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At the heart of general practice since 1960

Medicines management

Dr John Couch continues our series by looking at the requirements needed to earn points from medicines management

Points achieved with complete ease

Med 1 Details of prescribed medicines are available to the prescriber at each surgery consultation

Value two points

Few practices now use paper-based repeat prescribing systems as this task is just much more accurate and efficient by computer. The key things are ensuring all GPs and nurses have access to a terminal during consultations and that the computer record is kept up to date. All team members should know who is responsible for the latter. Make this part of your written prescribing protocol. Change repeat prescription details as soon as possible with special care when patients are discharged from hospital. See also Med 5 and Med 9.

Med 2 The practice possesses the equipment and up-to-date emergency drugs to treat anaphylaxis

Value two points

Check your drugs and equipment now and have a written list on display. Inspection of both will form part of the validation process. Do not forget doctors' bags. Ensure all team members know where drugs and equipment are stored. Also make treatment of anaphylaxis part of your resuscitation training programme and protocol.

Med 3 There is a system for checking expiry dates of emergency drugs at least on an annual basis

Value two points

The standard is annually, but six-monthly is safer. To be done well, especially in larger practices, one team member (choose the most organised person) should be responsible for checking surgery drugs/equipment and ensuring GPs check their bags. That person should keep a list of all expiry dates with forward diary entries for replacing at least one month before expiry. Note that validation will include inspection of some GPs' bags – you have been warned!

Med 4 The number of hours from requesting a prescription to availability for collection by the patient is 72 or less (excluding weekends and bank/local holidays)

Value three points

Since Med 8 offers extra points you should go for a 48-hour maximum target. Make sure your practice leaflet, repeat prescription slips and website (if applicable) include full details of your system. Ensure agreed plans for covering GP sickness, holidays and days off. Train as many reception staff as possible to do repeat prescriptions. Prioritise this work to avoid backlogs. Practices with branch surgeries should review their arrangements. Consider issuing extra quantities to reduce pressure at Christmas.

Med 8 The number of hours from requesting a prescription to availability for collection by the patient is 48 or less (excluding weekends and bank/ local holidays)

Value six points

See Med 4

Points achieved with good planning

Med 5 A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed four

or more repeat medicines (excluding OTC and topical medications) – standard 80 per cent or more

Value seven points

The optimum way to achieve this indicator is to use the 'prescription review date' facility on your practice computer system. Train all relevant team members. Set review dates no more than 12 months ahead and make sure they are observed. The latter is best done at GP level. Some patients will have already been seen recently or can be dealt with via a telephone call. The remainder can be asked to make an appointment. This system is also extremely useful in many Q&OF clinical areas. Setting individual review dates allows the GP and each patient to be reminded that a clinical review or test is due. Even better it is an excellent 'lever' for more reluctant patients!

Note that it is permissible for a GP, nurse or pharmacist to do the review. Structure the review carefully. Check for compliance, ensure the prescription list is up to date, delete drugs no longer used, bring quantities into line and monitor relevant clinical details, measurements and tests. Reset the date to an individually tailored point. Use an approved 'medication review' Read code. Some practice software systems automatically offer these when review dates are changed.

Med 6 The practice meets with the PCO prescribing adviser at least annually and agrees up to three actions related to prescribing

Value four points

Most practices will have been doing this for some time in relation to their prescribing budgets. Make sure all details are recorded for verification. Larger practices should have a prescribing lead to drive the actions forward.

Med 7 Where the practice has responsibility for administering regular injectable neuroleptic medication, there is a system to identify and follow up patients who do not attend

Value four points

Keep a manual sub-register of the few patients with mental problems on neuroleptics indicating those are given by the practice. Even where the drug is supplied and given by the CMHT enter the drug to allow identification. As nurses usually give the injection they are the obvious ones to complete and monitor the register. Have close liaison with a CPN – they have more time to chase up patients. Write your system down as a protocol and remember that verification will involve relevant team members being questioned.

Med 10 The practice meets with the PCO prescribing adviser at least annually, agrees up to three actions related to prescribing and subsequently provides evidence of change

Value four points

See Med 6. All relevant team members must sign up and the changes should be monitored regularly by the practice lead. All evidence, including computer searches, should be kept for verification. This may be a difficult indicator, especially for those already over budget, as the pulls of drug budgets and the Q&OF are in opposing directions!

Points achieved with real striving

Med 9 A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed repeat medicines (excluding OTC and topical medications) – standard 80 per cent or more

Value eight points

See Med 5. As total numbers involved in this indicator are high, many practices will find

this a tough one to achieve by 31.3.05 especially if they are starting from scratch and trying hard in other areas of the overall framework. However, those practices should be able to reach the 80 per cent standard by 31/3/06.

John Couch is a GP in Ashford, Middlesex

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