Service description

The management and dispensing of repeatable NHS prescriptions for medicines and appliances6, in partnership with the patient and the prescriber.

This service specification covers the requirements additional to those for dispensing, such that the pharmacist ascertains the patient’s need for a repeat supply and communicates any clinically significant issues to the prescriber.

Aims and intended outcomes

  • To increase patient choice and convenience, by allowing them to obtain their regular prescribed medicines and appliances directly from a community pharmacy for a period agreed by the prescriber.
  • To minimise wastage by reducing the number of medicines and appliances dispensed which are not required by the patient.
  • To reduce the workload of general medical practices, by lowering the burden of managing repeat prescriptions.
Service indicator and terms of service (ToS) referencePre-visit questionsAT comment / explanationNumark CommentLinks

ES2-1 The pharmacy shall have appropriate standard operating procedures (SOPs), including SOPs in respect of dispensing drugs and appliances, repeatable prescriptions and providing advice and support to people caring for themselves or their families. ToS - 28(2)(c)(v)

Does the pharmacy have a repeat dispensing SOP, signed by all relevant staff to say they have read it, understand it, and will follow it?

The AT does not need or want to check SOPs in detail, as it is for the contractor to ensure they are fit for purpose and provide adequate direction to staff to enable safe working practices. The AT may ask to see the signature sheet during the visit.

The Repeat dispensing SOPs and the flow chart are available for download from NumarkNet.

Repeat Dispesning SOP

Repeat Prescription Management SOP

ES2-2

When was the SOP last reviewed?

This should be indicated on the SOP.

All Numark SOPs are editable and allow for input of review dates and amendment.

SOPs

 

ES2-3 Repeatable Prescriptions for NHS medicines and such appliances, supplied in the normal course of the pharmacy business, are dispensed for patients on demand, with reasonable promptness. ToS - 5(2)

Does the pharmacy have sufficient resources (staff and stock) to ensure drugs are dispensed with reasonable promptness?

The Community Pharmacy Patient Questionnaire (CPPQ) can provide valuable feedback on the patient’s perception of the promptness of service.

 

CPPQ

ES2-4 A pharmacist may refuse to provide a drug or appliance ordered on a repeatable prescription in certain circumstances. ToS - 9(2) and 9(3)

Are staff aware of the circumstances that may be relevant for a refusal to supply and know what actions to take in such circumstances?

These arrangements could be covered within the SOP. During the monitoring visit, the AT may discuss these criteria with the pharmacist to assess understanding. The AT might also ask to see copies of anonymised records of referrals back to the prescriber (see below).

Numark SOP covers this eventuality.

Repeat Dispensing SOP

 

ES2-5 Where a patient requests the supply of drugs or appliances ordered on a repeatable prescription (other than on the first occasion that he makes such a request), the pharmacist must be satisfied with regards to certain issues. ToS - 9(4)

Does the SOP require the pharmacist to establish that it is clinically appropriate to dispense the prescription?

These arrangements could be covered within the SOP. During the monitoring visit, the AT may discuss these criteria with the pharmacist to assess understanding. The AT might also ask to see copies of anonymised records of referrals back to the prescriber (see below).

The “Repeat dispensing” SOP includes advice to patients as well as circumstances to consider when dispensing repeat prescriptions. If you do not keep anonymised records, you should indicate as appropriate.

Repeat Dispensing SOP

 

ES2-6 A pharmacist shall provide appropriate advice to patients to whom they provide drugs or appliances in accordance with a repeatable prescription in particular on the importance of only requesting those items which they actually need. For these purposes the pharmacist shall have regard to the details contained in the patient’s record in respect of the provision of appliances and the prescribing pattern for that patient. ToS – 10(1)(c) and 28(2)(c)(iv)

Does the SOP provide for appropriate advice to be given in particular about the importance of only requesting items they actually need?

     

ES2-7

Does the SOP include referring to the patient’s records when dispensing appliances to establish the prescribing pattern in order to advise about appropriate ordering?

     

ES2-8 Pharmacists should undertake appropriate training. ToS – 10(1)(g)

Do all the pharmacists employed or engaged by the pharmacy, have certificates or evidence of training in repeat dispensing?

