly.

Offer repeat information and review, especially when treating long-term
conditions with multiple medicines.

Review at agreed intervals patients’ knowledge, understanding and
concerns about medicines and whether they think they still need the
medicine.

Ask about side effects and the patient’s tolerance to these.

Ask about adherence to the prescribed regimen when reviewing
medicines. Clarify possible causes of non-adherence and agree any
action with the patient (including a date for follow-up).

Bear in mind that patients sometimes evaluate prescribed medicines in
their own way (for example, by stopping and starting them and
monitoring symptoms). Ask the patient if they have their own way of
weighing up their medicine.
16
Medicines Adherence-see NICE Clinical Guideline 76
http://www.nice.org.uk/nicemedia/pdf/CG%2076%20Medicines%20adherence%20Q
RG%20FINAL.PDF
Medication Review
Types of Medication Review
Review
Access to
patient notes
Patient /carer
involvement
Description
Assesses technical
issues relating to the
Does not need
Type 1
Prescription
prescription e.g.
No*
patient/carer to be
(Medicines) review
anomalies, changed
present
items and cost effective
prescribing
Concordance
Usually requires
Addresses issues
Type 2
and
Not
patient and /or
relating to patient’s
(Medicines
compliance
necessarily*
carer to be
medicine taking
use)
review
present
behaviour
Type 3
Addresses issues
Clinical
Requires patient
(Medicines
relating to patient’s use
Medication
Essential
and /or carer to
and
of medicines in the
Review
be present
condition)
context of their condition
* Any changes to medication will have to be communicated to the patient/carer
17
For more information see “A Guide to Medication Review.” National Prescribing Centre. 2008
http://www.npci.org.uk/medicines_management/review/medireview/resources/agtmr_web1.pdf

A full review of a patient’s medical record is to be undertaken when the
patient has had all the authorized repeats.

Regular review should be included as part of the policy for patients with
long term conditions e.g. asthma, COPD, diabetes, CVD, hypertension, heart
failure etc. or high risk patients on key drugs e.g. older patients taking
NSAIDs, patients on warfarin, controlled drugs, diuretics or two anti-platelets.

The practice should take note and act on any issues raised by Medicines
Use Reviews, carried out by community pharmacists, and feedback where
appropriate.

Regular medication review should be a priority for patients that are
housebound, in sheltered accommodation or in care homes. A six monthly
review will be appropriate for most of these patients. Practices should have
a system in place to remind practitioners when reviews are due and should
allocate the required time for GP, Community Matron, competent nurse or
pharmacist to undertake the reviews, in the patients home/care home if
necessary.

Review of the notes to be undertaken by competent health care
professionals ( please state categories of staff)

Depending on the results of the review, the prescriber will then either:


Authorize the prescription for further repeats and record in the
patient’s notes that a review has taken place and the prescription has
been re-authorized, or
Request that the patient attend a consultation
Frequency of Review

12 month review for all patients who are on repeat medication.
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
6 month review for all patients over 75 years who are on four or more
medications.

Patients should be notified when they are required to attend for a review of
their medication.

The following are examples of what a patient’s medication review may
include:

Review of the patients medical condition(s)

Review of the effectiveness of the patients medication

Any monitoring and subsequent test results

Patient’s understanding of the repeat prescribing system

Patient’s understanding of what their medication is for and its
effectiveness

Knowledge of dose, frequency and any other issues relating to
administration

Any side effects or problems with taking the drug which might require
review

A discussion around compliance and concordance

Other non-prescription drugs being taken e.g. over the counter or
herbal/alternative products

Any general queries they may have about their medication

What quantity of each drug does the patient currently hold

Can they open the containers easily
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
Following the review, the action taken is to be recorded in the patient’s
notes, preferably by read code.

All changes to the prescription are to be recorded on the computer system
by the reviewer.

