Processing Clinical Letters
→ Workflow Manager → ’My Tasks + Deputizing For’
→ Then, choose Document Management → Awaiting Filing
This ensures only the relevant medication letters are shown.
1️⃣ Open letter
- Check the document is “sent to“ in-house pharmacy team, or directly to you, and “type“ is coded (e.g. ‘Seen in Respiratory clinic’ / ‘Discharge Summary’)
- Check "Letter Date" e.g. 17-Jan-2024 as you’ll need this to find the letter in the consultation
- Open the patient’s consultations, and find the “provisional” document with the same document name & date
- Single-click the document, then select Edit Consultation - This ensures any notes or changes are captured in the same consultation as the original letter
- Once the consultation opens, double-click the document to open - Read through the advice for any medication changes, and make notes in the consultation
2️⃣ Does this letter get screened by a technician/dispenser?
To refer a letter to the Pharmacist, Click Change Owner and enter your site’s Pharmacist’s name
3️⃣ RAGG, interactions, monitoring and other resources
- Check SEL Formulary to ensure the drug is appropriate for GP prescribing
- Check BNF Online for interactions between the newly added drugs, and the drugs the patient is already taking - seek guidance from the practice pharmacist if adding drugs
- Check if the drug requires monitoring: Drug Monitoring
Some drugs from specific letters will require checking against an additional resource. Please check the table at the bottom of this page.
4️⃣ Add drugs
- Medication changes: actioned by going to the patient’s medication list:
- RED Drugs: Click Add Drug, set quantity to 0, click Issue, then click Change All → Hospital - these are only added for good record keeping
- New medications (to be continued by GP): Click Add Drug
- Changes to Doses: Click on the drug, and then Edit (ensure dose is correct using the BNF)
- Changes to Medications: Click on the drug, and then Replace
- Stopped Medications: Right-click on the drug, and select End Course - Write the clinic name & date of letter in the reason
- Medications given, but not to be continued: These are not routinely added to the record
- Pharmacy Info box: You should add the clinic name and date of letter in the Pharmacy Info box (e.g. "Diabetic letter 17/2/24" or "Discharge Summary 17/2/24")
- Repeat or Acute: Medications should be added onto repeat prescription if letter has advised "GP to continue", but medications that require a blood test or a review should be added on the "ACUTE" medication list until this has been completed.
- Once changes have been made and notes added into consultation, click Save consultation
5️⃣ Does this letter get reviewed by a pharmacist?
You can also send any other letters if you have any queries.
To refer a letter to the Pharmacist, Click Change Owner and enter your site’s Pharmacist’s name
If letter is sent to Pharmacist to review → Pharmacist will task the Technician / Dispenser after checks are complete to complete 6️⃣ Extra steps
If letter not sent → complete 6️⃣ Extra steps straight away
6️⃣ Extra steps
- Inform the patient of changes, either by text, email or phone call, and remind them to request repeat medication at least 48 hours before running out - via email, NHS patient-access app or through nominated pharmacy
- Arrange a medication review if this is due, or if patient has been advised to start a new medication, multiple medications or recently discharged from hospital and requires a follow up (see also Medication Reviews)
- If patient has a Monitored Dosage System (MDS), or a dosette box: Please contact their nominated pharmacy using the shared mailbox or telephone to alert the pharmacy team of any changes to their regular medications - ensure any communication is documented on the patient’s EMIS record.
