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Version 1.0 May 2007 The North Yorkshire and York PCT Manual Version 1.0 has been adapted from the former Craven, Harrogate and Rural District PCT Manual Version 3 and Hambleton and Richmondshire PCT Version 4.2
Contact:
Medicines Management Team
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
Version Control
This document outlines simply and clearly the processes involved in batch repeat dispensing. It provides a clear pathway of the patient journey between the professionals.
This guide has been written using the following reference materials: Centre for Pharmacy Postgraduate Education (CPPE) Repeat Dispensing Arrangements in England training materials NHS Repeat Dispensing Schemes in England briefing paper from the Department of Health Medicines, Ethics & Practice, A Guide for Pharmacists from the Royal Pharmaceutical Society of Great Britain (Version 29, July 2005) West Gloucester Primary Care Trust Hull and East Yorkshire Primary Care Trust. Craven and Harrogate Rural District Primary Care Trust. Hambleton and Richmondshire Primary care Trust
The glossary and PPA requirements have been reproduced with the kind permission of the Centre for Pharmacy Postgraduate Education. The EMIS Information Sheets have been reproduced with the kind permission of EMIS.
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Contents
Introduction ............................................................................................................................. 5 Overview ................................................................................................................................. 6 Information for GPs Patient Selection ............................................................................................................... 7 Authorising (FP10) Prescription ........................................................................................ 9 Batch Issue (FP10) ......................................................................................................... 11 GP/Pharmacist Communication ...................................................................................... 12 Termination of Batches ................................................................................................... 13 Information for Surgery Staff Patient Initiation............................................................................................................... 14 Information for Pharmacists Patient Selection ............................................................................................................. 15 Authorising (FP10) Prescription ...................................................................................... 17 Batch Issue (FP10) ......................................................................................................... 19 Dispensing Prescriptions................................................................................................. 21 Pharmacy Payment......................................................................................................... 24 Dispensing Discretions.................................................................................................... 25 GP/Pharmacist Communication ...................................................................................... 26 Termination of Batches ................................................................................................... 27 Sorting and Submission of Forms to PPA....................................................................... 28 Ordering Forms ............................................................................................................... 29 Glossary .......................................................................................................................... 30 Repeat Dispensing Pharmacy Protocol .......................................................................... 32 Repeat Dispensing Practice Protocol.............................................................................. 34 Participating GPs and Practices...................................................................................... 35 Participating Pharmacies ................................................................................................ 36 Appendices A: Consent Form ........................................................................................................... 37 B: Patient Introduction Leaflet ....................................................................................... 39 C: Compliance Card ...................................................................................................... 40 D: Repeat Dispensing Log............................................................................................. 41 E: Pharmacy Repeat Dispensing Referral Form ........................................................... 42 F: GP Repeat Dispensing Referral Form ...................................................................... 43 G: EMIS/Protechnic Exeter Instructions......................................................................... 44 H: Drugs not included in the scheme ............................................................................. 45 I: Record of destroyed batch issues form..................................................................... 46 J: Penultimate prescriptions (Repeat Dispensing Scheme) .......................................... 47 K: Locum Agreement Form ........................................................................................... 48 L: Repeat Dispensing GP Practice Standard Operational Procedure ........................... 49 M: Repeat Dispensing Community Pharmacy Standard Operational Procedure........... 50
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Introduction
Welcome to the North Yorkshire and York Primary Care Trust (PCT) Repeat Dispensing service. This is an operations manual for GPs, pharmacists, all surgery and pharmacy staff members and anyone else who is actively involved in the repeat dispensing process. The manual is colour-coded for greater ease. Paper Colour White Blue Lilac Audience Everyone GPs, Surgery Staff Pharmacists and Staff
Please ensure all staff involved with the repeat dispensing process read this manual. This document not only contains the operational implementation of the statutory requirements but also contains best practices. All best practices are listed in shaded boxes. You are not required to implement the best practices, however, they are highly recommended. We have included them because we believe they will ease implementation and ongoing repeat dispensing processes. Once you and your colleagues have finished reading the manual, please discuss the repeat dispensing processes amongst yourselves and resolve any questions that may arise with a member of the Medicines management Team at North Yorkshire and York Primary Care Trust. Keep the manual at hand for questions that arise during day-to-day repeat dispensing activities. If you need additional copies of the manual, the PCT is happy to provide them, please contact the Medicines Management Team (details below). If you have questions that are not answered by this manual, please contact:
Medicines Management
North Yorkshire and York Primary Care Trust The Hamlet Hornbeam Park Harrogate HG2 8RE Tel: 01423 815150 Fax: 01423 859600
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Overview
The graphic above represents a high-level overview of the repeat dispensing scheme. Each step along the middle line is explained in detail in this manual. It is important to remember - there is a good deal of flexibility in every step of the
process. The primary purposes of this service are: 1) to simplify the repeat dispensing process for patients whilst maintaining clinical review and safety reduce GP practice workload.
