Prescriptions are issued in three ways:
In a GP surgery by GPs only and no one else for:
- Acute – one-off drugs – first time prescribed or for antibiotics.
- Repeats – of previously prescribed by the GP and can be issued without the need to see the GP; however, some surgeries may stipulate 4-6 as maximum repeats after which the patient has to see the GP. Repeats are prepared by the receptionists and signed by the GP; sometimes a GP may give repeats on seeing the patient in the surgery during a routine appointment.
- In a Hospital by a Consultant to the patient – this has to be included in the list of items to prescribe from then to the patient in the GP surgery.
Acute Prescriptions by the GPs and prescriptions in the hospital by the Consultants are issued by very capable clinical persons and are not covered here.
The basic procedures for repeats are as below:
48 hours notice is usually required for a repeat prescription to be issued. The prescription will normally be ready within 2 working days after requesting it; however, it is not uncommon to see these issued earlier than 48 hours, depending on the medication and urgency.
All requests for repeat prescriptions should be made using the right-hand portion of the slip issued with your last prescriptions.
All other written requests include:
- Name and address
- Name of medicines, dosage and frequency
- Date last supplied
- Contact Phone Number
- Name of GP.
Telephone requests are not accepted.
Fax requests to surgery fax number.
Online requests can be made to surgery web site.
Postal requests, with a stamped addressed envelope; please allow for extra time for prescription to be returned.
Requesting a Pharmacy from the surgery would be advised as these can be collected on late evenings and Saturdays when the surgery would be closed.
Only request items that are needed. This avoids waste of medicines and unnecessary medicines lying around the house. However, one should not intentionally stop taking as prescribed medication without GP’s approval
All prescriptions are reviewed on a regular basis, with or without the patient’s presence. There may be a review date at the bottom of the prescriptions.
For going away on a holiday, or for ordering more medication than normal, specific reasons need to be given for such a request. A GP is not obliged to give more than 3 months supply at any one time and this too only in exceptional circumstances.
Apart from the patients, Carer, District Nurse, Pharmacist and Care Home Staff may request Repeats and in those cases it is crucial to maintain confidentiality, accuracy of medication information and Guarantee probity.
Collection of repeats as well as acute prescriptions:
The procedures to follow after the GPs have signed and sent to reception, are:
Keep the signed prescriptions in a secure place not visible to the public.
Check the name, address and date of birth with the person collecting the prescription to ensure the correct identity of the patient
Signed consent from patient for collection by a pharmacy would mean handing over these to the
Collection by underage or unauthorised persons without a written request should be refused
Prescriptions not collected for over 2-3 weeks should be highlighted and even destroyed and issue deleted from patient records.
2.8.2 Training for doing prescriptions
It is crucial for the surgeries to give utmost importance to issue of prescriptions. The person doing the repeat prescriptions should be very well trained, supervised, checked and re-checked before the person is allowed to prepare repeats. There are certain procedures and training time need to be followed sanctimoniously.
The dedicated receptionist should be working in the surgery for a period of 3 months before initial training is contemplated for repeats.
- The preparation of repeats must always be using the computer system and set up to generate counterfoils.
- The significance of checking the name, middle name and surname of the person before starting to prepare the repeats must be stressed. This is specially so if requests are made in writing, fax or online. Use of counterfoil would simplify enormously and avoid errors.
- The significance of sticking only to the previously prescribed medicines, dosage and frequency should also to be stressed. If the request contains a new medicine, branded version instead of generic prescribed hitherto, new dosage or any variant, then the receptionist should not prepare the repeats and refer the issue to Senior Receptionist for clarification and action.
- The receptionists should always have BNF book while preparing the repeats (MIMS should not to be used except to refer to it for pricing information).
- Never to take instructions over the telephone from the patient or his family or representative about repeats. The procedure stated above – ‘Telephone requests not accepted’ – should be rigidly followed.
- The trained receptionists should be taught how to prepare repeats; once the Senior Receptionist or PMgr is satisfied in the first instance about the accuracy and the skill of the receptionist then they should allow her a trial of 10 repeats to prepare, with BNF for reference.
- Once the trail batch is correctly prepared, accuracy is more important than speed, and checked, the receptionist could be asked to do repeats but SR or PMgr should check for the first 8-10 days and only then forward to the GPs to sign.
- Prescription is an important aspect of a GP surgery and any errors can result in tragic results affecting GP’s career. Hence, receptionist training is very important.
- Use of BNF is recommended because it would explain the details of the medication. Initially they may not seem very relevant; however, repeat is not a copying exercise alone from the counterfoil medications. For the long term, this knowledge gained by BNF referral would be of great advantage to the receptionist, the surgery and GPs.
- items not suitable for generic prescribing.
- Some drugs should be prescribed by BRAND name – not by GENERIC name due to differences in product formulations.
- Items not suitable as repeat medication- acute.
