Repeat Dispensing – Questions & Answers
1. Patients and Patient selection
Q. Do all Patients on repeat medication have to transfer to Repeat Dispensing?
A. Repeat Dispensing is voluntary and not all Patients will be suitable or wish to
participate. Careful selection of the Patient group is essential for the
arrangements to work smoothly (see Operations Manual for more details).
Q. Is Patient consent needed to support the Repeat Dispensing arrangement?
A. There are several issues that the Patient should be made aware of. In
particular, the need for information sharing between the GP and the Nominated
Pharmacy should be stressed. A consent form should be completed and ideally
filed in the Patient’s clinical notes or management plan. However, verbal consent
is sufficient and should be recorded, where given.
Q. How should Surgeries and Pharmacies use referral forms?
A. This is for Surgeries and Pharmacies to decide upon locally (see Operations
Manual for more details).
Q. What criteria have to be met for a Patient to qualify for the RD scheme?
A. A Prescriber may provide Repeat Dispensing services to a person only if:
(a) The person has agreed to receive such services.
(b) The Prescriber considers it clinically appropriate to provide such services.
(c) The medicines or appliances prescribed are to be provided more than once.
(d) The Patient is not a dispensing patient of a dispensing doctor.
Q. What happens if a Patient wants to change the Pharmacy from where they
obtain their RD medicines?
A. A Patient can choose to use a different Pharmacy at any time. However, they
would need to obtain a new, master repeatable prescription (RA form) as the
original can only be dispensed by the Pharmacy initially nominated.
2. Prescribing
Q. When should a prescriber not issue a RD prescription?
A. A prescriber may not provide Repeatable Dispensing services if they are:
(a) Not a repeatable prescribing Doctor – e.g. Acute care: walk-in centre’s etc..
(b) Not acting on behalf of such a Doctor.
(c) Make the professional judgment that it would not be clinically appropriate to
issue a RD prescription.
(d) Acknowledge that the Patient does not agree to participate in a RD scheme.
Q. What if a replacement RD prescription is needed?
A. If a Surgery has, in the past, issued a set of RD prescriptions that are still
valid and then issues another set of RD prescriptions, the Surgery must make
every effort to notify the Pharmacy that is holding the original prescription that it
is no longer required.
Q. Can handwritten items be added to RD prescriptions?
A. RD prescriptions have to be computer generated. Handwritten amendments of
any sort, including additional medications, will (technically) invalidate the
prescription.
Q. What if a RD Patient needs a prescription for an acute condition?
A. The Patient should consult their Surgery as normal and be given a standard
FP10 prescription for the short course of treatment (see Operations Manual for
more details).
3. Pharmaceutical
Q. Which medicines can be prescribed under the Repeat Dispensing Scheme?
A. All medicines except Scheduled drugs or Controlled drugs within the meaning
of the Misuse of Drugs Act 1971 can be prescribed using the Repeat Dispensing
Scheme. Appliances that can be prescribed on an FP10 can be prescribed as part
of the RD.
Q. Which medicines cannot be prescribed as a part of the RD Scheme?
A. Drugs excluded for the time being are specified in Schedules 1, 2 and 3 in the
Misuse of Drugs Regulations 2001 (these include flunitrazepam, phenobarbitone
and temazepam).
Q. Can phenobarbitone be prescribed on RD prescriptions, if it is to be used for
epilepsy?
A. No. Phenobarbitone is a Schedule 3 drug therefore cannot be prescribed on a
RD prescription. When phenobarbitone is used for epilepsy, Pharmacists can
make an emergency supply. This is an exemption of a Schedule 3 drug, but is
not applicable to RD prescriptions.
Q. Can diazepam be prescribed on a RD prescription?
A. As diazepam is not a Schedule 1, 2 or 3 Controlled drug, it is legally
prescribable. The PCT has however determined that benzodiazepines as a group
should not usually be prescribed as part of the NHS Repeat dispensing
arrangements because their license is for short term use only.
4. Flexibility
Q. What happens if a RD Patient goes into hospital?
A. They should be treated as a normal inpatient. If they have their medication
reviewed and changed, then locally agreed procedures should be followed. Any
remaining repeatable prescriptions (or more likely Batch Issues) not needed
should be destroyed or returned to the issuing Surgery in line with locally agreed
procedures (see Operations Manual for more details).
Q. What happens if a prescriber wishes to make change to a current RD
prescription?
A. This will be determined by local agreement and the extent of change but may
involve:
(a) Removing the Patient from Repeat Dispensing until their condition is stable.
(b) Cancelling current RD prescriptions and issuing a new set (RA form & Batch
Issues) for the required medicines.