2)
Practices should be adopted that ensure the successful fulfilment of these goals.
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Patient Selection
Information for GPs
1. Select patients that you feel would benefit from the scheme. Repeat dispensing is not suitable for all patients. It is for patients (adults or children):
You are the ultimate decision-maker. No patient may enter the scheme without his/her GP approval. Examples of ways to use the repeat dispensing scheme: patient taking Levo-thyroxine who has required no recent dose adjustments within the last three months and is unlikely to require a review for twelve months: 1 authorising prescription 12 batches of 28 days. patient taking two or three items to control hypertension, requires no further titration of doses, stabilised for at least three months and requires a review in six months: 1 authorising prescription 6 batches of 28 days medication. Patient taking hay fever medication as needed: 1 authorising prescription 5 batches of 28 tablets (patient can receive monthly allocation of medication as and when needed within one year of authorising prescription generation date). Patient takes analgesics when required. Some medicines that are not taken regularly, but on a when required (prn) basis, either with other regular medicines or alone can still be considered as part of the Repeat Dispensing process. Where patients take regular medication and prn medication, consider supplying on separate authorising and batch prescriptions e.g. one prescription with regular medicines, one prescription with prn medicines.
: Repeat dispensing is not a solution for Monitored Dosage Systems (MDS) supply. 2. It is best to introduce patients to the scheme in manageable increments. Start with small numbers while staff gain familiarity with the scheme. Initially, apply strict inclusion and exclusion criteria. These could be based upon any number of characteristics (such as number of medicines being taken, age, whether the patient has a carer, etc).
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Selection Criteria
1. The GP must decide which patients can participate in the scheme. 2. The inclusion and exclusion criteria must be considered. Inclusion criteria all patients must comply with these criteria: willing to participate patients living in own home in stable condition no recent hospitalisation on long-term medication that is unchanged for three months prior to the scheme regularly attends the same pharmacy patients are competent at managing their own compliance. Exclusion criteria any of the following must be excluded: patient refusal in unstable condition requiring frequent changes to their medication prescribed controlled drugs (Schedule 2 and 3) terminal illness dispensing patients (for the moment).
As the long-term prescribing of hypnotics and anxiolytics is discouraged, serious consideration must be given to patients prescribed these medicines as to their suitability. However, if the balance for patient benefit favours inclusion and the patient meets all other inclusive criteria, then they may be incorporated onto the scheme. 3. Other health care professionals may suggest suitable patients for the scheme but this must be discussed with the GP before it is discussed with the patient. Tip Repeat dispensing pilots have identified patients on thyroxine, antihypertensive, or diabetics stabilized on oral hypoglycaemic medication, as ideal candidates for early consideration.