Sufficient time should be allocated for a face to face medication review.
If patients are having difficulty remembering to take their medication they may
find a medicines reminder chart useful. Alternatively they can be initially
assessed for a monitored dosage system (MDS) using the form available at:
http://pcttransition/pcttransition/Pharmacy/MDS/MDS%20Initial%20assessment%20f
orm%20version%20final.pdf
The patient should then be referred to their community pharmacist along with a
completed copy of the form.
More information regarding MDS can be found at:
http://intranet.pct.xwalsall.nhs.uk/Medman/M_D_S.asp
Competency Framework for Practitioners Undertaking Face –to-Face Medication
Reviews
Competency Area
Competency
Overarching Statement
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Building a partnership
Listening
Communication
Listen actively to the patient
Helps the patient to interpret
information in a way
meaningful to them
Context
With the patient defines and
agrees the purpose of the
consultation
Has up-to-date knowledge
of area of practice and wider
health services
Managing a Shared
Consultation
Knowledge
Sharing a Decision
Understanding
Exploring
Deciding
Monitoring
Recognizes that the patient
is an individual
Discusses illness and
treatment options, including
no treatment
Decides with the patient the
best management strategy
Agrees with the patient what
happens next
For more information see “A Guide to Medication Review.” National Prescribing Centre. 2008
http://www.npci.org.uk/medicines_management/review/medireview/resources/agtmr_web1.pdf
A Template for Medication Review is available from the Medicines Management Team
Medicines Reconciliation-The aim of medicines reconciliation when patients
change care settings is to ensure that medicines prescribed in the new setting
(e.g. on admission to hospital) correspond to those that the patient was
taking in the previous care setting (e.g. medicines prescribed by the patient’s
GP)
Medicines Reconciliation on Discharge from Hospital

Medicines reconciliation is an important task, those that undertake it
should be competent to do so
21

The following members of the practice staff should be responsible for
medicines reconciliation (including the implementation of any drug
changes in the patients medical record)- a doctor or a competent
nurse, pharmacist or pharmacy technician.

There should be robust processes for the collecting and receiving
information regarding patient discharge information from secondary care

Any missing information on the discharge summary should be completed
by contacting the ward, pharmacy department, the discharging practitioner
or the patient

Where missing information cannot be obtained the prescriber should
undertake a full medication review with the patient.

The discharge information should clearly state which medicines have been
changed, those that have been stopped and those that have been
started and the reason.

The following data should be expected:
o Complete and accurate patient details including full name, date of
birth, weight if under 16 years, NHS/unit number, consultant,
ward, date of admission, date of discharge
o The diagnosis of the presenting condition plus co-morbidities
o Procedures carried out
o A list of all medicines prescribed for the patient on discharge form
hospital (not just those dispensed at the time of discharge)
o Dose, frequency, formulation and route of administration
o Medicines stopped and started, with reasons and dates
o Length of courses where appropriate (e.g. antibiotics)
o Details of variable dosage regimens e.g oral steroids, warfarin etc.
o Known allergies, intolerance and hypersensitivities and previous
drug interactions
o Any additional patient information provided such as corticosteroid
record cards, anticoagulant books etc.
o Details of any follow up appointments
22
Adapted from
http://www.npci.org.uk/medicines_management/safety/reconcil/resources
/reconciliation_guide-a5ordered.pdf


Ongoing concerns about missing data should be fed back to the tPCT
and provider. Practices should participate in local audits.
Any future monitoring required after the patient has been discharged
should be undertaken and facilitated by the use of screen messages and
reminders in the patients medical record

The process should be double checked by another person from the list
above

The

The practice pharmacist should be involved in medicines reconciliation,
especially where the patients are at high risk of harm from either their
prescribed medication e.g. patients discharged on controlled drugs,
NSAIDs or warfarin or diuretics or on two anti-platelets or when they are
in a vulnerable patient group e.g. the elderly, those with complex comorbidities and/or patients receiving polypharmacy.

