Repeat prescribing

Repeat prescribing allows patients to collect supplies of long-term medication without having to see a doctor and can save a GP time.

Your practice should have a repeat prescribing protocol in place, and you should familiarise yourself with the details. All staff should be trained to use the protocol, which should be dated and regularly reviewed.

MPS’s CRSA data for 2009 found that 34% of practices visited did not have a robust repeat prescribing policy in place – paving the way for prescribing risks.

Signing repeat prescriptions

GPs in a practice will normally take turns to sign repeat prescriptions and you may be asked to do this. Prescriptions should be generated in a quiet location where full concentration can be devoted to the task – signing prescriptions in a busy reception area is not ideal. The first time you do this it will take time, but remember that the legal responsibility for prescribing lies with the doctor who signs the prescription. This responsibility is the same whether it is a first or repeat prescription.

If you are uncertain about a particular prescription, do not feel pressurised into signing it simply because there are a pile of requests waiting. Have confidence in what you know, and what you don’t know. The notes should be available for you to refer to.

If you are unsure, you should:

  • Check the details of the drug if you are unfamiliar with it.
  • Check the patient’s medical record and contact them if necessary.
  • Discuss it with your trainer.
  • Pass the prescription back to the partner who knows the patient best.
  • Decline to sign it until the patient has made an appointment.

One recurring problem with repeat prescribing is that the initial error is repeated, and compounded. As a fresh pair of eyes you are in a good position to spot potential problems that more senior colleagues may have skipped.

For more information see the National Prescribing Centre’s Dispensing with Repeats: A Practical Guide to Repeat Dispensing, 2nd edition (2008).

Suitable drugs for repeat prescribing

A traffic light system is a good way of monitoring which drugs are suitable for a repeat prescribing approach:

  • Drugs that require minimum levels of monitoring (eg, antihistamines)
  • Drugs that are commonly prescribed on repeat but require careful monitoring (eg, thyroxine, statins, inhalers, insulin, etc)
  • Drugs that are not (usually) suitable for repeat prescribing (eg, hypnotics, antidepressants).

Case study – One prescription after another

Sixty-year-old Mrs F visited her GP, Dr L, complaining of tiredness and weight gain. Dr L requested some thyroid function tests and diagnosed hypothyroidism. Mrs F was prescribed thyroxine. The next time Dr L saw Mrs F she was feeling much better. Her latest blood test showed that she was euthyroid, and Dr L advised her to continue taking the same dose of thyroxine.

Over the next ten years, Mrs F regularly visited her GP practice to discuss her asthma and osteoarthritis. She requested thyroxine on repeat prescription, along with her other medications. Her prescriptions were signed by a variety of doctors from the practice. Mrs F didn’t ask any further questions about her thyroid condition and none of the doctors discussed her treatment.

A decade after being diagnosed with hypothyroidism Mrs F had a CVA, which led to paralysis. Thyroid function tests showed that she had sub-clinical hyperthyroidism.

Expert opinion suggested that Mrs F’s stroke could have been the result of arrythmias induced by excessive thyroxine therapy, and was critical of the GP’s lack of monitoring. Regular blood tests would have indicated the need to reduce Mrs F’s dose of thyroxine.

The case was settled for a substantial amount.

Source: Casebook Vol. 16 no. 1 - January 2008.

Tags