Happy? Or are we too busy to complain?
Repeat prescriptions are a monotonous chore for the GP – but they could become a thing of the past, says Dr Peter Stott
but they could become a thing of the past, says Dr Peter Stott
Checking and signing repeat prescriptions has to be one of the worst and most monotonous tasks in any GP's day. In my practice, more than 20 per cent of patients have repeat scripts. Most have several items, so on any day we often have 200-400 to sign, and spend an hour and half each doing it.
But there are changes on the horizon that offer some hope – supplementary prescribing, repeat dispensing and electronic transfer of prescriptions.
Supplementary prescribing is an essential qualification for nurse practitioners and for those pharmacists who work in clinical situations. The qualification involves a six-month day-release course with further supervised work at the end. The qualification is a part-step to the full independent prescribing (IP) qualification.
Nurse IPs use their own purple pads using the extended independent nurse formulary published at the back of the BNF. Don't confuse this with the simple nurse prescriber's formulary which is a dismal affair. The independent nurse prescriber's formulary will be extended year on year. They also get their own computerised stationery in 2006.
At the moment, the number of practices involved in supplementary prescribing can be counted on one hand. The stumbling block is that every patient has to have a written and agreed independent care plan (ICP). But once patients have an ICP, the nurse can issue acute scripts, repeat scripts, and can also change medication to anything listed within the care plan.
As practices become more organised and linked through PCT servers, ICPs will become commonplace. Standard operating procedures for conditions like diabetes, asthma and hypertension will need only minor amendment for individual patients. Electronic transmission of information will facilitate the whole process.
So supplementary prescribing offers some respite for the future. But the most exciting opportunities to release ourselves from the burden of repeat prescribing will come through something called 'repeat dispensing' and in particular the electronic form of this called 'electronic prescription transfer'.
The NHS repeat dispensing scheme (RDS) has received little attention, and to be honest, very little enthusiasm has been shown by GPs or pharmacists. My practice is a pathfinder site, and even we have been very lackadaisical!
Using RDS, just one signature on one script can enable the pharmacist to dispense a supply of medicines any number of times for up to a year. The year is the limit because it is the length of time defined by the NSF for older people before a medication review is necessary.
The GPC and the pharmaceutical services negotiating committee worked out the details back in 2001. GPs, nurse and pharmacist independent prescribers can all take part. The patient has to agree too. A special 'repeatable prescription' (authorisation) form is used. This is an ordinary FP10 with just a few variations in the way it is completed. The repeatable prescription is the legal prescription as defined by the Medicines Act.
The prescriber signs just once and it authorises repeat dispensing for that period of time until the doctor wants to review the patient again. The practice also generates 'batch prescriptions' again printed on FP10s for defined amounts of drugs and specific dispensing intervals.
These don't have to be signed individually but are used by the pharmacist for reimbursement purposes after receipt of medicines has been signed by the patient. Anything can be prescribed in this way, except schedule 2 and 3 controlled drugs.
The last piece in the jigsaw is electronic transfer of prescriptions (ETP). The department commissioned three pilot studies in 2001 which ran between June 2002 and April 2003. At that stage it was considered enough had been learned.
Twenty-two surgeries and 30 care trusts in Peterborough were one of the pilots using a system called the 'Salford model'. Patients enrolled to use the scheme, and their acute and repeat
e-scripts were generated by the GPs, sent electronically to the patient's pharmacy of choice, then to the Prescription Pricing Authority for payment.
All data was initiated by a doctor using a unique digital PIN signature, then encoded and sent electronically to a secure exchange. Using a personal barcode issued to the patient, any participating pharmacist could then call up the relevant information from the patient's care record and issue the prescription. So, throughout, the patient controlled access to the data and chose the pharmacist he wanted.
The target dates set by the Government for GP-to-pharmacist
e-scripts was 2004; and 2008 for pharmacist to PPA e-contact. Somewhat optimistic indeed, but we can be confident that e-scripting will happen – sometime.
E-scripting may sound futuristic, but taken together with supplementary prescribing and repeat dispensing, it brings new prescribers and new investment on to the scene. The result may be that GPs signing prescriptions for two hours a day will eventually become a thing of the past.
Peter Stott is a GP in Tadworth, Surrey
How to avoid that boring chore
•Get yourself a supplementary prescriber
•Start thinking about independent care plans
•Become involved in repeat dispensing
•Live long enough to see the initiation of e-prescribing
Repeat dispensing: www.ppa.org.uk/ppa/repeat_dispensing_service_pilot.htm
Repeat prescribing: www.dh.goc.uk/PolicyAndGuidance/MedicinesPharmacy
Electronic transfer of prescriptions: www.gov.uk/ipu/whatnew/deliveringit/index.htm