Repeat Dispensing Operations Manual by dffhrtcv3

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									Repeat Dispensing
Operations Manual
Version 1.0
May 2007

The North Yorkshire and York PCT Manual Version 1.0 has been adapted from the
former Craven, Harrogate and Rural District PCT Manual Version 3 and Hambleton
and Richmondshire PCT Version 4.2


Contact:
Medicines Management Team
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Version Control
This document outlines simply and clearly the processes involved in
batch repeat dispensing. It provides a clear pathway of the patient
journey between the professionals.

This guide has been written using the following reference materials:

•    Centre for Pharmacy Postgraduate Education (CPPE) Repeat Dispensing
     Arrangements in England training materials
•    NHS Repeat Dispensing Schemes in England briefing paper from the Department of
     Health
•    Medicines, Ethics & Practice, A Guide for Pharmacists from the Royal Pharmaceutical
     Society of Great Britain (Version 29, July 2005)
•    West Gloucester Primary Care Trust
•    Hull and East Yorkshire Primary Care Trust.
•    Craven and Harrogate Rural District Primary Care Trust.
•    Hambleton and Richmondshire Primary care Trust

The glossary and PPA requirements have been reproduced with the kind permission of the
Centre for Pharmacy Postgraduate Education.

The EMIS Information Sheets have been reproduced with the kind permission of EMIS.




         Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

Page 2                                        Version 1.0                                              May 2007
                          North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Contents
Introduction ............................................................................................................................. 5
Overview ................................................................................................................................. 6
Information for GPs
    Patient Selection ............................................................................................................... 7
    Authorising (FP10) Prescription ........................................................................................ 9
    Batch Issue (FP10) ......................................................................................................... 11
    GP/Pharmacist Communication ...................................................................................... 12
    Termination of Batches ................................................................................................... 13
Information for Surgery Staff
    Patient Initiation............................................................................................................... 14
Information for Pharmacists
    Patient Selection ............................................................................................................. 15
    Authorising (FP10) Prescription ...................................................................................... 17
    Batch Issue (FP10) ......................................................................................................... 19
    Dispensing Prescriptions................................................................................................. 21
    Pharmacy Payment......................................................................................................... 24
    Dispensing Discretions.................................................................................................... 25
    GP/Pharmacist Communication ...................................................................................... 26
    Termination of Batches ................................................................................................... 27
    Sorting and Submission of Forms to PPA....................................................................... 28
    Ordering Forms ............................................................................................................... 29
    Glossary .......................................................................................................................... 30
    Repeat Dispensing Pharmacy Protocol .......................................................................... 32
    Repeat Dispensing Practice Protocol.............................................................................. 34
    Participating GPs and Practices...................................................................................... 35
    Participating Pharmacies ................................................................................................ 36
Appendices
   A: Consent Form ........................................................................................................... 37
   B: Patient Introduction Leaflet ....................................................................................... 39
   C: Compliance Card ...................................................................................................... 40
   D: Repeat Dispensing Log............................................................................................. 41
   E: Pharmacy Repeat Dispensing Referral Form ........................................................... 42
   F: GP Repeat Dispensing Referral Form ...................................................................... 43
   G: EMIS/Protechnic Exeter Instructions......................................................................... 44
   H: Drugs not included in the scheme ............................................................................. 45
   I: Record of destroyed batch issues form..................................................................... 46
   J: Penultimate prescriptions (Repeat Dispensing Scheme) .......................................... 47
   K: Locum Agreement Form ........................................................................................... 48
   L: Repeat Dispensing GP Practice Standard Operational Procedure ........................... 49
   M: Repeat Dispensing Community Pharmacy Standard Operational Procedure........... 50




             Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

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North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual




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         Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

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                     North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Introduction
Welcome to the North Yorkshire and York Primary Care Trust (PCT) Repeat Dispensing
service.

This is an operations manual for GPs, pharmacists, all surgery and pharmacy staff members
and anyone else who is actively involved in the repeat dispensing process. The manual is
colour-coded for greater ease.


                  Paper Colour                 Audience
                  White                        Everyone
                  Blue                         GPs, Surgery Staff
                  Lilac                        Pharmacists and Staff


Please ensure all staff involved with the repeat dispensing process read this manual.

This document not only contains the operational implementation of the statutory
requirements but also contains best practices. All best practices are listed in shaded boxes.
You are not required to implement the best practices, however, they are highly
recommended. We have included them because we believe they will ease implementation
and ongoing repeat dispensing processes.

Once you and your colleagues have finished reading the manual, please discuss the repeat
dispensing processes amongst yourselves and resolve any questions that may arise with a
member of the Medicines management Team at North Yorkshire and York Primary Care
Trust.

Keep the manual at hand for questions that arise during day-to-day repeat dispensing
activities. If you need additional copies of the manual, the PCT is happy to provide them,
please contact the Medicines Management Team (details below).

