A commissioned 'repeat prescription review' service in community pharmacy should be explored to improve medicines adherence and patient understanding, the Royal Pharmaceutical Society (RPS) and Royal College of GPs (RCGP) have suggested.

The recommendation comes as part of 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 community pharmacies, GP practices, and primary care networks (PCNs) 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.

But the RPS and RCGP noted that 'some areas were outside the scope' of their working group, including 'changes in commissioning responsibilities or regulatory arrangements'.

They therefore issued 10 recommendations to support the work.

Funding recommended for community pharmacies to improve repeat prescribing

In particular, they encouraged commissioners to consider incentivisation for practices/PCNs and community pharmacies to engage with the toolkit.

And they suggested that 'the terms of service for NHS community pharmacies and the Community Pharmacy Contractual Framework could formally enable pharmacy teams to support patients to discuss how they are taking their medicines and raise any concerns with their community pharmacist at the point of dispensing'.

They added: 'The development and commissioning of a community pharmacy service to help people who are struggling or unable to manage their repeat prescriptions effectively could be explored.

'Such a "repeat prescription review service" could meet the needs of the large number of patients who express confusion about what medicines they have been asked to take and how to take them safely.

'Such a service could be tested to explore its impact on adherence and reducing the ordering of medicines that the patients are no longer taking.'

The need to raise awareness of medication safety, medicines waste and the environmental impact of medicines was also highlighted, with the guidance suggesting that 'a national, public awareness campaign should be considered'.

The guidance also called for commissioners to explore 'the formalisation and contractualisation of protected time to allow for discussion between general practice and community pharmacy'.

And it advised practices 'to make use of the nationally commissioned new medicines service (NMS) from their local community pharmacies'.

Hospital discharge process must be improved

The RPS and RCGP also highlighted the need to 'expedite digital solutions' that would allow hospital discharge medicines information to link into the patient record.

And they noted that utilisation of the Discharge Medicines Service (DMS) in England was 'currently not fully optimised'.

'The DMS enables hospitals to digitally share information about medication changes with the patient’s usual community pharmacy and has been shown to reduce readmission rates at 30, 60 and 90 days. Trusts and community pharmacies should make the most of this opportunity to reduce avoidable harm,' the guidance recommended.

The RPS and RCGP asked 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'.

They added: 'Any medicines stopped need to also be clearly documented with a reason for the cessation of therapy.'

The toolkit noted an example of a 2019 medication safety incident in which a patient was discharged from hospital with a prescription for 100 mL of oral morphine sulphate 10 mg/5 mL solution for acute pain relief.

But after discharge, the patient began to receive 300 mL of oral morphine sulphate 10 mg/5 mL regularly on repeat prescription, which continued, unchecked for four months.

Shortly after this, the patient died, and toxicology tests revealed a fatal level of morphine in their blood.

The coroner raised concerns that the local community pharmacy had requested repeat prescriptions without seeking the view of the patient. And they asked all pharmacists making a request for a prescription to a GP to ensure that the wishes of the patient are obtained, save in circumstances where this is not possible such as where the patient lacks capacity.

The new guidance asked general practice and community pharmacies to ensure that all high-risk medicines and particularly opioids, antidepressants and hypnotic medicines, 'are treated very carefully where they are to be prescribed as a repeat medication'.

James Davies, RPS director for England, told The Pharmacist that while 'many pharmacies have ceased their repeat ordering services or moved to a digital solution where the patient places the order', the RPS 'wanted to highlight the issue in the toolkit to remind pharmacy professionals that repeat ordering services need to have clear arrangements for consent'.