Wherever possible assistive technologies should be used to reduce patient
harm e.g. patient safety messages on ScriptSwitch.
practice pharmacist should facilitate the above process
Medicines reconciliation when patients are admitted to hospital

Medicines reconciliation is equally important when patients are admitted to
secondary care and practices should supply the following data as soon
as possible after admission either by e-mail or to a secure fax
o Complete patient details including full name, date of birth, weight
if under 16 years, NHS/unit number, GP, date of admission
o The presenting condition plus co-morbidities
o A list of all medicines currently prescribed for the patient including
those bought over-the-counter (where this is known)
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o Dose, frequency, formulation and route of administration
o An indication of those medicines that are not intended to be
continued
o Known allergies and previous drug interactions
N.B. Medicines reconciliation for any patient that crosses any other care “Interface”
e.g. from GP practice to a Care Home should adopt the same principles and data
sets
Competencies for Practitioners undertaking Medicines Reconciliation
Many of the competencies for staff undertaking medication review apply to
medicines reconciliation; however the NPC has indicated that the following skills
are required for practitioners undertaking medicines reconciliation:
Effective two way communication skills
Technical Knowledge







1.
2.
3.
4.
5.
6.
7.
Therapeutic Knowledge
This level of therapeutic knowledge would
normally be achieved by pharmacists,
doctors, or suitably experienced pharmacy
technicians or nurses.




Verbal,
Non verbal
Written skills
Active listening
Questioning techniques
Giving and receiving feedback
Understanding of relevant
policies and procedures e.g.:
Local medicines documentation
Discharge summaries
NMP Fax form
Patient own drugs policy
Repeat prescribing policy
GP practice system
MDS availability
Up to date knowledge of brand
and generic names of drugs
Forms in which drugs are
available
Licensed indications
Common dosage directions
24

Ability to correctly interpret a
prescription including dose and
directions

Knowledge of the legal
requirements for the prescribing,
recording, administration and
storage of medicines (including
controlled drugs)
A basic understanding of what
the medicine is intended to do and
how it works

Adapted from
http://www.npci.org.uk/medicines_management/safety/reconcil/resources/reconcilia
tion_guide-a5ordered.pdf
Prescribing by Community Nurses

Where a non-medical prescriber, based in the community, issues a
prescription for a patient they should fill in the attached form and fax it
to the patient’s practice as soon as possible. Form available from:
http://pcttransition/pcttransition/Pharmacy/Non%20Medical%20Prescribing/n
urse%20presc%20fax.pdf

On receipt of the above form, the patient’s doctor should be informed;
they will authorize appropriate changes to the patient medical record e.g.
the drug added as a repeat and the form scanned into the patient’s
computer record
25
Appendix 5
Repeat Dispensing Arrangements
 Patients in the scheme should be on stable medication regimens
 A medication review should be undertaken before patients are accepted
into the scheme
 The patient should complete a patient consent form
 “As required” and “as directed” medicines are not suitable for inclusion
in the scheme
 For maximum flexibility the prescriber should not specify a dispensing
interval; however a set interval may be appropriate for some patients or
in certain situations
 Schedule 1, 2 and 3 controlled drugs are not suitable for inclusion in
the scheme
 Care should be taken with inhalers, topical preparations and liquids oral
medicines to ensure that the patient does not receive excessive amounts
under the arrangements
26







The practice staff involved in the repeat dispensing arrangements should
be competent to issue the prescriptions
Relevant repeat authorizations (RA) and repeat dispensing (RD)
prescriptions should be banded together in a “set”, once produced.
Once the RA is signed the RA and RD prescriptions should be kept in
“sets” stored in such a way to prevent unauthorized access.
All the security considerations for ordinary repeats should apply to RA
and RD “sets” (See 2.6 in the policy)
It is essential to communicate any changes in medication to the patients
chosen dispensing pharmacist
Practices should have a system in place to act on any communications
from dispensing pharmacists regarding medicines on repeat dispensing RA
and RD prescriptions.
Community pharmacists have to be accredited before they can take part
in the repeat dispensing arrangements-those pharmacies taking part are
listed here:
http://intranet.pct.xwalsall.nhs.uk/Medman/Repeat_Dispensing.asp
For more information go to:
http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/
DH_4000157
Appendix 6
Practice Manager’s Responsibilities
Practice managers need to ensure that repeat prescribing process is practical,
efficient and clearly understood by all involved including patients and community
pharmacists. There should be an individual practice Repeat Prescribing and
Medication Review Policy based on this document.
1
Patient Education
27
GP practices should have a patient leaflet explaining the Repeat
prescribing system specific to the surgery