If you have questions that are not answered by this manual, please contact:

Medicines Management
North Yorkshire and York Primary Care Trust
The Hamlet
Hornbeam Park
Harrogate
HG2 8RE
Tel: 01423 815150
Fax: 01423 859600




           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

May 2007                                        Version 1.0                                              Page 5
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Overview




The graphic above represents a high-level overview of the repeat dispensing scheme. Each
step along the middle line is explained in detail in this manual.

It is important to remember - there is a good deal of flexibility in every step of the
process. The primary purposes of this service are:

1)   to simplify the repeat dispensing process for patients whilst maintaining clinical
     review and safety

2)   reduce GP practice workload.

Practices should be adopted that ensure the successful fulfilment of
these goals.



                       REMEMBER
                KEEP COMMUNICATION LOOPS
                        CLOSED



         Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

Page 6                                        Version 1.0                                              May 2007
                     North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Patient Selection
Information for GPs

1. Select patients that you feel would benefit from the scheme. Repeat dispensing is not
   suitable for all patients. It is for patients (adults or children):

    •   in a stable condition
    •   on long-term medication(s).

   You are the ultimate decision-maker. No patient may enter the scheme without
   his/her GP approval.

   Examples of ways to use the repeat dispensing scheme:

   •    patient taking Levo-thyroxine who has required no recent dose adjustments within
        the last three months and is unlikely to require a review for twelve months:
            1 authorising prescription
            12 batches of 28 days.

   •    patient taking two or three items to control hypertension, requires no further titration
        of doses, stabilised for at least three months and requires a review in six months:
            1 authorising prescription
            6 batches of 28 days medication.

   •    Patient taking hay fever medication as needed:
            1 authorising prescription
            5 batches of 28 tablets (patient can receive monthly allocation of medication as
            and when needed within one year of authorising prescription generation date).

   •    Patient takes analgesics when required. Some medicines that are not taken
        regularly, but on a ‘when required’ (prn) basis, either with other regular medicines or
        alone can still be considered as part of the Repeat Dispensing process. Where
        patients take regular medication and prn medication, consider supplying on separate
        authorising and batch prescriptions e.g. one prescription with regular medicines, one
        prescription with prn medicines.

        Repeat dispensing is not a solution for Monitored Dosage Systems (MDS) supply.

2. It is best to introduce patients to the scheme in manageable increments. Start with small
   numbers while staff gain familiarity with the scheme. Initially, apply strict inclusion and
   exclusion criteria. These could be based upon any number of characteristics (such as
   number of medicines being taken, age, whether the patient has a carer, etc).




           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

May 2007                                        Version 1.0                                              Page 7
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Patient Selection (continued)
Information for GPs

3. Work with your local pharmacists to identify good candidates for the scheme. If you feel
   comfortable that the pharmacist understands the inclusion criteria, you could ask the
   pharmacist to introduce patients to the scheme (by talking the patient through the Patient
   Introduction Leaflet, Appendix B).

4. As guidance, North Yorkshire and York PCT have developed the following criteria for
   patient selection, which has been approved by our prescribing leads.

Selection Criteria

1. The GP must decide which patients can participate in the scheme.

2. The inclusion and exclusion criteria must be considered.

   •     Inclusion criteria – all patients must comply with these criteria:
             willing to participate
             patients living in own home
             in stable condition
             no recent hospitalisation
             on long-term medication that is unchanged for three months prior to the scheme
             regularly attends the same pharmacy
             patients are competent at managing their own compliance.

   •     Exclusion criteria – any of the following must be excluded:
            patient refusal
            in unstable condition
            requiring frequent changes to their medication
            prescribed controlled drugs (Schedule 2 and 3)
            terminal illness
            dispensing patients (for the moment).

As the long-term prescribing of hypnotics and anxiolytics is discouraged, serious
consideration must be given to patients prescribed these medicines as to their suitability.
However, if the balance for patient benefit favours inclusion and the patient meets all other
inclusive criteria, then they may be incorporated onto the scheme.

3. Other health care professionals may suggest suitable patients for the scheme but this
   must be discussed with the GP before it is discussed with the patient.

Tip

Repeat dispensing pilots have identified patients on thyroxine, antihypertensive, or diabetics
stabilized on oral hypoglycaemic medication, as ideal candidates for early consideration.
          Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

Page 8                                         Version 1.0                                              May 2007
                     North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Authorising (FP10) Prescription
Information for GPs

                                   Authorising (FP10) Prescription




 The prescription
 medicines with
 the instalment                                                                        Number of batch
 interval                                                                              issues that
 (if given)                                                                            accompany the
                                                                                       authorising
                                                                                       prescription




 GP signature




This is an example of the Authorising (FP10) Prescription. The authorising prescription is
the legal authority to supply the medication. The reverse side is the same as the normal
FP10. This form must be computer generated.

