Better use of repeat dispensing would improve patient care

Ash_Soni_0411By Ash Soni, Vice Chair of the English Pharmacy Board
The Government announced today that prescription charges in England will rise from £7.85 to £8.05 on 1st April.

A new report, Prescription Charges and Employment, from The Prescription Charges Coalition has found that the cost of prescription charges prevents over a third of people with long term conditions who pay for their prescriptions from taking their medicines as prescribed. Some face medicines poverty, having to choose between paying for their medication and household expenses such as food or heating.

The RPS is a member of the Prescription Charges Coalition, a group of 29 organisations calling on all political parties to address this issue by agreeing to abolish the system of selective exemptions from the charge for people with long-term conditions.

One of the report’s recommendations is to lengthen the duration of GP prescribing intervals for people taking medication for a stable long-term condition, while maintaining their contact with the pharmacist.

Repeat dispensing schemes, enabling a prescriber to issue a batch of monthly prescriptions held by a pharmacy of the patient’s choice, could also be more effectively utilised, where identified to be appropriate.

Linking the prescription charge to the repeat authorisation, rather than to each prescription form, is likely to increase medicine adherence through reduced costs and inconvenience for this specific group of patients. It would also relieve pressure on GP workloads, while maintaining oversight and effective medicines optimisation at pharmacy level.

Sounds complex? Here’s a hypothetical example of how it could work:

Sarah has high blood pressure and is prescribed 28 tablets of Atenolol every month by her doctor. Her GP looks at her case notes and decides her condition is stable enough to provide a batch of six prescriptions to her pharmacist, from whom Sarah will collect her medicines on a monthly basis.

Because Sarah is receiving the same medicine every month, she will only have to pay the prescription charge once, at the start of the new system. If she was prescribed three medicines, she’d have to pay three charges at once – but that’s all, for the six month period. Her GP is pleased, as it removes the admin burden of having to write monthly prescriptions. He also knows that the monthly dispensing arrangement means that he doesn’t have to worry about medicines waste as she isn’t holding 6 months worth of medicine in advance. He continues to see her twice a year for a review.

This shift also moves the provision of care to centre on individual patient needs and allows for agreement between the prescriber, patient and pharmacist on the period of time between authorisation of a new prescription. It would also reduce the cost of prescriptions for some patients which could make a real difference to those struggling to pay for prescriptions. It seems an obvious benefit for all to me.