- Go back to documents on workflow, select the same document and click Complete Task
Letter Types
Type of letter | Person to process | Resources to check | Changes review by Pharmacist | Additional cautions | Source |
|---|---|---|---|---|---|
Respiratory, Chest, ENT, Asthma, COPD, Urology, Uro-Gynae, Gynaecology, Ophthalmology, Hepatology, or Liver Clinic | Technician / DispenserPharmacist | If there are any complex drug changes, any GREY/RED medications requested, or for guidance on monitoring. | Blood monitoring may be required with any dose changes. | Specialist/Secondary Care Clinics | |
Nephrology or Renal Clinic | Technician / DispenserPharmacist | Renal Drug Handbook | If there are any complex drug changes, any GREY/RED medications requested, or for guidance on monitoring. | If patient is a transplant patient or undergoing dialysis. | Specialist/Secondary Care Clinics |
Cardiology, Vascular or Heart Failure Clinic | Technician / DispenserPharmacist | For guidance on monitoring, follow up reviews, and screening any complex medication changes. | Specialist/Secondary Care Clinics | ||
HIV Clinic | Technician / DispenserPharmacist | If any non-antiretroviral (HIV medications) are requested for further review. | Medications should NOT be added on repeat prescription and only to be issued as HOSPITAL only drug. Add a record of any medications the patient is being supplied through the specialist team, issue as hospital only. Review any drug interactions with patients regular repeat prescription (if applicable) - alert specialist clinic if any interactions identified. | Specialist/Secondary Care Clinics | |
Dermatology Clinic | Technician / DispenserPharmacist | Check SEL Emollient Guidelines to find cost-effective products | If medication is listed as AMBER-3 on SEL formulary, Pharmacist to review for further guidance on shared-care agreements. | Specialist/Secondary Care Clinics | |
Rheumatology Clinic | Technician / DispenserPharmacist | If medication is listed as AMBER-3 on SEL formulary, Pharmacist to review for further guidance on shared-care agreements. | Specialist/Secondary Care Clinics | ||
Pain, MSK or Neurology Clinic | Technician / DispenserPharmacist | For guidance on initiating or continuing controlled drugs. | Specialist/Secondary Care Clinics | ||
Diabetes Clinic | Technician / DispenserPharmacist | If any changes to insulin therapy advised by clinic for further screening. | Specialist/Secondary Care Clinics | ||
Endocrinology Clinic | Technician / DispenserPharmacist | Blood monitoring may be required with any dose changes. | Specialist/Secondary Care Clinics | ||
Paediatric Clinic | Technician / DispenserPharmacist | Always to be reviewed. | Specialist/Secondary Care Clinics | ||
Anticoagulation Clinic | Technician / DispenserPharmacist | If any injectable anticoagulants prescribed e.g. Enoxaparin, Tinzaparin, Fondaparinux, Dalteparin. If any DOACs, Pharmacist to review SEL formulary for restrictions for primary care prescribing based on indication. | Warfarin: check that regular INR testing is occurring and record on EMIS, confirm current warfarin dose with patient. DOACS: check we have an up to date (actual-body) weight, and recent renal profile to calculate Creatinine Clearance. | Specialist/Secondary Care Clinics | |
Gastroenterology Clinic | Technician / DispenserPharmacist | If medication is listed as AMBER-3 on SEL formulary, Pharmacist to review for further guidance on shared-care agreements. | Specialist/Secondary Care Clinics | ||
Allergy Clinic | Technician / DispenserPharmacist | If patient is < 12 years old. | Specialist/Secondary Care Clinics | ||
Haematology or Oncology Clinic | Technician / DispenserPharmacist | For guidance on initiating or continuing controlled drugs. | Specialist/Secondary Care Clinics | ||
Discharge Summaries | Technician / DispenserPharmacist | For guidance on monitoring, follow up reviews, and screening any complex medication changes. | Other Hospital & Clinical Letters | ||
A&E | Technician / DispenserPharmacist | If there are any complex drug changes, any GREY/RED medications requested, or for guidance on monitoring. | Check for any medications supplied that are advised for ‘GP to continue’. A+E letters do not routinely require addition to repeat medications. Any acute medications supplied by A+E should not routinely be added to patients prescription record unless advised by pharmacist. | Other Hospital & Clinical Letters | |
Palliative Care Team | Pharmacist | Should be processed as a priority. | Other Hospital & Clinical Letters | ||
Mental Health Team | Technician / DispenserPharmacist | If new prescribing of antipsychotics, any ADHD medication, requests for cross tapering anti-depressants, or patients with severe mental health needs (because of high risk self harm/overdose). | May need 7-day scripts. | Other Hospital & Clinical Letters | |
Midwife | Technician / DispenserPharmacist | Medicines Complete for Drugs in Pregnancy and Lactation and BUMPs | If any antibiotics requested for UTI. | Other Hospital & Clinical Letters | |
NHS 111 or Pharmacy | Technician / DispenserPharmacist | If unsure on expected actions. | Consider if letter require escalation to duty-doctor, i.e. any advice for patient to be monitored by own GP. If the patient requested any emergency supplies via the Pharmacy First service - is the patients repeat prescription up to date? | Other Hospital & Clinical Letters | |
Shared Care Agreements | Pharmacist | Other Hospital & Clinical Letters | |||
Private Clinic | Technician / DispenserPharmacist | For guidance on requests to transfer to GP for prescribing. | Private Providers & Third Parties | ||
Gender Identity or ADHD Clinic | Pharmacist | Private Providers & Third Parties | |||
Patients or Other Third Parties | Technician / DispenserPharmacist | If unsure on expected actions. | Private Providers & Third Parties |
- SEL Joint Medicines Formulary
- BNF
- SPS: Drug Monitoring Requirements
- MedicinesComplete: Martindale (for checking licensing - ask pharmacy lead for log-in details)
- NEWT Guidelines (for checking if tablets can be crushed or dispersed - ask pharmacy lead for log-in details)
- Key Resources - Drugs & Medicines
- Drug Monitoring
- EMIS Prescribing
- Repeat Prescribing