1 The Causeway
Goring by Sea
Worthing
West Sussex
BN12 6BT.
To:
Prescribing Leads
Practice Managers
Community Pharmacists
Dear Colleague
Repeat prescribing intervals, repeat dispensing and pharmaceutical waste
Each year there is a significant amount of money wasted through medicines not being taken
as prescribed. This has an impact on three areas:
1. The prescribing budget;
2. The cost to the PCT to have the medication collected and destroyed;
3. Patient care – patients are not getting benefits from their medicines.
Nationally the level of waste medicines has been estimated to be 5% of the primary care
prescribing budget. For West Sussex PCT this could represent £6 million per annum that
could be spent on other areas of patient care. Reasons for waste are well documented and
include non-concordance, adverse reactions, changes in medication and over-prescribing.
Due to the financial position of the West Sussex PCT it is vital that we take all possible steps
to make the best use of scarce resources and to make savings where possible. Therefore, as
a matter of urgency, we are asking practices to review repeat prescribing policies in line
with national and local guidance and to make use of the repeat dispensing service provided
by community pharmacies for suitable identified patients. Savings made will reduce spend on
the practice prescribing budget and provide the health economy with a significant contribution
towards the current year’s financial recovery plan.
As you are aware robust and efficient repeat prescribing processes can reduce waste as well
as the potential for adverse incidents by ensuring that appropriate quantities are prescribed
and reviewed regularly. Quantities prescribed should take into account what each patient
needs, the nature and stability of their clinical condition, patient safety and convenience,
avoidance of waste, likely complications and any necessary monitoring.
We would recommend that the following principles are adopted:
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Prescribe the minimum amount required for acute conditions;
Prescribe a maximum of 28 days for:
 Newly diagnosed conditions,
 Patients in care homes,
 Patients with complex regimes,
 Changes in medication,
 Palliative care,
 Controlled drugs,
 Expensive medication,
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Do not transfer on to a repeat prescription until the condition/medication is stable;
Consider monitoring requirements before deciding on a suitable duration for repeat;
Check concordance before authorising repeats;
Some medicines e.g. antidepressants, drugs for obesity should either not be put onto
repeat or should be restricted to 28 day supply with reauthorisation at frequent
intervals i.e. 3 months maximum;
In the elderly, where new morbidity, side-effects and changes in medication are more
common, 28-day quantities are recommended to reduce waste and help prevent
errors.
Review the amount of dressings prescribed in line with local guidance and advice.
Repeat prescribing should be for no more than 1 or 2 months, with a few
exceptions e.g. contraceptive pill, HRT etc.
Review patients’ response to treatment regularly so that ineffective medicines can be
stopped and patients can discuss their use of their medicines.
The medicines management teams in the localities will be available to support practices in
reviewing processes and to facilitate uptake of repeat dispensing services. The PCT will be
introducing a campaign to target waste medicines in the new financial year.
Yours sincerely
Dr Andrew Foulkes (PEC Chair)
Carol Gareze (Director of Primary and Community Care)
David Phizackerley, Sue Carter, Fiona McGonigle (Area Medicine Management Leads)
(With acknowledgement to Hampshire PCT)
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