Repeat Dispensing

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Repeat Dispensing

• Lesley Irvin

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What is repeat dispensing?

• A convenient way for patients to receive repeat
  medication without the need for repeated visits
  to GP surgery
• A process whereby medicines usage is improved and
  potential waste reduced
• A way to reduce GP and practice staff workload
• A way to develop pharmacy skills and services

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Whats in it for me? GPs

• Reduced workload in processing and signing
  prescriptions
• Improved patient compliance may mean less surgery
  visits
• Early indication of medicine related problems
• Closer working with local pharmacies

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Whats in it for me? Pharmacists

• Improved understanding of patients conditions and
  needs
• Chance to develop skills and services
• Improved communication with GPs
• Improved workload planning

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Whats in it for me? Patients

• Convenience
• Time and money savings
• Closer relationship with pharmacist
• Better understanding of medicines
• Less need to stockpile
• Early identification of medicines related problems

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Whats in it for me? PCTs

• Improved medicines management less waste,
  reduced expenditure
• Satisfied patients and practitioners
• Long term improvement in health outcomes
• Potential reduction in medicines related hospital
  admissions

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Recipe for successIngredients

• A surgery
• GP software
• An infusion of training
• Patient selection and consent
• Local pharmacies
• PCT support

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What we did

• Pathfinder site
• Initial meeting
• Patient selection
• Practice staff and GP training
• Community pharmacy visits and ongoing support
• Technician lead sign up clinics

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Initial meeting at surgery

• GP prescribing lead, Practice Manager, PCT
  pharmacist and technician, local community
  pharmacists
• Orientation
• Agree process for the surgery
• Agree time scale for 50 patient introduction
• Agree patient selection criteria

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Initial patient selection

• Patients aged 16 to 65
• Stable chronic condition
• No changes in medication in last six months
• Patients taking a single medicine eg
  levothyroxine, a couple of medicines eg
  beclometasone and salbutamol inhalers or with a
  seasonal, predictable condition such as hayfever

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Training for Practice Staff

• Technician lead
• One to one
• Process explained
• Consent form explained need for scanning
• Generating the prescription
• Importance of good communication
• Benefits to practice and patients

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Community Pharmacy Support

• PCT Pharmacist visit
• Process explained
• Training checked
• Importance of SOPs, locum training etc
• Secure storage conditions
• Supplies of communication forms given
• Ongoing support given where required

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The sign up clinic

• Process explained
• General health checked
• Medication review performed if necessary
• Process explained consent obtained
• Agreement to use one pharmacy
• Pharmacy procedures explained
• Any necessary tests arranged
• Prescriptions prepared

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Results BWWPCT
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What problems have we encountered?

• Failure to attend sign up clinic
• Patients getting collection and delivery service,
  or post dated scripts
• GPs not using consent forms
• GPs not documenting sign up
• GP reluctance to become involved
• Community Pharmacists not yet accredited
• Repeat dispensing SOPs not in place

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The next steps

• One to one training with GPs
• Appointment of Practice repeat dispensing
  coordinators
• Further training for community pharmacies
• Community pharmacies to identify suitable
  patients
• Enable all Torex practices to generate repeat
  dispensing scripts

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Volume of RD prescriptions

• Small numbers
• Helps initially
• Specialist system
• Limited staff contact and knowledge
• Reduced practice compliance
• Reduced patient compliance

• Large numbers
• Whole team involvement including locums
• Becomes the normal
• Improved benefits to practices and pharmacies
• Improved patient experience

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Recommendations

• Good patient selection
• Thorough training
• Good communication
• Raising patient awareness
• Start small but aim big
• Standardise arrangements

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Contact

• To obtain a copy of this presentation and/or the
  supporting documentation used by BWWPCT
• Email lesley.irvin_at_bwwpct.nhs.uk