1️⃣ Receiving requests

How patients can send a request

• We can accept requests from patients, someone nominated by the patient, district nurses, pharmacists and care homes
• There is an accurx (named ‘Ordering repeat prescriptions’) available to send to patients to remind them how they can request repeat medication
• Email prescription requests in the Generic Inbox should be moved to the Pharmacists folder for actioning.

Telephone Requests

• Prescription requests should not be accepted by phone, except under specific circumstances where a patient is unable to access any of the options mentioned above.
• In such cases, all staff should ensure that everything is properly documented, with the addition of a note on the patient’s EMIS record to state that “telephone prescription requests accepted due to <insert reason>.”

Turnaround times

Urgent Prescriptions

Requests for urgent repeat prescriptions (less than 48 hours) → send urgent Task pharmacy to review the request. If the medication is needed that same day, they will process it immediately. Once the prescription is completed, contact the patient to let them know that it has been sent to the pharmacy.

2️⃣ Processing by pharmacy team

Inbox for requests

• Paper prescription requests can be found at reception in the designated Prescription Box
• Email requests can be found in the ‘Pharmacist’ folder on each practice’s generic inbox
• Online requests can be found in ‘Requests’ and ‘Requests with Queries’ in Workflow Manager under ‘Medicine Management’ in EMIS

Checks

Most prescriptions are checked by Pharmacy Technicians. All requests should be checked to ensure they are clinically and practically valid prior to processing, and sending for signing.

1. Confirm the patient’s details against EMIS, especially if the request is on paper or through email
2. Confirm the correct dose, strength & form, and that the request is coming at an appropriate interval (as seen in under- or over-use)
3. Ensure the indication given is still accurate, and is within the number of authorised issues remaining, if appropriate
4. Check if the medication has any monitoring requirements, or if the medication needs reviewing
5. Review any recent letters & appointments to ensure no medication changes
6. If there any queries, our pharmacists will be able to review any requests. If they are unable to resolve the issue, this should be escalated to the prescriber.

Signs of Misuse

Rejections

Repeat intervals

• Repeats should be issued in good time to avoid interruption in treatment. In practice, this means a maximum of 14 days before.
• Patients may request their medication early if they are going on holiday, for example. This should be discussed with the prescriber.
• Patients should have their medications synchronised, so they can be ordered and collected at the same time - if you issue an unusual quantity, leave a note to explain why (To synchronise, or to replace a lost pack etc.)

Exceptions to 3 month issues

• Schedule 2 & 3 Controlled Drugs must be limited to 30 days
• Between 6 months & 1 year for contraceptives and HRT, once the patient has been reviewed
• Dosette boxes & MDS should be issued for 28 days

Electronic repeat dispensing

eRD allows a prescriber to authorise, or pre-issue, a batch of prescriptions at once, for up to 1 year (4 issues of our regular 84 day interval)

• All 4 prescriptions will be sent to the pharmacy, but can only be dispensed at intervals specified when setting up the eRD (They will be made available 7 days before the next batch is due)
• Only after the 4 issues have been used will we have to re-issue prescriptions
• This process reduces the frequency a patient needs to request prescriptions, and makes the collection process easier for them
• When issuing a drug on EMIS, Change the ‘Rx Type’ to ‘Repeat Dispensing’ and enter 4 into ‘Authorised issues’ (ensuring the duration is 84 days)
• Ensure all 4 issues have been used previously, before issuing a new eRD

See also EMIS NOW: Repeat Dispensing (no sign in required)

3️⃣ Signing prescriptions

Signing Process

• Prescription requests have usually been screened by a pharmacy technician, however occasionally another clinician or reception team will generate the request
• Any prescription or medication queries should be raised to the pharmacy team first, and then to the GP if unresolved
• EPS Nominations should be changed before issuing prescriptions - see below

Specific cases & monitoring

• Drugs that need frequent monitoring must have reviews recorded in the patient’s record - if using blood tests from the hospital, these must be moved into EMIS
• Before reissuing any prescriptions for CDs, the Pharmacy Team and the signing doctor should check that quantities and timing of request are appropriate
• If a controlled drug script is being written by hand, it must have the total quantity & dosage in words and figures

See also 🖥️Drug Monitoring

Generic & unlicensed prescribing

Generic

All medications should be prescribed generically, using their approved name as stated in the BNF, unless specified and documented otherwise.

Unlicensed

The GMC Guidance advises:

Unlicensed medicine is a term used to describe medicines which are not licensed in the UK or are outside the terms of their UK licence and are commonly used in areas of medicine such as paediatrics, psychiatry, and palliative care.

• Penrose Health Clinicians may prescribe unlicensed medications when, after a thorough assessment of a patient, it is necessary for medical reasons to meet the patient’s needs
• Local and national prescribing guidelines must be always followed, including cost-effective prescribing first-line medications whenever possible and clinically appropriate. See SEL Formulary
• GSTT Provide useful information we could provide to patients

Errors

• Prescriptions issued on the recommendation of a non-prescriber, i.e., a nurse, pharmacist, or allied healthcare professional, remain the responsibility of the named, authorised prescriber
• Clinicians must only prescribe medicines, devices, or dressings when they are satisfied and have sufficient knowledge of the patient’s health and they are content that the prescription is fully justified

Patient instructions

• If there are any particular instructions (i.e. blood tests or reviews due) these should be sent in an accurx at the time of sending
• Comments added to the prescription are unlikely to be seen by the patient

4️⃣ Sending prescriptions to patients

EPS - Electronic Prescription Service

EPS allows our prescriptions to be sent to pharmacies digitally, make it more convenient and efficient compared to paper scripts.

• Private prescriptions, installment dispensed CD, and prescriptions to be collected in Scotland, Wales or Northern Ireland are to be issued on FP10s
• The only other exception is during IT downtime, where it is expected that urgent prescriptions would be handwritten on FP10s
• FP10s are kept in the surgery safe - speak to the reception manager if you need these

EPS nominations

To set an EPS Nomination

1. Open ‘Medications’ on a patient’s record
2. Click on Nominations in the top ribbon
3. Choose ‘Find’ next to Primary to select the new pharmacy

One-off Nominations

1. Open the issue screen for the appropriate medication
2. Click on Nominations on the top bar
3. Choose ‘Find’ next to “Would you like to choose One-Off Pharmacy nomination?”

How to get a token (EPS - Any Pharmacy)

This is useful if a patient is unsure where they would like to dispense a medication (i.e. on holiday, or an item is low stock)

1. From the Issue screen, select ‘Change All’
2. Select ‘EPS - Any Pharmacy’ and Issue
3. Click on the last issue date, and then right click to copy Token ID
4. Add Token to accurx message