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GP signature
This is an example of the Authorising (FP10) Prescription. The authorising prescription is the legal authority to supply the medication. The reverse side is the same as the normal FP10. This form must be computer generated. 1. Before you put the patient on an authorising prescription, please first synchronise the existing medicines. This will help to avoid drug wastage. 2. Complete the form within the EMIS/Protechnic Exeter/Torex/In-house system choosing the patients drugs and/or appliances that are needed more than once. You may list several items on the authorising prescription form. Controlled drugs listed in the Restrictions on the following page are not allowed. For directions on generating the authorising prescription and batch issues in EMIS/Protechnic Exeter see Appendix G. 3. Choose the number of occasions that the drugs/appliances may be provided. This will determine the number of batch issues printed. Remember, an authorising prescription may not last longer than one calendar year. 4. Do not specify an instalment interval unless clinically necessary. An instalment interval restricts the amount of medicines that a patient may have at one time, for example, listing dispense every 28 days. Without an instalment interval, the pharmacist has more leeway to handle unusual situations such as holiday supply. In these situations, pharmacists may use their professional judgement to dispense instalments at an appropriate time. If the GP does specify an instalment interval, such as dispense
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Restrictions : Schedule 2 and 3 controlled drugs cannot be prescribed within the scheme. Schedule 2 includes the opiates, the major stimulants and quinalbarbitone. Schedule 3 includes a small number of minor stimulant drugs. You may agree to restrict other medicines as a policy in your practice. : Only computer-generated prescriptions may be used in the scheme - handwritten prescriptions are not acceptable. : Repeat dispensing services do not apply to bulk prescriptions. : Hypnotics and anxiolytics require further consideration. Patient benefit must outweigh the desire to reduce prescribing of this class of drugs.
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This is an example of the Batch Issue (FP10). The batch issue enables the pharmacist to receive payment for the provision of repeat dispensing services. The reverse side is the same as the normal FP10. 1. The batch issue is generated by a computer with the associated authorising prescription and is generated on the same date as that prescription. It is not signed by the GP. 2. The patient must sign the declaration on the back of the batch issue before receiving each instalment. Patients may choose to keep batch issues in their possession or they may ask the pharmacist to store them. If the patient loses the batches, he/she must return to the GP for a new authorising prescription. The pharmacist will need to be informed. FOR THE PURPOSES OF SECURITY AND EFFICIENCY, PATIENTS SHOULD BE PERSUADED THAT BATCH PRESRIPTIONS BE STORED AT THE PHARMACY.
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GP/Pharmacist Communication
Information for GPs
For the repeat dispensing scheme to be successful, it will require excellent communication between GPs and pharmacists. This is not a one-off event but a lasting relationship. 1. Prior to implementing the scheme, meet with the pharmacists in your local area. At this meeting, discuss the following topics: The ideal patient profile this profile may change over time. At first the profile may be bound to strict inclusion and exclusion criteria so that you are not overwhelmed by the volume of work associated with introducing patients into the scheme. However, once the process becomes more familiar, the exclusion criteria may be relaxed to allow more patients to enter the scheme. A monthly target - of the number of patients that you would like to introduce into the scheme this will control the workload for staff members. Ideally, 50 patients in a sixmonth period, for an average sized surgery. Communication procedures these are important for not only generally communicating about the scheme but also discussing patient-specific matters. You must ensure that surgery staff knows the pharmacists name, or a regular member of staff in the dispensary so that telephone calls are not unnecessarily delayed. Share your telephone numbers, fax numbers and email addresses. Agree upon the best method of communication as well as the best communication time. REMEMBER KEEP COMMUNICATION LOOPS CLOSED Method of synchronising the prescriptions certain patients may be good candidates for the service but have medicines on varying schedules. The pharmacist may be able to help you to synchronise these medicines. Discuss this possibility and determine the best path of action, with your community pharmacist, prescribing advisor or technician.
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
Termination of Batches
Information for GPs
There are many instances where Batch Issues may be terminated without being filled. Some of these include: change in patients medication loss of batch issues patient decides to leave GP practice patient decides to change pharmacy patient does not collect remaining batches the authorising prescription has expired.
