New national repeat prescribing guidance has been published in a bid to improve consistency and patient safety – and practice pharmacists have been described as 'well placed' to lead its implementation.

The Royal Pharmaceutical Society (RPS) and the Royal College of GPs (RCGP) have this week launched a new repeat prescribing toolkit, in what is believed to be the first guidance of its kind for 20 years.

The 92-page blueprint encourages GP practices, PCNs and community pharmacies to work together to understand their repeat prescribing processes through a self-assessment exercise.

It sets out how teams could map out their prescribing processes and make changes to improve efficiency for healthcare teams as well as patient safety.

For instance, it highlighted one practice where patients requiring regular blood tests as part of medication monitoring had not carried this out consistently or had not checked the results before authorising repeat prescriptions. In this practice, one patient on high risk-medicines had not had blood tests recorded for 12 months and others had no blood tests recorded at all.

And in another practice with a dispensary, 35% of dispensary tasks were missed, including tasks relating to controlled drugs, while 39% of administrative/reception jobs were missed, such as booking medication review appointments for patients.

Overhauling this process saved approximately 11 hours per day of dispensary and admin/reception teams’ time was released, and patients felt 'reassured, supported and better informed', the guidance reported.

While in another practice, redesigning the repeat prescribing process saved over 28 hours of GP time and 42 hours of reception team time per month, the toolkit highlighted.

The national guidance advised that 'PCNs or practice pharmacists are well placed to lead this work'.

But it noted that 'improvements are most likely to happen where the whole practice team is involved in addressing any issues'.

And it said practice managers and prescribing lead GPs could play a 'key role' in 'helping to keep up momentum and support any changes'.

'This work will need a team/PCN approach,' the toolkit said.

And it made wider suggestions to improve repeat prescribing in the future, including:

  • Incentivising practices, PCNs and community pharmacies to engage with the toolkit
  • Improving GP and pharmacy systems with greater functionality to help to recognise the oversupply and over ordering of repeat medication, particularly for higher-risk medicines, and help practices and pharmacies to identify and address it
  • Further development of the NHSBSA (NHS Business Services Authority) and NHSE oversupply tool to increase functionality to measure the oversupply of higher-risk medicines such as opioids, antidepressants, benzodiazepines and antimicrobials
  • Funding community pharmacies to discuss medicines adherence and concerns with patients
  • 'Urgently modernising' the electronic repeat dispensing process 'to ensure it works smoothly and resolve some of the well-known challenges'
  • Launching a national and accredited course for non-clinical staff who are essential in supporting the repeat prescribing process and support given to GP practices to enable reception staff to have the time to complete such training
  • Raising awareness of, medication safety, medicines waste and the environmental impact of medicines
  • Digital solutions to allow hospital discharge information relating to medicines to link into the patient record should be expediated
  • Secondary care and specialist services to make very clear to primary care on discharge of a patient from hospital, the reasons for medicines to be prescribed on repeat, the indication and the intended duration of therapy
  • The commissioning of a clinical guideline to pull together, in one place, recommendations on the frequency of medication reviews for all higher risk, repeat medications
  • Exploring the formalisation and contractualisation of protected time to allow for discussion between general practice and community pharmacy
  • A national review of the issue of ‘bulk authorisation’ of repeat prescriptions

Clare Howard, RPS fellow and clinical lead author said the toolkit represented 'a significant step forward in ensuring the safety and efficiency of repeat prescribing systems, ultimately benefiting patients and the NHS as a whole'.

While Dr Michael Mulholland, honorary secretary of the RCGP, said that repeat prescribing 'makes up a large part of general practice workload and we need to make sure we are always streamlining and improving the process'.

Professor Tony Avery, national clinical director for prescribing at NHS England, thanked the RPS and RCGP 'for their excellent work in producing this toolkit'.

'I feel certain that it will prove a useful resource for general practices and community pharmacies and will benefit patients,' he said.

'With over one billion prescriptions dispensed annually in England, over three quarters of which are repeat prescriptions, it is essential that repeat prescribing systems in general practices are safe for patients and efficient for all involved.'