Why do GPs get asked for seven-day prescriptions for monitored dosage system (MDS)/Multi-compartment compliance aid (MCA) dispensing?
There are a small number of patients who satisfy the eligibility criteria for the supply of an MDS/MCA tray under the Equality Act 2010, and the national NHS community pharmacy funding contains a contribution towards the provision of such auxiliary aids.
Additionally, in the past some PCTs commissioned local enhanced services for dispensing and managing those patients who require compliance aids and additional pharmaceutical support in their own homes. Some local commissioners may choose to continue this provision.
If it is clinically appropriate for a patient to receive a seven-day supply of their medicines because their treatment may need regular review and/or frequent changes, then a seven-day prescribing interval may be written and the pharmacy will provide a seven-day supply of the medicines to the patient.
Pharmacists may discuss seven day prescriptions with prescribers if they have decided to provide medicines in MDS/MCA trays, because of the dangers of wastage if treatment changes.
However, some pharmacists may request a seven-day prescription in an attempt to cover the cost of MDS/MCA trays for other patients that do not fall within the criteria of the Equality Act 2010.
It is important that patients are not given the expectation that their medicines will be dispensed in an MDS/MCA, unless they satisfy the eligibility criteria or a local service to manage patients who require compliance aids has been commissioned.
Do pharmacists and pharmacy staff advise patients about the minimal benefits of some OTC medicines that may have limited therapeutic value?
The sale of OTC medicines is a vital aspect to the self management of many minor health problems that may otherwise require a GP consultation.
Licensing regulations and continuous scrutiny by the Medicines and Healthcare products Regulatory Agency (MHRA) ensure that OTC medicines are only available for purchase if considered safe, are made to acceptable quality standards, are proved to be effective for their clinical indication and have appropriate labelling.
Many medicines are available from non pharmacies where no professional advice is available. But, in pharmacies, medicines can only be sold by a person who is competent to do so, and is either a pharmacist or subject to supervision by a pharmacist.
Publicity for OTC medicines can lead to members of the public selecting medicines that are unsuitable and the availability of professional advice in a pharmacy prevents many inappropriate purchases.
In providing professional advice and selling medicines (either personally or under their supervision) pharmacists must comply with provisions in their professional code, and the safety and welfare of the patient are primary concerns.
Do pharmacy contractors set the reimbursement costs of 'specials' medicines?
Specials have not been subjected to testing for safety, quality and efficacy, and prescribers will need to explain the risks when they discuss treatment alternatives with the patient.
The reimbursement price of many 'Specials' is set out in the Drug Tariff. Items not listed in the Drug Tariff will be reimbursed at the price charged by the manufacturer. 'Specials' manufacturers are often highly specialised units that make products to order.
The cost of carrying out appropriate testing of a product before release can amount to several hundred pounds, so as well as the clinical considerations, these bespoke products should be prescribed only where there is no suitably licensed alternative.
Pharmacists are ideally placed to advise GPs on suitable products. The pharmacist is eligible to be reimbursed for these products in accordance with the national arrangements described above.
Within the community pharmacy, who can access patient records?
As is the case with GP practices, all pharmacy staff engaged in supporting NHS activity must comply with the Data Protection Act, NHS information governance requirements and the NHS Confidentiality Code of Practice.
As such, access to the patient medication record will be limited to those members of staff involved in providing pharmaceutical care to the particular patient.
The same NHS information governance requirements apply to community pharmacies and general practices.
Will community pharmacy premises be suitable for future locally commissioned and enhanced services?
Pharmacy contractors have invested significantly in the standards of their premises and continuously monitor patient and public feedback, to ensure the expectations of the service users are met.
As part of the specifications for locally commissioned or enhanced services, commissioners can require contractors who provide these services to meet specific premises requirements.
There are also premises requirements for some advanced services, for example to provide MURs and/or the NMS, contractors must have a confidential consultation area that meets certain criteria to ensure patients and pharmacists can sit down and have confidential consultations without being overheard.
How do repeat prescription ordering systems work?
Over recent years as repeat prescription volumes have increased many pharmacies have responded by introducing a prescription reordering service for their patients.
This service consists of the safe storage of the reorder portion of the patient’s monthly prescription, together with a commitment to present the reorder form to the GP practice when instructed to do so by the patient. Some pharmacies then collect the new repeat prescription from the practice and may provide home delivery.
Some pharmacies have also introduced an ‘express reordering service’ that enables a patient taking a regular medication to predict their requirements for the next supply period when they receive their current supply.
Whichever system is in operation within the pharmacy, the pharmacist needs to ensure that requests for repeats are triggered by the patient, and that decisions to reorder are not taken by pharmacy staff without input from the patient.
Such reordering systems have become, in the main, a well accepted process for patients and GP practices. The efficiency and smooth running of the systems is dependent on strong and effective communication links between GP practices and their local pharmacies.
To avoid the repeat reordering service creating additional workload for practices, or additional expenditure for the NHS, it is essential that pharmacies and practices understand each others’ working procedures, workload pressures and where there may be inefficiencies and potential risks resulting from the service.
Some of these services have been introduced by pharmacies because the repeat dispensing service has not been fully utilised by GPs. GP practices may wish to consider the significant benefits that repeat dispensing (batch dispensing) can bring to all those involved in the process.