By Clare Howard, RPS Fellow and Clinical Lead author, the Repeat Prescribing Toolkit
I’m delighted to be the lead clinical author on the Repeat Prescribing Toolkit, a new resource from the Royal Pharmaceutical Society in collaboration with the Royal College of General Practice.
Way back in the early 2000s, I worked with a small group of fantastic GP practices. They were very open and supportive, allowing me to really understand how they managed their repeat prescribing processes.
My approach focused on the medication safety of each practice’s repeat prescribing system, and I learned a lot. Little did I know that this small project would lead me to be involved with improving repeat prescribing processes for nearly 25 years.
In completing this audit work, I saw that each GP practice operated differently and that issues around clinical risk, medication safety and practice team efficiency could all be addressed.
Shortly after completing the project, we successfully bid to become a Department of Health repeat dispensing (RD) pathfinder site and established RD in dispensing and non-dispensing GP practices. While not perfect, RD did show that, when general practice and community pharmacy work together and new systems are sensibly introduced, significant gains in repeat prescribing efficiency are possible without compromising patient safety. The patients that I spoke to loved RD convincing me that repeat prescribing systems can be improved to benefit both practices and patients.
In September 2021, the DHSC National Overprescribing Review report was published in England and rightly highlighted the effect that poorly managed and monitored repeat prescribing systems have on overprescribing or polypharmacy. Some patients expressed concerns about taking, medicines such as antidepressants, for long periods without adequate review.
Recommendation 7 of the report asked the RCGP and RPS to develop a toolkit to improve the consistency of repeat prescribing processes in general practice and support this with training resources. This would be the first national guidance for 20 years – and both electronic prescribing (EPS) and electronic Repeat Dispensing (eRD) had become available during that time.
We set out to create a practical tool that GP practices can use to self-assess their current repeat prescribing processes.
This webinar explains how we established this process for the work
Medication safety
We approached this project with a strong focus on medication safety. Whilst most patients receive their repeat medicines safely, some are prescribed high-risk medicines for long periods of time without proper monitoring or review. We reviewed Coroner’s Prevention of Future Deaths reports (PFD) linked to this issue which made for very sobering reading. Our toolkit aims to help practices assess how robust their current arrangements are.
Organisational Culture
With the immense pressure that general practice is under, it is hard to carve out the time to think about the culture in the practice but not doing so means that opportunities to improve efficiency and safety can be missed.
It’s important for practices to think about their organisational culture before tackling repeat prescribing. In line with NHS England’s primary care safety strategy, the culture in the practice dictates how medication safety and processes like repeat prescribing operate. It’s important that all staff feel able to highlight areas of concern.
How to use the toolkit
We hope that GPs, Pharmacists, Practice Managers and reception staff will look at the self-assessment questions in section 7 and complete an honest appraisal of where the risks lie in relation to their repeat prescribing practice.
Collaboration with community pharmacies and Patient Participation Groups can provide valuable insights into how well repeat prescribing systems are functioning.
Pharmacists working in general practice can play a significant and leading role in this work, but it requires the whole practice team’s involvement and commitment to achieve lasting improvements.
Take a look at the RPS/RCGP Repeat Prescribing Toolkit
Watch the webinar
Find out how RPS can help you with prescribing support
Read more RPS blogs.