In all of these instances, there must be communication between GP and pharmacist so that appropriate action may be taken. 1. If you know that the patients batch issues have become invalid, contact the pharmacist. 2. The pharmacist will destroy the remaining batch issues, and record the destruction on the form (Appendix I).
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Patient Initiation
Information for Surgery Staff
Once the GP has decided that the patient is suitable for the scheme: 1. Ask the patient if he/she has a regular pharmacy. 2. Introduce the patient to the scheme. Give the patient an Introduction Leaflet (Appendix B). Explain the benefits of the scheme and the new way that the patient may now receive his/her medicines. Explain that his/her medications may not be dispensed at another pharmacy without returning to the surgery for a new authorising prescription.
3. Record the patients pharmacy choice in the patient record. 4. Give the patient a Consent Form (Appendix A) to sign. Keep one copy in the surgery, scan into computer if preferred. Give one copy to the patient for personal records.
5. Inform the patient about a Compliance Card (Appendix C) which will be completed by the pharmacist and given to the patient. Patient Consent Form (Appendix A) Introduction Leaflet (Appendix B)
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Patient Selection
Information for Pharmacists
1. Discuss patient selection with your local GPs. recommendations for suitable candidates. Some GPs may want your
However, some GPs may prefer to handle patient selection independently. Patient selection has ramifications of increased workload for surgery staff as patients are introduced to the scheme and their medicines are synchronised. Talk to your local GPs before you talk to any patients. Recommend patients that you feel would benefit from the scheme. Repeat dispensing is not suitable for all patients. It is for patients who are: in a stable condition on long-term medication(s).
The GP is the ultimate decision-maker. No patient may enter the scheme without his/her GP approval.
: Repeat dispensing is not meant to be a solution for Monitored Dosage Systems (MDS) supply.
2. As guidance, North Yorkshire and York PCT have developed the following criteria for patient selection, which has been approved by our prescribing leads.
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As the long-term prescribing of hypnotics and anxiolytics is discouraged, serious consideration must be given to patients prescribed these medicines as to their suitability. However, if the balance for patient benefit favours inclusion and the patient meets all other inclusive criteria, then they may be incorporated onto the scheme. 5. Other health care professionals may suggest suitable patients for the scheme but this must be discussed with the GP before it is discussed with the patient.
Tip Repeat dispensing pilots have identified patients on thyroxine, antihypertensive, or diabetics stabilized on oral hypoglycaemic medication, as ideal candidates for early consideration.
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GP signature
This is an example of the Authorising (FP10) Prescription. The authorising prescription is the legal authority to supply the medication. It is not submitted for payment. The reverse side is the same as the normal FP10. This form must be computer generated. 1. The first time that you receive an authorising prescription from the patient, ask the patient if he/she would like you to store the batch issues in the pharmacy. Please
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
Restrictions : Schedule 2 and 3 controlled drugs cannot be prescribed within the scheme. Schedule 2 includes the opiates, the major stimulants and quinalbarbitone. Schedule 3 includes a small number of minor stimulant drugs. Only computer-generated prescriptions may be used in the scheme - handwritten prescriptions are not acceptable. Repeat dispensing services do not apply to bulk prescriptions. Hypnotics and anxiolytics require further consideration. Patient benefit must outweigh the desire to reduce prescribing of this class of drugs.
: :
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This is an example of the Batch Issue (FP10). The batch issue enables the pharmacist to receive payment for the provision of repeat dispensing services. The reverse side is the same as the normal FP10.
1. Before giving the patient his/her medicines, ask the patient to sign the declaration on the
back of the batch issue. The batch issue is not signed by the GP.
2. Encourage the patient to leave the batch issues at the pharmacy. This will
the batch issues and brings the batch issues into the pharmacy in the wrong order (for example, brings in 6 of 12 before 4 of 12), dispense as normal. However, it is considered good practice to dispense the batch issues in order (see page 29).
