RPS professional practice guide

Supporting people to manage their repeat medicines

People can access and manage their repeat medicines in different ways through their pharmacy. There are NHS repeat medication services such as ‘Repeat Dispensing’ (England), ‘Batch Repeat Dispensing service’ (Wales) and ‘Medicines Care Review’ (previously Chronic Medication Service) (Scotland). There are also non-NHS repeat medication services depending on the pharmacy.

The care, well-being and safety of people must be paramount in the delivery of professional pharmacy services such as repeat medicines management, prescription collection and delivery.

This guide can be used by superintendents and pharmacy teams to support with;

  • Reviewing practices and policies
  • Repeat medicines management services – in collaboration with local prescribers, where the pharmacy team provide professional support to people on the rational, safe and effective use of medicines
  • Prescription collection services – where the pharmacy team receives or collects prescriptions on behalf of a person, their carer or representative
  • Delivery services – where a medicine is delivered to a person, their carer or representative.

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You should consider the following when implementing any repeat medicines management service, prescription collection service or delivery service. 

Consent 

GPhC standards for pharmacy professionals require you to ‘‘obtain consent to provide care and pharmacy services’’.

GPhC guidance on consent defines and explains the different types of consent and says:

For consent to be valid, the person must “have sufficient, balanced information to allow them to make an informed decision”.

Consent can be provided by people in different ways:

  • By an action – a person dropping in a repeat slip to the pharmacy team to be sent to the practice on their behalf
  • By conversation – a person calling or speaking to the pharmacy team to request a repeat medicine, collection or delivery
  • In writing – a person emailing the pharmacy team to request a repeat medicine, collection or delivery.

Use your professional judgement to decide what type of consent to get while considering legal requirements, NHS service requirements, and local policies.

Where appropriate, record what the person is consenting to.

Examples include:

  • If a person has given consent for their medicines to be delivered to a neighbour
  • If a ‘reminder system’ is part of the repeat medicines management service, then written consent helps the pharmacy team show that consent exists to contact the person to re-order required medicines.

 

Pharmaceutical care

Ensure all people using these services are provided with high quality pharmaceutical care and can use their medicines safely and effectively. 

Some people using these services may have little, if any, personal contact with the pharmacy team or other healthcare professionals. For example, a person may not be able to leave the house due to a condition which affects their mobility, but they deserve the same high-quality pharmaceutical care provided to others.

To achieve this and to safeguard people, consider:

  • Providing information to people about the services available to them so they can make an informed choice
  • Educating the person or their carer about how the service works
  • Checking you have the correct contact details for the person or their carer
  • Making sure the pharmacy team providing services are appropriately trained and follow correct procedures
  • Confirming with the person or their carer at the time of ordering whether each individual medicine is still being needed, this includes ‘when required’ medicines
  • Whether each of the medicines prescribed are still clinically appropriate at the time of supply and the risks of not supplying
  • Whether a direct conversation, or face-to-face contact with the person or their carer is needed
  • Whether there are adherence or compliance issues
  • Whether referral to the prescriber is necessary e.g. new or acute medicines requests may need a review appointment first
  • Whether the person has ownership of their medicines and has been involved in the ordering process – avoid asking if “all the medicines” are needed
  • Whether recent changes to medicines could have been made but not updated on the persons repeat e.g. medicine changes post hospital discharge – consider if a medicines review is needed to support transfer of care
  • Whether access to electronic health records (where available and with consent) is needed e.g. use of Summary Care Record (England) – for information on acute, repeat and discontinued repeat items.

 

Audit trail

Ensure a robust audit trail is available for these services. An audit trail helps to maintain a responsive service to people, allowing the pharmacy team to know what has happened to a person’s request for medicines. It also provides evidence of quality for regulators and commissioners.

Examples of good record keeping include:

  • A record of interventions
  • A signature to indicate safe receipt of medicines by the person or their carer should be obtained
  • Near miss and improvement cycle documentation
  • Records for when delivery is not successful
  • Records for when medicines have not been collected from the pharmacy and actions

Improving quality

An indicator of high-quality services is the existence of a system which can improve through the feedback of service users as well as staff delivering the service, to enhance quality of care.

Examples of systems include:

  • Regular audit/review of service
  • Review of incidents and errors.

The following resources can be used to support with improving quality: clinical audit hub, professional standards on error reporting and our pharmacy guides on raising concerns, near misses errors and making things right when there's been a dispensing error.

Confidentiality

All services need to be designed to protect a person’s confidentiality as required by legislation, regulatory standards, NHS regulations and NHS codes of practice. An example of this is where patients have asked for their medicines to be delivered to a neighbour, patient confidentiality must also be protected.

For further information, see GPhC guidance on confidentiality and RPS GDPR news.

Stakeholders

Successful services operate with the support of local prescribers and people using them.

It’s important when designing services to work collaboratively with prescribers, people, carers and family members.

It’s also important to consider and support the efficient and effective working in both the pharmacy and the practice.

Collaboration with the practice team is essential. If there’s a pharmacist at the practice, consider suggesting a meeting to discuss:

  • How you can work together to share information
  • How you can deal with repeat medicine requests in the best way
  • The services you offer including NHS and non-NHS repeat medication services

Responsibilities and workload can be distributed better as you have different strengths that can be brought together to benefit the person needing the medicine. For example, community pharmacists will have knowledge on the person needing the medicine and their ordering patterns and knowledge of the services. Practice pharmacists will have access to medical records, the prescriber, and have a better understanding of GP practice preferences.

Reviewing people’s medicines regularly is essential by both community pharmacist, practice pharmacists or prescriber

The Scottish Governmenhas indicated that in Scotland managed repeat medicines schemes should only be used in exceptional circumstances with the agreement of the GP practice and person or their carer.

Efficiency

Improving adherence and reducing medicine waste are key national priorities for the NHS.

Pharmacy teams have a significant role in supporting these priorities by ensuring that systems are in place so that medicines supplied are clinically appropriate and used correctly. Ensure that medicines which are not needed are not re-ordered and supplied.

To achieve this, consider:

  • Having a regular conversation with the person or their carer to confirm that each of the medicines are still required and appropriate
  • Re-ordering medicines taking into consideration the time needed for the practice to process the request and the persons need for the medicine
  • Re-ordering medicines as close as possible to the expected time of supply to mitigate the risk of prescribing changes
  • Recording medicines which are not supplied in the person records and discussing with the prescriber if appropriate.