1. Before you put the patient on an authorising prescription, please first synchronise the
   existing medicines. This will help to avoid drug wastage.

2. Complete the form within the EMIS/Protechnic Exeter/Torex/In-house system choosing
   the patient’s drugs and/or appliances that are needed more than once. You may list
   several items on the authorising prescription form. Controlled drugs listed in the
   Restrictions on the following page are not allowed. For directions on generating the
   authorising prescription and batch issues in EMIS/Protechnic Exeter see Appendix G.

3. Choose the number of occasions that the drugs/appliances may be provided. This will
   determine the number of batch issues printed. Remember, an authorising prescription
   may not last longer than one calendar year.

4. Do not specify an instalment interval unless clinically necessary. An instalment
   interval restricts the amount of medicines that a patient may have at one time, for
   example, listing ‘dispense every 28 days’. Without an instalment interval, the pharmacist
   has more leeway to handle unusual situations such as holiday supply. In these
   situations, pharmacists may use their professional judgement to dispense instalments at
   an appropriate time. If the GP does specify an instalment interval, such as ‘dispense

           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

May 2007                                        Version 1.0                                              Page 9
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Authorising (FP10) Prescription (continued)
Information for GPs

   every 28 days, authorising number of issues = 6’, then the patient would have to visit the
   GP to receive a one-off prescription for his/her holiday period.

5. The standard expiry of an authorising prescription is one year from the date it was
   generated. The EMIS/Protechnic Exeter software does not allow you to issue a
   prescription for more than one year.

6. Sign the Authorising Prescription only.

   The patient does not complete details on the authorising prescription, but will do so on
   the batch issues at each collection from the pharmacy.



Restrictions

   Schedule 2 and 3 controlled drugs cannot be prescribed within the scheme. Schedule 2
   includes the opiates, the major stimulants and quinalbarbitone. Schedule 3 includes a
   small number of minor stimulant drugs. You may agree to restrict other medicines as a
   policy in your practice.

   Only computer-generated prescriptions may be used in the scheme - handwritten
   prescriptions are not acceptable.

   Repeat dispensing services do not apply to bulk prescriptions.

   Hypnotics and anxiolytics require further consideration. Patient benefit must outweigh
   the desire to reduce prescribing of this class of drugs.




          Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

Page 10                                        Version 1.0                                              May 2007
                     North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Batch Issue (FP10)
Information for GPs

                                            Batch Issue (FP10)



 The
 prescription
 medicines
 with the
 instalment
 interval (if
 given)




 Batch number                                                                              Date the
 and total                                                                                 prescription
 number of                                                                                 was generated
 batches




This is an example of the Batch Issue (FP10). The batch issue enables the pharmacist to
receive payment for the provision of repeat dispensing services. The reverse side is
the same as the normal FP10.

1. The batch issue is generated by a computer with the associated authorising prescription
   and is generated on the same date as that prescription. It is not signed by the GP.

2. The patient must sign the declaration on the back of the batch issue before receiving
   each instalment.

Patients may choose to keep batch issues in their possession or they may ask the
pharmacist to store them. If the patient loses the batches, he/she must return to the GP for
a new authorising prescription. The pharmacist will need to be informed.

FOR THE PURPOSES OF SECURITY AND EFFICIENCY, PATIENTS SHOULD BE
PERSUADED THAT BATCH PRESRIPTIONS BE STORED AT THE PHARMACY.




           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

May 2007                                        Version 1.0                                              Page 11
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual

GP/Pharmacist Communication
Information for GPs

For the repeat dispensing scheme to be successful, it will require excellent communication
between GPs and pharmacists. This is not a one-off event but a lasting relationship.

1. Prior to implementing the scheme, meet with the pharmacists in your local area. At this
   meeting, discuss the following topics:

   •      The ideal patient profile – this profile may change over time. At first the profile may
          be bound to strict inclusion and exclusion criteria so that you are not overwhelmed by
          the volume of work associated with introducing patients into the scheme. However,
          once the process becomes more familiar, the exclusion criteria may be relaxed to
          allow more patients to enter the scheme.

   •      A monthly target - of the number of patients that you would like to introduce into the
          scheme – this will control the workload for staff members. Ideally, 50 patients in a six-
          month period, for an average sized surgery.

   •      Communication procedures – these are important for not only generally
          communicating about the scheme but also discussing patient-specific matters. You
          must ensure that surgery staff knows the pharmacist’s name, or a regular member of
          staff in the dispensary so that telephone calls are not unnecessarily delayed. Share
          your telephone numbers, fax numbers and email addresses. Agree upon the best
          method of communication as well as the best communication time.

   •      REMEMBER KEEP COMMUNICATION LOOPS CLOSED

   •      Method of synchronising the prescriptions – certain patients may be good
          candidates for the service but have medicines on varying schedules. The pharmacist
          may be able to help you to synchronise these medicines. Discuss this possibility and
          determine the best path of action, with your community pharmacist, prescribing
          advisor or technician.

