Repeat prescribing policy

Person responsible for review of this policy is: Dr J. Monteiro
Date of last review: 3 January 2017
Date of next review: 3 January 2018

Purpose

The purpose of this policy is to set out a prescribing procedure that ensures that the prescriber can monitor usage and the effects of repeat medication and that the patient is offered regular medication reviews. A robust prescribing procedure ensures that the prescriber can monitor usage and the effects of repeat medication and that the patient is offered regular medication reviews.
This policy is relevant to all employers and anyone who works at The Monteiro Clinic.
The policy will be reviewed annually to ensure that it remains effective and relevant.

The repeat prescribing process

The number of hours from requesting a prescription to availability for collection by the patient is 48 hours or less (excluding weekends and bank/local holidays).

The following personnel are allowed to request repeat prescriptions

  • Patient
  • Legally responsible for patient (parents or care)

Requests should be received by the following method

  • Written request
  • Via The Monteiro Clinic DATABASE.
  • The Monteiro Clinic do not accept Verbal requests.

The following information must be obtained before a request is processed

  • Patient’s full name.
  • Patient’s address or date of birth.
  • Name/strength/ form and dosage of medication(s).
  • Any queries arising from the request should be clarified at this stage.
  • N.B. It is NOT acceptable for a patient to request “all repeats” or their “blue tablets”, or use a description of medication rather than specify the name (e.g. heart tablets, pain killers).

Production of Repeats

The practice computer system must be used for generation of all repeat prescriptions to ensure a clear record of supplies including the label.

Repeat Prescribing Protocol

An invoice with medication description must be generated with every sale.
If a prescription requires delivery, patients must make their own arrangements;

Processing a Request for a Repeat Prescription

Check that the items requested are on the patients’ current repeat list. If the patient requests any items not on the list, refer to the GP.
If the item appears on the list, check the name, form, strength and dosage instructions are identical to the request. If there are any discrepancies, refer to the GP.
If the authorised number of issues has been met, re-authorise for one issue only and refer to GP.
Check medication review date has not been exceeded -refer to GP to see if he/she wishes to see patient.
Where prescription requests are earlier or later than expected, and may indicate over or under use of that item, refer to the prescriber so that they can find out why the patient is not using the medication as intended.
Cancel repeats that have not been ordered for one year or more, exceptions are seasonal medications e.g. hay fever.
The supply of Controlled Drugs should always be limited by GP.

Repeat Prescribing Protocol

Authorisation
The GP is the only person who can add authorised medications to a patient’s repeat medication list.
When a medication is first added to a repeat prescription, it should be noted clearly why it was started in the first place.
Often newly prescribed medication (until suitability is confirmed) and medication with frequent dose changes would be better set up as an acute prescription.
The number of repeats, or the period of time, allowed before the next review should be defined.

Compliance check
If a patient is over- or under- using medication, a prescription must not be generated:
Attach an explanatory note to the patient’s records. Inform the GP.
Patients should be given information explaining the repeat prescribing system

Patient information
A poster explaining the practice repeat prescribing policy should be displayed in the reception area and the message reiterated face to face when necessary.
The repeat prescribing policy is displayed on the website.

Quality Assurance
Audit of the repeat prescribing system should be conducted annually.

Clinical Control

Initiation
The prescriber must be satisfied that drug treatment is appropriate and necessary.
Consideration should be given to non-drug treatments and lifestyle interventions.
The patient must be reviewed at least once before granting a prescription repeat Status.
Prescribe medication to cover the period until assessment of suitability only.
Consider patient sensitivities and significant interactions.

Authorisation
The prescriber should be satisfied:

  • The drug is effective (look for objective evidence)
  • Long term treatment is needed.
  • The patient is concordant.
  • No important adverse effects are experienced.
  • Only prescriptions for patients with stable, chronic conditions should enter the repeat system.
  • The prescriber should check the following:
  • Drug name, strength, form and dose.
  • Indication for each drug.
  • Monitoring plan.
  • Date of next review.

Review
3 to 12 months should be adopted as the standard review interval.

Repeat Prescribing Protocol

Dose adjustment

  • Document any side effects/ ADRs/ allergies in the patient’s note.
  • Ensure necessary tests are being carried out at appropriate intervals.
  • An entry should be made in the medical records at the time of medication review to indicate that it has occurred, noting any changes.
  • Update the computer, including review date and print a new paper record.

Clearly record

  • Drug name, strength, form and dose
  • Indication for each drug
  • Monitoring plan
  • The GP must update the computer records immediately upon return to surgery

Common Chronic Disorders

  • Hypertension: 4/6 months
  • Hypercholesterolemia: 4/6 months
  • Thyroid: 6/12 months
  • Gout: 6/12 months
  • Depression: 3/6 months
  • Sleeping disorders: 3/6 months

 

Other Chronic Disorders

  • 3/12 months.