Pharmacy contractors are responsible for ensuring pharmacists they employ are competent to provide the repeat dispensing service. At the monitoring visit, you may be asked for production of certificates or other evidence.

Numark advises members to complete the CPPE training on repeat dispensing.

CPPE

ES2-9 If a pharmacist takes possession of a non- electronic repeatable prescription or an associated batch issue, securely store that repeatable prescription or associated batch issue. ToS – 10(1)(h)

Do you have secure storage for repeatable prescriptions and batch issues?

During the monitoring visit, the AT may ask to see your secure storage. The storage should ensure that patients or other members of the public cannot access them.

The Numark Repeat Dispensing SOP makes reference to the Pharmacy Filing system. Numark members are asked to ensure that the filing system fulfills the requirements of clinical governance and data security standards. Filling systems and similar equipment is available from Office Depot

Repeat Dispensing SOP

ES2-10 The pharmacist will maintain records of repeatable prescriptions in such a form as to provide a clear audit trial of supplies under the repeatable prescription (including dates and quantities supplied). ToS – 10(1)(j)

Do you keep records that provide for an audit trail of supplies made against repeatable prescriptions?

The AT will not ask to see individual records, but you may be asked to show how records of supplies are maintained.

Please refer to the Numark Repeat Dispensing SOP.

Repeat Dispensing SOP

ES2-11 The pharmacist must destroy any surplus batch issues relating to medicines or appliances which are not required, or where the patient is refused the medicines or appliances in accordance with paragraph 9 of the Terms of Service. ToS – 10(1)(k)

Do you have appropriate means of destroying surplus batch issues?

As these contain sensitive personal information, they must be destroyed as confidential waste. During the visit, the AT may ask to see how you destroy confidential waste.

Most pharmacies have an “approved” cross cut shredder. This is an appropriate means to destroy confidential waste. Numark members can also opt for an external service to destroy confidential waste.

Shred It

ES2-12 The pharmacist ensures the patient is referred back to prescriber for further advice if supply of medicines or appliances has been refused. ToS – 10(1)(l)

How many anonymised records of patients who have been referred back to the prescriber in the last 12 months does the pharmacy have available for monitoring purposes?

The AT does not anticipate that a typical pharmacy will experience the need for large numbers of patients to be referred back to prescribers, so the number that have been anonymised for monitoring purposes may be low. The AT may ask to see copies of the anonymised referral forms or discuss with you the circumstances when referral might be appropriate. If the number of records is very low, you may wish to retain up to two years’ worth of records for monitoring purposes.

If you do not keep anonymised records, please indicate appropriately If you do not keep anonymised records, please indicate appropriately.

Interventions and Problem Solving SOP

ES2-13 Notify the prescriber of any clinically significant issues arising in connection with the prescription and keep a record of that notification ToS – 10(1)(m)

How many anonymised records of notifications to prescribers of clinically significant issues during the last 12 months does the pharmacy have available for monitoring purposes?

The AT does not anticipate that a typical pharmacy will experience the need for large numbers of notification of clinically significant issues on repeatable prescriptions, so the number that have been anonymised for monitoring purposes may be low. The AT may ask to see copies of the notifications or discuss with you the circumstances when notification might be appropriate. If the number of records is very low, you may wish to retain up to two years’ worth of records for monitoring purposes.

An advice, intervention and referral form is attached to the Interventions and Problem solving SOP

Interventions and Problem Solving SOP

 

ES2-14 Ensure the prescriber is notified if supply of medicines or appliances has been refused ToS – 10(1)(n)

How many anonymised records of notifications to prescribers of patients who have been refused under paragraph 9(4) in the last 12 months does the pharmacy have available for monitoring purposes?

The AT does not anticipate that a typical pharmacy will need to refuse to dispense many prescriptions under paragraph 9(4) (see above for the situations that give rise to the need to refuse). Therefore, the number of records that have been anonymised for monitoring purposes may be low. The AT may ask to see copies of the notification forms or records or discuss with you the circumstances when refusal might be appropriate. If the number of records is very low, you may wish to retain up to two years’ worth of records for monitoring purposes.

If you do not keep anonymised records, please indicate appropriately).

 

6Pharmacies are required to supply any drugs ordered via a prescription. With regards appliances they are only required to supply those that they supply in the normal course of  their business.