   Document these agreements and review them on a regular basis.

2. Invite your local pharmacists to practice meetings as appropriate. This will facilitate
   regular communication.

3. Report any patient-specific medicine changes to the pharmacist. These include any
   change to the type, quantity, strength or dosage of drugs or appliances ordered on that
   person’s authorising prescription. It also includes any concerns that you may have that
   the items are no longer appropriate or safe for the patient.

A Repeat Dispensing Referral Form (Appendix F) has been produced to assist you in
contacting the pharmacist for common types of communication. The Pharmacist also has a
standard Referral Form (Appendix E).

           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

Page 12                                         Version 1.0                                              May 2007
                     North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Termination of Batches
Information for GPs

There are many instances where Batch Issues may be terminated without being filled.
Some of these include:

•   change in patients’ medication
•   loss of batch issues
•   patient decides to leave GP practice
•   patient decides to change pharmacy
•   patient does not collect remaining batches
•   the authorising prescription has expired.

In all of these instances, there must be communication between GP and pharmacist so that
appropriate action may be taken.

1. If you know that the patient’s batch issues have become invalid, contact the pharmacist.

2. The pharmacist will destroy the remaining batch issues, and record the destruction on
   the form (Appendix I).




           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

May 2007                                        Version 1.0                                              Page 13
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Patient Initiation
Information for Surgery Staff

Once the GP has decided that the patient is suitable for the scheme:

1. Ask the patient if he/she has a regular pharmacy.

2. Introduce the patient to the scheme.

   •      Give the patient an Introduction Leaflet (Appendix B).
   •      Explain the benefits of the scheme and the new way that the patient may now receive
          his/her medicines.
   •      Explain that his/her medications may not be dispensed at another pharmacy without
          returning to the surgery for a new authorising prescription.

3. Record the patient’s pharmacy choice in the patient record.

4. Give the patient a Consent Form (Appendix A) to sign.

   •      Keep one copy in the surgery, scan into computer if preferred.
   •      Give one copy to the patient for personal records.

5. Inform the patient about a Compliance Card (Appendix C) which will be completed by the
   pharmacist and given to the patient.

Patient Consent Form (Appendix A)                             Introduction
                                                              Leaflet
                                                              (Appendix B)




                                                              Compliance Card (Appendix C)




           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

Page 14                                         Version 1.0                                              May 2007
                     North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Patient Selection
Information for Pharmacists

1. Discuss patient selection with your local GPs.                         Some GPs may want your
   recommendations for suitable candidates.

   However, some GPs may prefer to handle patient selection independently. Patient
   selection has ramifications of increased workload for surgery staff as patients are
   introduced to the scheme and their medicines are synchronised. Talk to your local
   GPs before you talk to any patients.

   Recommend patients that you feel would benefit from the scheme. Repeat dispensing is
   not suitable for all patients. It is for patients who are:

   •   in a stable condition
   •   on long-term medication(s).

   The GP is the ultimate decision-maker. No patient may enter the
   scheme without his/her GP approval.

    Repeat dispensing is not meant to be a solution for Monitored Dosage Systems
    (MDS) supply.


2. As guidance, North Yorkshire and York PCT have developed the following criteria for
   patient selection, which has been approved by our prescribing leads.




           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

May 2007                                        Version 1.0                                              Page 15
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Patient Selection (continued)
Information for Pharmacists

Selection Criteria

3. The GP must decide which patients can participate in the scheme.

4. The inclusion and exclusion criteria must be considered.

      •   Inclusion criteria – all patients must comply with these criteria:
              willing to participate
              patients living in own home
              in stable condition
              no recent hospitalisation
              on long-term medication that is unchanged for three months prior to the scheme
              regularly attends the same pharmacy
              patients are competent at managing their own compliance.

      •   Exclusion criteria – any of the following must be excluded:
             patient refusal
             in unstable condition
             requiring frequent changes to their medication
             prescribed controlled drugs (Schedule 2 and 3)
             terminal illness
             dispensing patients (for the moment).

As the long-term prescribing of hypnotics and anxiolytics is discouraged, serious
consideration must be given to patients prescribed these medicines as to their suitability.
However, if the balance for patient benefit favours inclusion and the patient meets all other
inclusive criteria, then they may be incorporated onto the scheme.

5. Other health care professionals may suggest suitable patients for the scheme but this
   must be discussed with the GP before it is discussed with the patient.



Tip

Repeat dispensing pilots have identified patients on thyroxine, antihypertensive, or diabetics
stabilized on oral hypoglycaemic medication, as ideal candidates for early consideration.