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Dispensing Prescriptions
Information for Pharmacists
The method of requesting a repeat is flexible you may allow patients to request them in person, by telephone or by any other suitable method. An authorising prescription has to be dispensed for the first time within six months of it being written. 1. Before providing any repeat items to the patient, you, the pharmacist, must personally ensure that: the patient is taking or using medicines appropriately the patient is not suffering from any side effects from their treatment which indicate the need or desirability of a review of their treatment the patients medication regime or health has not changed in a way that indicates the need or desirability of a review of their treatment since the repeatable prescription was issued. 2. If at any time you are concerned about the safety or appropriateness of a repeat prescription: inform the patient to make an appointment with his/her GP contact the GP directly. 3. You may always refuse to provide the drugs or appliances but must inform the GP of your rationale. 4. Before providing any repeat items to the patient, you must always check that: your pharmacy holds the authorising prescription a satisfactory batch issue has been presented by the patient or is held by the pharmacy the GP has signed the authorising prescription the batch issue matches the authorising prescription (the batch issue has not been altered) the authorising prescription has not expired. 5. Endorse the batch issue with the quantity of drug provided and the provision date. 6. Ask the patient to sign the batch issue before providing the repeat items. 7. Update the patients compliance card with the date that he/she should pick up the next batch of medicines. 8. If you are dispensing the penultimate batch issue, inform the patient that he/she will need to schedule an appointment with the doctor. (Appendix J)
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The first time a patient brings in his/her authorising prescription, note in the log the Patients ID (from the PMR), GP name, the batch number (number 1 in this case), total number of batches, the date the prescription was dispensed (which will be the current date) and the next anticipated supply date. You may wish to enter into your diary or calendar the patients next supply date as a reminder. Within a couple of days of the anticipated supply date, dispense the repeat medicines and have them waiting on a shelf for the patient. At this point, write a new entry into the Repeat Dispensing Log, entering the Patient ID, GP name, batch number, number of batches and leave the rest of the fields blank.
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Pharmacy Payment
Information for Pharmacists
1. The fee structure for community pharmacists includes:
Annual Repeat Dispensing Payment is a nationally agreed annual rate of payment to all community pharmacy contractors divided into 12 single monthly payments (Drug Tariff Part VIA).
2. Each dispensed batch issue (FP10) will be submitted for reimbursement at the end of the month in the normal way to the PPA. There will be a new order detailing the method for sorting and submitting the batch issues in the end of month batch. A new FP34C will be automatically issued to pharmacists by the PPA which will highlight this new order.
3. Pharmacists will have to submit the legal repeat authorising prescription (FP10) to PPA
for storage when all of the batch issues have been dispensed, it has expired or the medication is no longer required.
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Dispensing Discretions
Information for Pharmacists
There are certain dispensing discretions that would make sense to accompany the implementation of repeat dispensing, for example dose optimisation. However, since these require changes to the Medicines Act of 1968, these discretions will not be allowed until the legislation is changed. 1. Delete an Item from a Batch Issue You are allowed to delete an item from a batch issue if the medicine is not needed by the patient. This would follow the same procedures as with traditional dispensing you would cross the item off the Batch Issue and mark it ND (not dispensed). 2. Dispensing Intervals There are no controls around dispensing intervals unless the GP specifically marks the prescription with an instalment interval such as dispense every 28 days. Since in most cases the dispensing interval will not be specified, you could dispense all batch issues at once. However, this would violate the intent of repeat dispensing. The pharmacist must regularly counsel the patient on his/her use of medicines. If this process does not take place there is clearly a danger to the patients health and safety, not to mention huge cost implications due to high levels of waste medication. The PCT will randomly audit for these occurrences.
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GP/Pharmacist Communication
Information for Pharmacists
For the repeat dispensing scheme to be successful, it will require excellent communication between GPs and pharmacists. This is not a one-off event but a lasting relationship.
