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GPs buried under trusts' workload dump

GPs told to refuse third party script orders in bid to cut medicines waste

GPs have been told to refuse repeat prescriptions ordered on behalf of patients by pharmacists, in a bid to cut down on medicines waste.

NHS West Lancashire CCG has tasked GPs with writing to any patients using such third-party order schemes, to explain that from next month they will have to start ordering their own repeat prescriptions.

But the CCG has also stressed that GP practices are expected to ‘support any patients or carers that have any difficulties’ with ordering their own repeat prescriptions.

The CCG is hoping that it can save £600,000 if it can successfully roll out its medicines waste publicity campaign, which has the strapline ‘being a hoarder is out of order’.

The move comes as a number of CCGs are adopting similar bans on repeat ordering, after a trial at NHS Luton CCG reportedly helped to curb its prescribing budget spend significantly last year.

Other CCGs which have moved to curb third party prescription requests include NHS North East Essex CCG, NHS Cambridgeshire and Peterborough CCG, NHS Southport and Formby CCG and NHS South Sefton CCG.

This is the latest in a line of prescribing savings schemes of late, including GP being asked to stop writing prescriptions for drugs available over the counter, as CCG attempt to tighten their purse strings. GPs have also been told to tighten up procedures to help cracking down on fraudulent claims for free prescriptions.

NHS North East Essex CCG, which placed a ban on third-party prescription requests last month, said it hoped the move would 'reduce wasted medicines', put patients 'in charge' and help GPs have 'a clearer picture' of medicines ordered.

It added in a statement: 'This change will help our local NHS use money more efficiently for the benefit of the residents of North East Essex.'

Commissioning leads in West Lancashire explained that its new scheme is intended to tackle medicines wastage. An estimated £300m of NHS funds is spent every year on medicines that are not used, the CCG said, equating to around £600,000 in West Lancashire alone.

In a press statement, West Lancashire CCG said that ‘GP practices across the region will no longer accept repeat prescriptions from pharmacists ordering on behalf of a patient or carer’ and that ‘patients and carers will now be required to order these prescriptions for themselves (apart from in exceptional circumstances)’.

The statement added: ‘To ease any concerns, GP practices are writing to all those affected in early October, explaining fully what is happening, when and why, and clearly explaining how they can now order their medication moving forward.

‘In addition, GP practice staff will be trained to support any patients or carers that have any difficulties.’

Asked what extra funding it was offering GP practices to help patients with repeat prescriptions in the place of pharmacies, a CCG spokesperson said: 'GP practices are not being paid anything extra, as West Lancashire CCG already funds medicines management coordinators.

'These coordinators, who have been in position for around seven years, are responsible for supporting the safety and efficiency of repeat prescribing systems.'

Patients are being encouraged to sign up to the free ‘Patient Access’ website and smartphone app available in the area, to help manage their repeat ordering.

Dr Peter Gregory, a GP at Parkgate Surgery in Ormskirk and clinical lead at West Lancashire CCG, said: ‘The NHS in West Lancashire has a responsibility to its patients to address some very important medicines safety issues. We are moving away from pharmacists ordering repeat prescriptions on behalf of patients, as there is a risk that medicines are being ordered that are no longer required.

‘With this campaign, we want to engage with patients, to give them the confidence to take control of how they take and order their medicines and to only order what they need. At its core, ultimately it is about everyone in West Lancashire working together, residents, GPs and pharmacists so that collectively we can help to tackle this issue of medicines waste.’

However, GPC clinical and prescribing lead Dr Andrew Green, a GP in East Yorkshire, cautioned that the CCG was 'wrong in thinking that a ban is the solution' to this problem and could actually cause a significant extra workload for GP practice.

He said: 'If practices have got used to large numbers of requests coming in from their local pharmacies in batches, and then all those requests are converted into individual patient contacts, it is likely that GP staff will have many more contacts to deal with, putting pressure on staff time and telephone systems.'

Sati Ubhi, chief pharmacist at NHS Cambridgeshire & Peterborough CCG, said: 'One potential contributory factor to the inappropriate provision of medicines is when medicines have been ordered on behalf of the patient by others. For the majority of our patients, it is they who are best placed to make decisions about their own health and to decide which repeat medicines they need.

'To help improve the ordering of repeat prescriptions, the CCG intend to make all practices aware of the benefits of giving patients the responsibility to manage their own medicines where they are able to do so.'


Readers' comments (30)

  • Let's hope GPs are as efficient as pharmacists in dealing with RPs.

    So far I haven't been very impressed with GP responses to essential medications.

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  • i agree with Shaba Nabi 4 .17pm. A nominal charge for each item, with no exceptions for age, illness, long term condition etc. Even with polypharmacy of 8 items, 50p an item would only cost £4 a month. See how successful the plastic bag tax has been in reducing waste

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  • A poorer service for patients and more work for GP staff with multiple single transactions. I thought pharmacists were supposed to be one of the staff groups helping streamline workload? That said though, medicines waste is a huge issue and all steps in the ordering process should be reviewed and an increase in patient education.

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  • Private GP - pharmacists "deal" with rpt script requests by passing them on to the practice. GPs generally request 2 working days' notice for processing. That seems to be manageable for most patients and won't be any quicker if you involve a third party.

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  • The only prescriptions that I would order from the GPs were those for the MDS trays as we'd work a week in advance. Otherwise I felt it was important for patients to "own" the process of being responsible for their medication and not sub contract the responsibility to the pharmacy. In my opinion these managed repeat services are open to abuse and I'm not surprised that they're being clamped down on. More work for the GPs though

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  • Boots! Dodgy repeat script service. Text patients, then dispense scripts if they don't reply. I have instances of deceased patients not replying so the medicines are delivered anyway!

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  • As a patient, I use repeat prescriptions from pharmacy. I actually went into the GP surgery I use (as a patient not as a health professional) and asked for my prescriptions to be tidied up as previously i got different amounts, some for 1 month and some for two. I now get 1 months supply of all of them

    The pharmacist asks me to tick which I need on the repeat prescription form, so when I have a 'good month' and don't use so many Tramadol I don't tick the box and I can avoid being a hoarder.

    Works beautifully from a patient perspective, the GP practice I use will also take repeat requests by telephone, a rare luxury these days I know. If pharmacy ordering ends I will switch to ordering online as our wonderful practice has done brilliantly at promoting this as a facility.

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  • In Australia most script items are 1 month supply with 5 repeats - i.e. dispensed by the chemist for 6 months unless changed by the Dr. Working patients pay 10 to 15 pounds per pack, concessional patients pay around 3 pounds. There's no hoarding and very little waste.

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  • I find this worrying, not all patients use the same pharmacy, some will go th the pharmacy that gives them the brand the patient thinks is best. Drugs that can be bought over the counter and cost less than a script, should not be issued at all. Just because someone is entitled to free scipts should not entitle them to free headache tablets and cold remedies, and I now of some patients that obtain OTCs e.g paracetamol, very cheap to buy, for family members because they get them free.
    I would not allow a pharmacist to prescribe for me, unless he / she knows my medical history, they are not qualified to make such decisions.

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  • good for the NHS, bad for GPs.

    sounds like most of our workload.

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