           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

Page 16                                         Version 1.0                                              May 2007
                     North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Authorising (FP10) Prescription
Information for Pharmacists
                                   Authorising (FP10) Prescription




 The prescription
 medicines with
 the instalment
                                                                                    Number of batch
 interval (if given)
                                                                                    issues that
                                                                                    accompany the
                                                                                    Authorising
                                                                                    Prescription


                                                                                    Date the prescription
                                                                                    was generated
 GP signature




This is an example of the Authorising (FP10) Prescription. The authorising prescription is
the legal authority to supply the medication. It is not submitted for payment. The reverse
side is the same as the normal FP10. This form must be computer generated.

1. The first time that you receive an authorising prescription from the patient, ask the
   patient if he/she would like you to store the batch issues in the pharmacy. Please
   encourage the patient to store the batch issues at the pharmacy.

2. Stamp the authorising prescription with the pharmacy’s stamp and endorse it.

3. In addition to your normal prescription checks, pay close attention to two pieces of
   information on the form.

   Instalment Interval
   The GP may designate an instalment interval on the authorising prescription and batch
   issues such as ‘dispense every 28 days’. If this is listed, you are not allowed to
   dispense the next batch of the prescription until the 28th day or after. You will need
   to track this information so that batches are not dispensed prematurely.

   Prescription Date
   • An authorising prescription is valid for 12 months from the date it was generated.
   • The first batch issue must be dispensed for the first time within 6 months of the
      generation date.
   • Batch issues are no longer valid 12 months after the generation date.
           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

May 2007                                        Version 1.0                                              Page 17
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Authorising (FP10) Prescription (continued)
Information for Pharmacists

4. Keep the authorising prescription in the pharmacy until all batches have been dispensed
   or it is no longer valid (for example, a drug dosage has changed, it has expired, etc).

5. Send the authorising prescription to the PPA for processing (see Sorting and Submission
   of Forms to PPA Section).

     The patient does not sign the authorising prescription; the patient signs the batch
     issues.



Restrictions

     Schedule 2 and 3 controlled drugs cannot be prescribed within the scheme. Schedule 2
     includes the opiates, the major stimulants and quinalbarbitone. Schedule 3 includes a
     small number of minor stimulant drugs.

     Only computer-generated prescriptions may be used in the scheme - handwritten
     prescriptions are not acceptable.

     Repeat dispensing services do not apply to bulk prescriptions.

     Hypnotics and anxiolytics require further consideration. Patient benefit must outweigh
     the desire to reduce prescribing of this class of drugs.




          Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

Page 18                                        Version 1.0                                              May 2007
                     North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Batch Issue (FP10)
Information for Pharmacists

                                            Batch Issue (FP10)



 The
 prescription
 medicines
 with the
 instalment
 interval (if
 given)




                                                                                           Date the
 Batch number                                                                              prescription
 and total                                                                                 was generated
 number of
 batches




This is an example of the Batch Issue (FP10). The batch issue enables the pharmacist to
receive payment for the provision of repeat dispensing services. The reverse side is the
same as the normal FP10.

1. Before giving the patient his/her medicines, ask the patient to sign the declaration on the
   back of the batch issue. The batch issue is not signed by the GP.


2. Encourage the patient to leave the batch issues at the pharmacy. This will
   alleviate problems of lost or stolen batch issues.

3. Store the batch issues in a secure location.

4. If the patient loses the batches, he/she must return to the GP for a new authorising
   prescription.

5. The batch issues do not need to be dispensed in order. If a patient chooses to keep
   the batch issues and brings the batch issues into the pharmacy in the wrong order (for
   example, brings in 6 of 12 before 4 of 12), dispense as normal. However, it is
   considered good practice to dispense the batch issues in order (see page 29).




           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

May 2007                                        Version 1.0                                              Page 19
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Batch Issue (FP10) (continued)
Information for Pharmacists

6. You may only dispense medicines from batch issues where you hold the matching
   authorising prescription. If a patient brings in a batch issue and you do not hold
   the authorising prescription, you must apply your judgement whether this is a
   genuine mistake (and inform the patient he/she must go back to their original
   pharmacy) or if this is a possible stolen prescription (and alert the appropriate
   authorities).

7. In addition to your normal prescription checks, pay close attention to two pieces of
   information on the form:

   Instalment Interval
   The GP may designate an instalment interval on the authorising prescription and batch
   issues such as ‘dispense every 28 days’. If this is listed, you are not allowed to
   dispense the next batch of the prescription until the 28th day or after. You will need
   to track this information so that batches are not dispensed prematurely.

   Prescription Date
   • An authorising prescription is valid for 12 months from the date it was generated.
   • The first batch issue must be dispensed for the first time within 6 months of the
      generation date.
   • Batch issues are no longer valid 12 months after the generation date.

8. Endorse the batch issue.

9. This batch issue is sent to the PPA as an invoice for payment. Please see Sorting and
   Submission of Forms to the PPA section (page 28).




          Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

Page 20                                        Version 1.0                                              May 2007
                     North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Dispensing Prescriptions
Information for Pharmacists

The method of requesting a repeat is flexible – you may allow patients to request them in
person, by telephone or by any other suitable method.

An authorising prescription has to be dispensed for the first time within six months of
it being written.

1. Before providing any repeat items to the patient, you, the pharmacist, must
   personally ensure that:
   •   the patient is taking or using medicines appropriately
   •   the patient is not suffering from any side effects from their treatment which indicate
       the need or desirability of a review of their treatment
   •   the patient’s medication regime or health has not changed in a way that indicates
       the need or desirability of a review of their treatment since the repeatable
       prescription was issued.

2. If at any time you are concerned about the safety or appropriateness of a repeat
   prescription:
   •    inform the patient to make an appointment with his/her GP
   •    contact the GP directly.

3. You may always refuse to provide the drugs or appliances but must inform the GP
   of your rationale.

4. Before providing any repeat items to the patient, you must always check that:
   •   your pharmacy holds the authorising prescription
   •   a satisfactory batch issue has been presented by the patient or is held by the
       pharmacy
   •   the GP has signed the authorising prescription
   •   the batch issue matches the authorising prescription (the batch issue has not been
       altered)
   •   the authorising prescription has not expired.

5. Endorse the batch issue with the quantity of drug provided and the provision date.

6. Ask the patient to sign the batch issue before providing the repeat items.

7. Update the patient’s compliance card with the date that he/she should pick up the next
   batch of medicines.

8. If you are dispensing the penultimate batch issue, inform the patient that he/she will need
   to schedule an appointment with the doctor. (Appendix J)



           Best practices are displayed in grey-shaded boxes. Please see Introduction for more detail.

May 2007                                        Version 1.0                                              Page 21
North Yorkshire and York Primary Care Trust - Repeat Dispensing Operations Manual


Dispensing Prescriptions (continued)
Information for Pharmacists

All the usual terms of service issues around fraudulent prescriptions, standard of dispensed
products, point of dispensing checks, endorsements, complaints and reasonable time to
supply the prescription will need to apply at each dispensing episode.

As a condition of providing repeat dispensing services, all participating pharmacies ensure
that all pharmacists employed within the pharmacy (including locums) have been suitably
informed of repeat dispensing procedures.

Repeat Dispensing Log
You will need to track patients’ repeat prescription information so that you will know when a
patient has missed a batch. Report any missed batches to the GP. To assist you, the PCT
has created a Repeat Dispensing Log (Appendix D). This log will help you to dispense
medicines in anticipation of the patient request. It will also provide data to measure the
scheme’s success. The PCT will use this form to monitor contractors RD supervision.




•   The first time a patient brings in his/her authorising prescription, note in the log the
    Patient’s ID (from the PMR), GP name, the batch number (number 1 in this case), total
    number of batches, the date the prescription was dispensed (which will be the current
    date) and the next anticipated supply date. You may wish to enter into your diary or
    calendar the patient’s next supply date as a reminder.

•   Within a couple of days of the anticipated supply date, dispense the repeat medicines
    and have them waiting on a shelf for the patient. At this point, write a new entry into the
    Repeat Dispensing Log, entering the Patient ID, GP name, batch number, number of
    batches and leave the rest of the fields blank.



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Dispensing Prescriptions (continued)
Information for Pharmacists

•   If the patient does not collect his/her medicines within a reasonable time period, phone
    the patient. If the patient still does not come into the pharmacy, notify the GP. Endorse
    the Batch Issue as “Not Dispensed” and record the return of medication back to stock.

•   When the patient does collect, ensure compliance is maintained and there are no
    adverse events due to medication before you provide the medicines. Enter the dispense
    date and the next anticipated supply date. Also check that the prior supply due was
    collected.




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Pharmacy Payment
Information for Pharmacists

1. The fee structure for community pharmacists includes:

   •      Annual Repeat Dispensing Payment is a nationally agreed annual rate of payment
          to all community pharmacy contractors divided into 12 single monthly payments
          (Drug Tariff Part VIA).

2. Each dispensed batch issue (FP10) will be submitted for reimbursement at the end of the
   month in the normal way to the PPA. There will be a new order detailing the method for
   sorting and submitting the batch issues in the end of month batch. A new FP34C will be
   automatically issued to pharmacists by the PPA which will highlight this new order.

3. Pharmacists will have to submit the legal repeat authorising prescription (FP10) to PPA
   for storage when all of the batch issues have been dispensed, it has expired or the
   medication is no longer required.




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Dispensing Discretions
Information for Pharmacists

There are certain dispensing discretions that would make sense to accompany the
implementation of repeat dispensing, for example dose optimisation. However, since these
require changes to the Medicines Act of 1968, these discretions will not be allowed until the
legislation is changed.