- Controlled Drug Prescriptions.
A prescription for Schedule 2 and 3 CDs (with the exception of temazepam and preparations containing it) must contain certain details and receptionist must follow surgery procedures.
2.8.3 Dos and Don’ts
Do’s: Always ensure:
- that the prescription required to be given has already been
- prescribed to the patient by checking the records / hospital notes.
- the dosage, quantity and frequency are similar to those previously prescribed
- that the patient has to wait 48 hours (2 working days) before the prescription can be issued.
- that the patient is also made aware that if the medicine has not been prescribed during the previous three months then the patient has to be seen by the doctor before medication can be given.
Don’ts: issue prescriptions – (seek GP’s advice)
- If the drug(s) has not been prescribed previously.
- If the dosage or quantity or frequency is not clear.
- If the drug has not been prescribed in the previous three months.
- If it is ‘branded’ drug (opt for ‘generic’ variety).
- If it is not available in NHS.
- If the drug is prohibitively expensive.
- If it is an ‘Acute’ drug – one off treatment which is not a repeat e.g. antibiotics.
- i) New:
- GP’s to give prescriptions for any new drug not prescribed before.
- If it is recommended by the Hospital following a referral – then receptionist can issue prescriptions.
- If hospital recommends a drug, for example 30 mg for 30 days and then reduce to 20 mg for 30 days, do not, repeat do not, issue two prescriptions one with 30 mg and one with 20 mg at the same time.
Patient might take 50 mg each day leading to disastrous results.
Issue 30 mg prescription for 30 days and then ask the patient to come and collect 20 mg prescription after 30 days.
- ii) Acute:
These are one off drugs (not repeats) and should be
given only by GP – never by receptionists.
2.8.4 Branded and Generics
The following is a list of some common drugs and their well-known brand names – usually the original patent-holder’s name.
Note that generic names are normally written with a lower case initial letter. Brand names are capitalised.
There are various publications giving extensive lists of branded and generic drugs. Many branded drugs are also available ‘generically’. These are chemically identical drugs produced by manufacturers who specialise in unbranded products.
Doctors have been encouraged to prescribe generic versions where these exist in an attempt to control costs. Unbranded versions of non-prescription products – such as common painkillers – can also be bought, often at much lower prices than the equivalent brands. Although the packaging and tablet size, shape and colour may differ, the active ingredient is identical.
A number of very large practices have employed a practice pharmacist, although the majority of practices will rely on the expertise of PCT medicines management pharmacists or those employed by practice based commissioning (PBC) groups. The practice pharmacist may also have a prescribing qualification, which adds significant scope and flexibility to their role.
The practice pharmacist would undertake many duties including:
- preparing practice formulary
- NICE guidance interpretation and implementation within the practice
- repeat prescription review
- clinical audits and associated recommendations
- clinical switching programmes
- patient medication review
- clinics for long-term conditions.
The majority of complaints would be about not giving the repeats within 48 hours and in some instances sooner than 48 hours as the patient has run out of medication.
However, it is the few complaints, which usually are very serious. These would invariably pertain to wrong dosage and wrong medication due to misreading the name of the patient. These can lead to serious side effects and even entail the GP to face ‘Fitness to Practice’ investigations.
If the Surgery has a healthy rapport with the local pharmacies, generally the pharmacists would be able to stop issuing the medicine and get these corrected without the patient knowing. If the pharmacist is away, then the error would be precipitated and lead to serious consequences.
Practice has to be very vigilant when it comes to issue of repeat prescriptions.
I There are several procedures involved in prescribing and these are too detailed to include; generally each surgery would have methodology for each; if not, PMgr should make it a point to have instruction for each of these to assist the GP, Nurses and staff:
- Management Control
- Compliance check
- Flagging of problems
- Hospital Discharge Medication/Outpatient attendance/Home Visits
- Hospital communications
- Patient information
- Quality assurance
- Clinical controls – Review of medication
- Specific patient groups
- Domiciliary visits
- Electronic Prescription Service (EPS) is a new service that will make it easier for GPs to issue prescriptions and more convenient for patients to collect their medicines. Using EPS means that prescriptions by GPs and other prescribers will be transferred electronically to the pharmacist nominated by the patient. The prescriptions will also be sent automatically to the Prescription Pricing Authority.
II All practices must have good control of prescription costs and on the amount of acute prescriptions to repeats. Both clinical and management controls should be in place to control costs:
- Conduct an audit to prescriptions issued – acute and repeats
- Recall patients over 6/12 monthly intervals for determining over and under use of medicines
- Find out any medication they no longer require
- GPs have to ensure the repeat prescription is appropriate and the drug is effective
- Have procedures for recently discharged patients from hospitals using their hospital care plan
- Have procedures for medications for newly registered patients
- Review procedures for certain long-standing medications.
- Procedures for changes to medication when a hospital letter is received.