1. Prior to implementing the scheme, meet with your local area GPs, or at the very least
have a conversation on the telephone. At this meeting, discuss the following topics:
The ideal patient profile this profile may change over time. At first the profile may
be bound to strict inclusion and exclusion criteria so that the surgery is not overwhelmed by the volume of work associated with introducing patients into the scheme.
A monthly target of the number of patients that the GP would like to introduce into
the scheme this will control the workload of surgery staff members.
Document these agreements and review them on a regular basis. 2. You will now be monitoring how patients use medicines on a regular basis. Report back any concerns you have to the GP. Please use the Pharmacy Repeat Dispensing Referral Form (Appendix E) for issuing and recording formal communication with the patients GP practice. GPs have their own version of a referral document to facilitate communication to pharmacies (Appendix F).
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Termination of Batches
Information for Pharmacists
There are many instances where Batch Issues may be terminated without being filled. Some of these include: change in patients medicine(s) loss of batch issues patient decides to leave GP practice patient decides to change pharmacy patient does not collect remaining batches the authorising prescription has expired.
In all of these instances, there must be communication between GP and pharmacist so that appropriate action may be taken. 1. If you know that the patients batch issues have become invalid, contact the GP. 2. Destroy the remaining batch issues and record, (Appendix I). Local arrangements may dictate that unused prescriptions are returned to the prescriber and if so, the returned batches recorded. 3. Send the authorising prescription to the PPA. The PCT will randomly audit pharmacies to ensure the proper handling of invalid batch issues.
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3. All of the following forms must be kept separate from the FP10 prescriptions (submitted for processing and reimbursement as in paragraph 2) and collated by form type as follows: 3.1 repeat Authorising forms.
Pharmacies will need to submit the legal repeat authorising prescription when all batch issues have been dispensed, it has expired, or the medication is no longer required. These will need to be submitted in a separate bundle to the PPA the month after they are no longer required by the pharmacy for dispensing.
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Ordering Forms
The forms needed for repeat dispensing will be available to order from Ryedale House (the normal supplier of GP prescription forms). All forms are free of charge. Forms available from North Yorkshire Family Health Services (4th Floor, Ryedale House, 60 Piccadilly, York, YO1 9PE): FP10SS Patient Consent Form (RD01) (Appendix A) Patient Introduction Leaflet (RD02) (Appendix B) Forms available directly from this document (please photocopy): Patient Compliance Card (Appendix C) Repeat Dispensing Log (Appendix D) Pharmacist Repeat Dispensing Referral Form (Appendix E) GP Repeat Dispensing Referral Form (Appendix F) Record of destroyed batch issues form (Appendix I) Penultimate prescriptions (Repeat Dispensing Scheme) (Appendix J) Locum Agreement Form (Appendix K)
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Glossary
Authorising FP10 Prescription The authorising prescription will authorise a set number of repeats through the production of batch issue FP10s. The authorising prescription must be signed by the General Practitioner (GP) or Nurse Practitioner (NP), but the patient does not have to sign the declaration on the back of the prescription form. Batch Issue (FP10) A batch issue is essentially an invoice submitted by the pharmacist to the PPA for payment purposes. Batch issues will be supplied with each authorising prescription for use in the Repeat Dispensing Arrangements. A batch issue is not a legal prescription and will not be signed by the prescriber. It must, however, be signed on the back by the patient in the normal way at the time of dispensing. Dose Optimisation This involves giving patients the most appropriate strength of their prescribed medication which reduces the number of tablets/capsules they have to take and can decrease prescribing costs. Patient Consent Patients have to be made aware that information relating to their condition and prescription will be shared between the GP and the pharmacist. Patients will need to sign consent forms that will be filed or scanned in their medical notes and retained within the GP practice. This is in keeping with the Caldicott Committee Recommendations. Primary Care Trust Free standing statutory Trust responsible for health services in a geographical area in England. Prescription Pricing Authority (PPA) The PPA are responsible for pricing all NHS prescriptions, providing reimbursement and remuneration to pharmacists and other dispensing contractors and collating and producing prescription cost and analysis (PACT) data. Within the repeat dispensing arrangements, the PPA will be responsible for handling batch issues as they are submitted and storing the authorising prescriptions a the end of the repeat period. Patient Medication Record These are computer-based records maintained within the pharmacies that patients use. Most pharmacists will keep a record of all patient items dispensed, both private and NHS, from doctors, dentists and nurse prescribers within any care setting (community, drug misuse and hospital). Some pharmacists will also keep records of medication purchased from the pharmacy (OTC), especially where this is relevant to the medical condition eg aspirin. Repeat Dispensing The process by which a prescription is dispensed in several intervals rather than all at once.