1. Delete an Item from a Batch Issue
   You are allowed to delete an item from a batch issue if the medicine is not needed by the
   patient. This would follow the same procedures as with traditional dispensing – you
   would cross the item off the Batch Issue and mark it ‘ND’ (not dispensed).

2. Dispensing Intervals
   There are no controls around dispensing intervals unless the GP specifically marks the
   prescription with an instalment interval such as ‘dispense every 28 days’. Since in most
   cases the dispensing interval will not be specified, you could dispense all batch issues at
   once. However, this would violate the intent of repeat dispensing. The pharmacist
   must regularly counsel the patient on his/her use of medicines. If this process
   does not take place there is clearly a danger to the patient’s health and safety, not
   to mention huge cost implications due to high levels of waste medication. The
   PCT will randomly audit for these occurrences.




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GP/Pharmacist Communication
Information for Pharmacists

For the repeat dispensing scheme to be successful, it will require excellent communication
between GPs and pharmacists. This is not a one-off event but a lasting relationship.

1. Prior to implementing the scheme, meet with your local area GPs, or at the very least
   have a conversation on the telephone. At this meeting, discuss the following topics:

   •      The ideal patient profile – this profile may change over time. At first the profile may
          be bound to strict inclusion and exclusion criteria so that the surgery is not
          overwhelmed by the volume of work associated with introducing patients into the
          scheme.

   •      A monthly target of the number of patients that the GP would like to introduce into
          the scheme – this will control the workload of surgery staff members.

   •      Communication procedures – these are important for not only generally
          communicating about the scheme but also discussing patient-specific matters.
          Ensure that the pharmacy staff is familiar with the local GPs and surgery staff so that
          telephone calls are not unnecessarily delayed. Share your telephone numbers, fax
          numbers and email addresses. Agree upon the best method of communication as
          well as the best communication time.

   •      Method of synchronising the prescriptions – certain patients may be good
          candidates for the service but may have medicines on varying schedules. The GP
          may appreciate your help to synchronise these medicines. Discuss this possibility
          and determine the best path of action.

   Document these agreements and review them on a regular basis.

2. You will now be monitoring how patients use medicines on a regular basis. Report back
   any concerns you have to the GP.

Please use the Pharmacy Repeat Dispensing Referral Form (Appendix E) for issuing and
recording formal communication with the patient’s GP practice.

GP’s have their own version of a referral document to facilitate communication to
pharmacies (Appendix F).




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Termination of Batches
Information for Pharmacists

There are many instances where Batch Issues may be terminated without being filled.
Some of these include:

•    change in patients’ medicine(s)
•    loss of batch issues
•    patient decides to leave GP practice
•    patient decides to change pharmacy
•    patient does not collect remaining batches
•    the authorising prescription has expired.

In all of these instances, there must be communication between GP and pharmacist so that
appropriate action may be taken.

1. If you know that the patient’s batch issues have become invalid, contact the GP.

2. Destroy the remaining batch issues and record, (Appendix I). Local arrangements may
   dictate that unused prescriptions are returned to the prescriber and if so, the returned
   batches recorded.

3. Send the authorising prescription to the PPA.

The PCT will randomly audit pharmacies to ensure the proper handling of invalid batch
issues.




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Sorting and Submission of Forms to PPA
Information for Pharmacists

FP34C (Pharmacy Contractor)

Failure to comply with these requirements may result in payments to contractors being
unavoidably delayed.

1. Complete one invoice only per month.

2. Prescription forms must be sorted as follows:

   2.1    into patient charge group, i.e. exempt, paid and paid at old rate
   2.2    within each group into the following order, starting from the top:
          2.2.1 forms referred back from previous month(s)
          2.2.2 forms FP10 MDA by prescriber surname
          2.2.3 forms FP10D
          2.2.4 forms FP10P/NC or SS with PN indicator by prescribing nurse surname
          2.2.5 forms FP10P/NC or SS with CN indicator by prescribing nurse surname
          2.2.6 forms FP10P/NC or SS with SP indicator by prescriber surname
          2.2.7 forms FP10SS/NC Hospital Forms
          2.2.8 (Repeat Dispensing) First Batch issue forms(s) (FP10SS) i.e. 1 of x by
                  prescriber
          2.2.9 (Repeat Dispensing) Batch issue form(s) (FP10SS) e.g. 2 of x, 3 of x,
                  etc. by prescriber surname
          2.2.10 all other FP10 forms by prescriber surname (NB any prescribers with fewer
                  than 20 forms can be placed into a miscellaneous section at the end of
                  each group).

3. All of the following forms must be kept separate from the FP10 prescriptions (submitted
   for processing and reimbursement as in paragraph 2) and collated by form type as
   follows:

   3.1    repeat Authorising forms.

Pharmacies will need to submit the legal repeat authorising prescription when all
batch issues have been dispensed, it has expired, or the medication is no longer
required. These will need to be submitted in a separate bundle to the PPA the month
after they are no longer required by the pharmacy for dispensing.