(c) Informing the Pharmacist to allow them to destroy the remaining Batch
Issues and send the original RA form to the PPD.
Patient safety is paramount. Consult with your RD lead for more information
about clinical governance issues around managing minor medication changes.
5. Communication
Q. Can the PCT define ‘every effort’ (as specified in Regulations) that the
GP/Prescriber must make to ensure that the Pharmacist is informed of any dose
changes?
A. There is no official definition of this. GP’s / Prescribers must be able to
demonstrate what steps they made to contact the Pharmacy to inform them of
the dose change.
Q. What must a Surgery do if a RD Patient is removed from their list?
A. If a RD prescription is issued to a Patient and that person is removed from the
Surgery list, before the expiry of that RD prescription, the Surgery must:
(a) Notify that person that the RD prescription should no longer be used.
(b) Make every effort to notify the Pharmacist who has been providing Repeat
Dispensing services to that person, that the RD prescription should not be
dispensed.
6. Dispensing
Q. How long is a RD prescription valid for?
A. The first Batch Issue must be dispensed for the first time within six months of
the set being generated. In total, and depending upon the prescribers
instructions, forms can be valid for up to one year. So, if a 12 month RD
prescription set is first dispensed five months after generation, subsequent issues
can only continue for a further seven months.
Q. Do the Batch Issues need to be dispensed in the correct order?
A. Although this is good practice and will make tracking easier, Batch Issues do
not have to be dispensed in sequential order.
Q. What happens to Batch Issues that are no longer needed?
A. This depends on local agreements - a Pharmacist should destroy any Batch
Issues not needed, or return them to the issuing Surgery (see Operations Manual
for more details). It is important that local policies governing this matter are
adhered to.
Q. What should the Pharmacist do if a Patient has lost one or more of the Batch
Issues?
A. If a Patient has lost one or more Batch Issues they can present the remaining
ones to the Pharmacist holding the RA form for dispensing. This should be
communicated to the issuing Surgery. If they have lost all of the remaining Batch
Issues they should be referred back to the Surgery.
Q. How will Surgeries know which Pharmacy the Patient will take their
prescription to?
A. Surgeries should store this information on the Patient’s computer record (see
Operations Manual for more details). It would be good practice for a Pharmacy
to make contact with the prescriber on the first occasion that they receive a set
of RD prescriptions.
Q. Are there any guidelines for endorsing Batch Issues and RA fotrms?
A. The Drug Tariff states that Batch Issues should be endorsed as normal
prescriptions. Community Pharmacists should keep a record with, or attached to
the RA form, of the date the medicines are supplied and any interventions that
were made (see Operations Manual for more details). The Regulations require
that there is a clear audit trail of supplies under these arrangements.
6. Dispensing cont…
Q. When should a Pharmacist refuse to dispense a RD prescription?
A. The Pharmacist may refuse to dispense, and advise the person to contact the
prescriber as soon as possible when:
(a) The Pharmacist has no record of the RS form associated with the Patient’s
request.
(b) The Patient does not have the RA form and associated Batch Issues, and has
not asked the Pharmacist to retain them.
(c) The RA form is not signed by an appropriate prescriber.
(d) A Batch Issue contains an irregularity (e.g. the drug or dosage specified in
the Batch Issue differs from that specified on the associated RA form).
(e) The RA form or Batch Issues are not computer generated.
If a Pharmacist has reason to be concerned about the appropriateness of a
person receiving any items ordered on a RD prescription – the Pharmacist has
two options, and should do one of the following:
(i) Supply the items and inform the person that they should make an appointment at the
Surgery. It is good practice to contact the prescriber as soon as is practicable.
(ii) They may refuse to provide the drugs or appliances and should inform the prescriber
as soon as is practicable.
7. Administration
Q. How can Surgeries and Pharmacies who are a part of RD Scheme be
identified?
A. All community pharmacies were required to be able to dispense prescriptions
under the Repeat Dispensing arrangements by October 2005.
Q. Can the Prescription Pricing Division (PPD) provide information on the volume
of prescriptions dispensed as part of the RD scheme?
A. Yes, the online system (ePACT) used to provide the PCT/CCG with reports on
“traditional” prescriptions also provides information the dispensing of RD
prescriptions.
Q. Should Pharmacies record the Batch Issues that were not collected by
Patients & subsequently destroyed?
A. Such information should be communicated to the issuing Surgery (see
Operations Manual for more details).
Q. Does a Pharmacist have to retain the master repeatable prescription (RA
form) and all the associated Batch Issues?
A. The Pharmacist must in all cases retain and store the master repeatable (RA)
prescription. Dispensed Batch Issues are sent to the PPD for reimbursement. The
Pharmacy must store the other Batch Issues only if agreed with the Patient.