The total number of prescriptions generated in the UK in 2020 exceeded 1.4 billion in comparison to a mere 813 million 10 years previously.
Prescription therapy in the UK is bigger business than ever and provides a fundamental service to those needing short or long term medications/aids. The prescription process however has been subject to unexpected pressures and changes in recent years that affect both prescribers, pharmacists and patients.
Having the luxury of ordering your repeat medications or having access to acute therapy on prescription is something the UK has led in for years. However, when the process breaks down, this can leave patients without vital medications.
In order to see where changes can be made to improve the process, it’s necessary to see how all the moving parts can affect each other.
Requesting a Prescription
In 2022, prescriptions can be requested in a variety of ways. In person at the surgery using a pre-printed repeat slip or written request, by dedicated telephone lines, online via Patient Access or by using a local pharmacy.
The average turnaround once the surgery has received a request for repeat prescriptions in the UK is 72 hours (3 working days). However, on occasion, this process can take longer.
An additional problem can occur if a patient requests items they are very close to completely running out of. In this case the 72 hour workaround can mean a patient is left without medication.
Within the surgery, prescription requests also come in via letter from hospitals, other third party medical entities (eg: physiotherapists, mental health community teams) and district nursing teams.
Once the requests arrive in their various forms, the administration teams then forward the requests to the GP. This can be the GP on duty that day, or, if there are a significant number, the prescription requests are shared amongst prescribers.
The authorising GP then has several checks to make before signing the request.
- Two patient identifiers have to be checked.
- Check medication requested is a new medication or has been repeated before.
- Does the medication have any contraindications to other medicines prescribed, particularly if it’s new?
- What is the quantity being requested?
- Does the patient need a medication review before issuing?
- Does the patient need any monitoring tests before issuing (the effects of many medications need to be monitored using blood tests and BP readings)
- Are there any current warnings about the medication such as availability or substituted medications.
- Is the patient asking for more than one drug and if so do the quantities match or will there be another request?
- Is the requested drug being overused or underused according to dosage instructions?
- Is there a more efficient and effective way of prescribing?
- Are there any special considerations such as urgency?
- Is it a controlled drug which has different considerations to other medications?
In most practices, the duty GP allocated to prescriptions is also on duty for same day phone calls and urgent appointments. This then reduces the time available for prescriptions. If prescription authorisation is split between other authorising clinicians, this is on top of their own workload and appointments.
Once the prescription is authorised it is most commonly sent electronically to the patients chosen pharmacy.
Upon receipt of an NHS prescription, pharmacy staff must check if the item(s) can be prescribed on the NHS prior to dispensing. The following factors need to be established:
- Nature of product. Is the drug permitted on the NHS or is the appliance as an exception?
- Prescriber type. Does the prescriber hold relevant registration(s) to issue prescriptions for the requested items?
- Dental or Nurse Prescribers’ formulary. Are the prescribed items listed in the relevant prescribers formulary?
- Form type. Is the product prescribed on a valid NHS prescription?
- Prescriber endorsements. Has the prescriber annotated the prescription with the correct endorsements?
Therefore, with many variables affecting the process of a repeat prescription added to the volume of requests, delays can occur.
So how can this be improved?
- Change the method with which you request your prescription. It might be beneficial to arrange with your local pharmacist that they request your repeat medications on your behalf.
- Request medications earlier that 3 days. The GP recommends 5-7 days before running out.
- Sign up for Patient Access. This enables you to order your repeat meds with the click of a button any time of day or night. This is then received by the practice once the shift starts at 8:00am each day.
- Liaise with the pharmacist about potential availability of medications to pre-empt any deficit.
- Ensure you book and attend any appointments you are requested to that relate to medication or condition monitoring. Non-attendance of routine testing can delay the authorisation of your medication.
- Can the medication you require be bought over the counter? Paracetamol, antihistamines, indigestion relief, decongestants etc. can be bought from most stores at reasonable prices.
- Plan ahead – if you are going on holiday please place repeat medication requests into the surgery giving plenty of time for processing.
Follow the link for more information about UK prescriptions