It is important to clearly explain the Practice’s repeat prescribing process
to patients. This will help patients to understand how the process
works, which will aid in reducing the number of inappropriate request,
drug wastage, and errors

Patients should be informed of the repeat dispensing arrangements if or
when the practice offers the service

Display posters to highlight and remind patients about the repeat
prescribing process

Provide leaflets that explain the various aspects of the process in clear
and simple terms

Ensure that the information is specific to your practice’s repeat
prescribing process
2 Policy for uncollected prescriptions
There should be a standard time limit for the collection for signed
prescriptions after which those not collected should be investigated, e.g.
a medication review with the practice pharmacist.
3 Staff Training
Practice staff involved in the repeat prescription process should be
appropriately trained on, the practice protocols for repeat prescribing, the
practice protocols for the repeat dispensing arrangements, what their
responsibilities are and the need for accuracy. This training should be
ongoing and is particularly important for new staff members. Practice
pharmacists can provide the medicines management aspects of this
training. Ensure that sufficient, adequately trained staff are available to
cover sickness, holiday, sudden departures, etc
28
4 Community pharmacists
Community pharmacists should have telephone access to doctors. There
should be a set procedure for community pharmacists to contact the
doctors to discuss urgent and non-urgent matters (e.g. telephone at a
certain time or leave a message at reception).
5 Monitoring
The repeat prescribing process should be monitored regularly, providing
guidance when needed and regulated for signs of fraud.
There should also be a system of checking a patient’s compliance with
the prescribed treatment.
6 Security
A robust system for the secure storage of prescriptions pads should be
in place. Signed repeat prescriptions should be stored in a way that
prevents unauthorized access. See Security of Prescription Form Guidance
from The NHS Business Services Authority-Security Management Service
available at:
http://www.nhsbsa.nhs.uk/PrescriptionServices/Documents/PPDPrescripti
onFormProductArea/security_prescriptions.pdf
7 Recall system
There should be a recall system within the overall repeat prescribing
policy that is clear to staff, doctors and patents alike and sufficiently
flexible to meet the clinical needs.
8 Auditing
Review and audits of the repeat prescribing process should be
undertaken regularly. A built-in quality assurance mechanism should be
incorporated into the repeat prescribing system to monitor: overprescribing, under prescribing and review of prescribing.
Auditing the Repeat Prescribing System
The repeat prescribing system should be audited on a regular basis
Examples of how the repeat prescribing process can be audited are:
29

The number of new repeat items that are linked to a diagnosis

The number of patients who have had an annual medication review as a
percentage of the total requiring review over the last 12 months (using
a sample size of 100)

The number of patients over 75 who are on four or more medications
reviewed in the last 6 months as a percentage of those patients over
75 years who are on four of more medications

The percentage of repeat prescriptions without specific dosage instructions

Auditing the number of repeat prescriptions that have been synchronized

Auditing how accurately patient’s medical records are updated

Surveying patients to ascertain how well they understand the repeat
prescribing process
e.g. A questionnaire given to patients when they collect their repeats.
Additionally, specific therapeutic areas can be audited.
For example:

Monitoring patients taking drugs that have a narrow therapeutic index e.g.
lithium, amiodarone, methotrexate or theophylline

Auditing statin usage or the prescribing of two anti-platelets according to
current clinical evidence
30