GPs have been urged to review their repeat prescribing processes in the first guidance to be published in 20 years.
The RCGP and the Royal Pharmaceutical Society (RPS) have together produced a new ‘practical toolkit’ for repeat prescribing systems in practices in England.
Published today, the NHS England-commissioned guidance aims to efficiency for GP practices but also patient safety, for example by identifying oversupply of high-risk medication.
With over one billion prescriptions dispensed annually, 77% of which are repeat prescriptions, the need for efficiency and safety ‘is paramount’, the organisations stressed.
Repeat prescriptions also account for nearly 80% of NHS medicine costs for primary care, and the ‘significant’ workload for GP practices related to this ‘necessitates streamlining and improvement’, they added.
The toolkit, which was commissioned by NHS England, takes the form of a ‘self-assessment process’, to help practices and PCNs to assess their local arrangements.
The guidance recommends practices undertake a full ‘process-mapping exercise’ of their repeat prescribing system, with input from the local patient participation group and community pharmacies.
It said: ‘In many areas PCNs have streamlined repeat prescribing systems across a number of practices but this is not universal and so this toolkit refers to general practice and PCNs.
‘This repeat prescribing toolkit is not a clinical or prescribing guideline. However, it does identify some higher-risk clinical scenarios that practices or PCNs should pay particular attention to.
‘While it will take time to discuss and complete the repeat prescribing self-assessment and address all the actions that come from the discussions, we are hopeful that all practices will engage on some level with the toolkit and self-assessment process to understand where any current risks lie.’
Practices were also encouraged to review ‘recent errors, mistakes, near misses and complaints’ related to the repeat prescribing process and understand why they happened.
RCGP honorary secretary Dr Michael Mulholland: ‘Safe and appropriate prescribing is a key skill for GPs, and something we take very seriously, taking into account the unique circumstances of every patient, in conversation with them.
‘Repeat prescribing makes up a large part of general practice workload and we need to make sure we are always streamlining and improving the process.
‘This new toolkit aims to support GP practice teams and primary care networks, working with community pharmacies and patients, to create a collaborative, safe and efficient process for repeat prescribing with the aim of improving practice processes, patient care and reducing waste.’
The guidance also includes recommendations to improve repeat prescribing in the future (see box), including a call for ICB to incentivise safer repeat prescribing in practices.
It provides guidance on improving communication with patients about repeat prescribing, supported by case studies, flow charts, action plan templates, and other resources.
A new NHS dashboard has also been developed, highlighting potential oversupply of medicines for several prescribing areas.
Suggestions to improve repeat prescribing in the future
- Commissioners are encouraged to consider incentivisation for practices/PCNs and community pharmacies to engage with this work and complete the repeat prescribing self-assessment and action plan
- GP and pharmacy system suppliers are asked to provide greater functionality to help to recognise the oversupply and over ordering of repeat medication, particularly for higher-risk medicines, and help practices and pharmacies to identify and address it
- We encourage the NHSBSA and NHSE to further develop the oversupply tool to increase functionality to measure the oversupply of higher-risk medicines such as opioids, antidepressants, benzodiazepines and antimicrobials
- The terms of service for NHS community pharmacies and the Community Pharmacy Contractual Framework could formally enable pharmacy teams to support patients to discuss how they are taking their medicines and raise any concerns with their community pharmacist at the point of dispensing
- eRD requires urgent modernisation to ensure it works smoothly and resolve some of the well-known challenges
- A national and accredited course should be made available for non-clinical staff who are essential in supporting the repeat prescribing process and support given to GP practices to enable reception staff to have the time to complete such training
- There is a significant need for a greater information to inform the public of, and raise awareness of medication safety, medicines waste and the environmental impact of medicines
- NHSE should be encouraged to expedite digital solutions to allow hospital discharge information relating to medicines to link into the patient record to create a digital audit trail of any medication changes
- Secondary care and specialist services are asked to make very clear to primary care on discharge of a patient from hospital, the reasons for medicines to be prescribed on repeat, the indication and the intended duration of therapy
- A clinical guideline should be commissioned to pull together, in one place, recommendations on the frequency of medication reviews for all higher risk, repeat medications
- Commissioners are asked to explore the formalisation and contractualisation of protected time to allow for discussion between general practice and community pharmacy
- The issue of ‘bulk authorisation’ of repeat prescriptions requires a more in-depth, national review
Source: RCGP and RPS
NHS England’s national clinical director for prescribing Professor Tony Avery, a GP and professor of primary health care at the University of Nottingham, said: ‘With over one billion prescriptions dispensed annually in England, over three quarters of which are repeat prescriptions, it is essential that repeat prescribing systems in general practices are safe for patients and efficient for all involved.
‘I would like to thank colleagues from the Royal Pharmaceutical Society and the RCGP for their excellent work in producing this toolkit together.
‘I feel certain that it will prove a useful resource for general practices and community pharmacies and will benefit patients.’
RPS fellow and clinical lead author Clare Howard said: ‘The toolkit represents a significant step forward in ensuring the safety and efficiency of repeat prescribing systems, ultimately benefiting patients and the NHS as a whole.
‘By working together, the RPS and RCGP have developed practical guidance and useful resources which will enable GP practices and PCNs to self-assess their current arrangements and make meaningful improvements in their repeat prescribing processes.’
Some pharmacies game to system to maximise profits. Smart dubious practices
About damn time! We need to run a river through the Augean Stables of the current Repeat Prescribing. I have been looking at this for over a year. Medicines Optimisations Team are obsessed with penny pinching by making short term tactical GP Workload and GP – Patient Aggro laden meds changes when the real elephant in the room has been wasteful processes and direct pharmacy requests. Patient complain they are given meds they have never requested (“I have enough of that moisturiser to float a battleship doc! Why are you sending it to me?” “I am sending it because the pharmacy said you wanted it”). I have audited this and the numbers are astounding. Want to improve patient safety, reduce adverse drug reactions, reduce costs and reduce the size 14 carbon footprint of NHS Primary Care Prescribing? Tackling this is the way. There is also a singular obession from Secondary Care that Dossett Boxes improve compliance- not so. plenty of my patients quite happily take the cellophane off and with a kid with a tray of Lego build little pyramids of their weekly meds. Need to clamp down on the plague of the 7 day Dossett Box script. By all means pay community pharmacy fairly but don’t dump work on GP practices. I am sitting here at 2100 with a huge pile of sometimes pretty surreal Community Pharmacy requests.