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Until such time as s/he is required in accordance with the Drug Tariff, to send the repeatable prescription or batch issues to the PPA. Communication Procedure A local communication protocol must be in place between practices and local pharmacies. Communication should follow locally agreed policies. All paperwork associated with repeat dispensing should be stored for a minimum of two years. Interview and Counselling Counselling of the patient must be carried out at each repeat dispensing to ensure the patient: has an understanding of their medication is compliant is not experiencing any side effects re-enforce health promotion issues check any recent over the counter purchases refer patient back to GP for any new problems, using the appropriate method of communication if a patient is unable to collect their prescription, and wishes to send a representative, they must contact the pharmacy to enable the pharmacist to conduct an interview or counsel the patient over the telephone. It is the responsibility of the pharmacist to inform patients when they require a further repeatable prescription and batch issues. At the second to last prescription the pharmacist must refer the patient back to the practice for a medication review and remind the patient that any blood monitoring requirements should be done a week before their review. At the last batch issue the pharmacist must check with the patient that they have had or arranged an appointment with their GP. Remind the patient that they have no further batch issues (Appendix J).
Incident Reporting Incidents should be reported using the pharmacy SOP. reporting to the Medicines Management Team: North Yorkshire and York Primary Care Trust The Hamlet Hornbeam Park Harrogate Tel: 01423 815150 HG2 8RE Fax: 01423 859600
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Participating Pharmacies
Pharmacy Contact Address Tel/Fax/Email Initiated Service?
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Chemist Name of chemist required on patients record. NOTE on consultation screen: Press A: add Press P: problem Press 8BM4 or type in repeat dispensing. Enter Type in name of designate Pharmacy of the patients choice. Press F8 to file.
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North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
Schedule 1
Cannabis Lysergide (LSD)
Schedule 2
Diamorphine (Heroin) Morphine Pethidine Secobarbital Glutethimide Amphetamine Cocaine Methadone Oxycodone
Schedule 3
Barbiturates (excluding Secobabital) Buprenorphine Diethypropion Flunitrazepam Mazindol Meprobamate Pentazocine Phentermine Temazepam
Schedule 4 and Hypnotics and Anxiolytics (require risk vs. benefit assessment) As the long-term prescribing of hypnotics and anxiolytics is discouraged, serious consideration must be given to patients prescribed these medicines as to their suitability. However, if the balance for patient benefit favours inclusion and the patient meets all other inclusive criteria, then they may be incorporated onto the scheme. Diazepam Nitrazepam Lorazepam Lormetazepam Chlordiazepoxide Alprazolam Oxazepam Zaleplon Zopiclone Zolpidem Loprazolam Buspirone
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North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
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North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
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North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
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North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
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North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
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North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
3.
Pharmacies will need to submit the legal repeat authorising prescription when all batch issues have been dispensed, it has expired, or the medication is no longer required. These will need to be submitted in a separate bundle to the PPA the month after they are no longer required by the pharmacy for dispensing.
Please note: If a batch prescription is no longer valid because the patient does not need the item or items, the GP has ceased treatment or it is no longer covered by an authorising prescription, then in ALL cases you must destroy the relevant batch issues and not submit the to the PPA .
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North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual
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