REpeat medication management, prescription collection and delivery services

Toolkit

This information sheet is designed to be of assistance to superintendents and pharmacy teams and intended as a resource to help review practices and policies, offering guidance on repeat medication management, prescription collection and delivery services. The care, well-being and safety of patients must be paramount in the delivery of professional services. 

By repeat medication management service we mean a service that is operated in co-operation with local prescribers, in which pharmacists and pharmacy teams provide professional support to assist patients in the rational, safe, effective use of medicines.

By prescription collection service we mean any scheme where a pharmacy receives or collect prescriptions on behalf of the patient, their carer or their representative.

By delivery service we mean where a medicine is delivered to a patient or their carer away from the registered pharmacy premises.

Consent 

All people using the services have given consent

GPhC standards of conduct, ethics and performance require registrants to “Get consent for the professional services you provide and the patient information you use"

Further detailed information is available from GPhC guidance on consent which defines and explains the different types of consent. This adds “You must use your professional judgement to decide what type of consent to get

For consent to be valid it must be informed, according to GPhC the person must ‘have sufficient, balanced information to allow them to make an informed decision

Consent can be provided by people in different ways for example:

  • By an action: A person dropping in a repeat slip to the pharmacy for transferring to the clinic
  • By conversation: A person calling or speaking to the pharmacy team to request a repeat, collection or delivery
  • In writing: A person emailing the pharmacy to request a repeat, collection or delivery.

If a ‘patient reminder system’ is part of the repeat medication service, then written consent helps the pharmacy to show that consent exists to contact the patient to re-order required medicines.

Where patients have asked for their medicines to be delivered to neighbours patient confidentiality must also be protected.


Pharmaceutical care

All people using the services are provided with high quality pharmaceutical care and can use their medicines safely and effectively

People using these services (particularly delivery services) are more likely to have little, if any, personal contact with the pharmacy team or other healthcare professionals. They maybe housebound, disabled or elderly but deserve the same high quality pharmaceutical care provided to others. To achieve this consider:

  • Confirming with the patient or carer whether the medicines are needed before re-ordering
  • Whether the medication prescribed is 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 patient or carer is needed
  • Whether there are adherence or compliance issues
  • When providing a repeat medication management service, the pharmacy team should take care to order medicines using an interval that takes into account the risk of prescribing changes, appropriate quantities, time for the clinic to process a request and a responsive service for patients
  • Checking that you have the correct contact details for the patient or carer.

Audit trail

A robust audit trail is available for services

GPhC standards of conduct, ethics and performance require registrants to “Keep full and accurate records of the professional services you provide in a clear and legible form

An audit trail helps to maintain a responsive service to patients, allowing the pharmacy team to know what has happened to a patient request for medicines, and 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 patients or 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

The services are able to improve in response to feedback, enhancing quality of care. There is an improvement system.

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 e.g:

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

Confidentiality - The services are run in away which protect patient confidentiality

All services need to be designed to protect patient confidentiality as required by legislation, regulatory standards, NHS regulations and NHS codes of practice, including in situations where patients have asked for their medication to be delivered to neighbours.


Stakeholders

Stakeholders are supportive of the services and can input into service design.

Successful services operate with the support of local prescribers and people using them. It is important when designing services to work with prescribers, patients, carers and family members.

The Scottish Government have indicated that in Scotland managed repeat medication schemes should only be used in exceptional circumstances with the agreement of the GP practice and patient or carer.


Efficiency

Services are designed efficiently, helping people to take medicines the way they should, thereby reducing waste.

Improving adherence and the reduction of avoidable waste are key national priorities for the NHS. The pharmacy team has a significant role in supporting these priorities by ensuring that systems are in place so that medicines supplied are clinically appropriate, and that medicines which are not needed are not re-ordered and supplied.

  • When providing a repeat medication management service, re-order medicines using an interval that takes into account time for the surgery to process the request, a responsive service for patients and as close as possible to expected time of supply in order to mitigate the risk of prescribing changes
  • A regular conversation with the patient or carer can help to confirm that medication is still required and appropriate
  • Medication which is not supplied should be recorded in medication records and discussed with the prescriber as appropriate.
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