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Ordering Forms
The forms needed for repeat dispensing will be available to order from Ryedale House (the
normal supplier of GP prescription forms). All forms are free of charge.

Forms available from North Yorkshire Family Health Services (4th Floor, Ryedale House, 60
Piccadilly, York, YO1 9PE):
FP10SS
Patient Consent Form (RD01) (Appendix A)
Patient Introduction Leaflet (RD02) (Appendix B)

Forms available directly from this document (please photocopy):
Patient Compliance Card (Appendix C)
Repeat Dispensing Log (Appendix D)
Pharmacist Repeat Dispensing Referral Form (Appendix E)
GP Repeat Dispensing Referral Form (Appendix F)
Record of destroyed batch issues form (Appendix I)
Penultimate prescriptions (Repeat Dispensing Scheme) (Appendix J)
Locum Agreement Form (Appendix K)




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Glossary
Authorising FP10 Prescription
The authorising prescription will authorise a set number of repeats through the production of
batch issue FP10s. The authorising prescription must be signed by the General Practitioner
(GP) or Nurse Practitioner (NP), but the patient does not have to sign the declaration on the
back of the prescription form.

Batch Issue (FP10)
A batch issue is essentially an invoice submitted by the pharmacist to the PPA for payment
purposes. Batch issues will be supplied with each authorising prescription for use in the
Repeat Dispensing Arrangements. A batch issue is not a legal prescription and will not be
signed by the prescriber. It must, however, be signed on the back by the patient in the
normal way at the time of dispensing.

Dose Optimisation
This involves giving patients the most appropriate strength of their prescribed medication
which reduces the number of tablets/capsules they have to take and can decrease
prescribing costs.

Patient Consent
Patients have to be made aware that information relating to their condition and prescription
will be shared between the GP and the pharmacist. Patients will need to sign consent forms
that will be filed or scanned in their medical notes and retained within the GP practice. This
is in keeping with the Caldicott Committee Recommendations.

Primary Care Trust
Free standing statutory Trust responsible for health services in a geographical area in
England.

Prescription Pricing Authority (PPA)
The PPA are responsible for pricing all NHS prescriptions, providing reimbursement and
remuneration to pharmacists and other dispensing contractors and collating and producing
prescription cost and analysis (PACT) data. Within the repeat dispensing arrangements, the
PPA will be responsible for handling batch issues as they are submitted and storing the
authorising prescriptions a the end of the repeat period.

Patient Medication Record
These are computer-based records maintained within the pharmacies that patients use.
Most pharmacists will keep a record of all patient items dispensed, both private and NHS,
from doctors, dentists and nurse prescribers within any care setting (community, drug
misuse and hospital). Some pharmacists will also keep records of medication purchased
from the pharmacy (OTC), especially where this is relevant to the medical condition eg
aspirin.

Repeat Dispensing
The process by which a prescription is dispensed in several intervals rather than all at once.

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Repeat Dispensing Pharmacy Protocol
Pharmacy procedure
• A standard proforma must be completed by the pharmacy giving confirmation to the PCT
   that they wish to participate in the scheme.
• The pharmacy will only be able to accept repeat dispensing prescriptions from GP
   practices who are participating in the scheme.
• A prescription has to be dispensed for the first time within 6 months of the date of being
   generated and is valid for 12 months from being generated.
• Pharmacies can only participate in the scheme if they are accredited.
• Pharmacies can only accept repeatable prescriptions and batch issues that have been
   computer generated. Handwritten prescriptions will not be accepted by the pharmacy.
   Handwritten amendments or additions to computerised repeatable prescriptions must not
   be accepted.
• The repeat dispensing scheme does not apply to controlled drugs in Schedules 1, 2 and
   3. (See Appendix H)
• The pharmacist and at least one key member of staff must be aware of the protocol and
   procedure for repeat dispensing and must have completed the PCT approved training
   pack.
• It is the responsibility of the repeat dispensing pharmacy that provides the service to
   ensure that any pharmacist employed in connection with the Repeat Dispensing (RD)
   has received appropriate information that maintains continuing high quality service
   provision. The locum must sign and date the declaration form (Appendix K) and fax a
   copy to the PCT.
• All the usual aspects governing supply, as laid down in the Medicines and Ethics Guide,
   apply to each repeat dispensing.

Consent
Written consent must be obtained by the practice from the patient and a record of this will be
kept at the practice. A record must be kept in the patient’s notes of the pharmacy nominated
by the patient.

The patient will then be able to:
•    leave the repeatable prescription and batch issues with the practice for collection by the
     pharmacy of their choice or
•    take the repeatable prescription and batch issues to the pharmacy of their choice who
     is participating in the scheme. It is strongly recommended that patients’ leave batch
     issues with the pharmacy.

Safety and Storage
A pharmacist should store securely at the premises from which s/he provides
pharmaceutical services:
•   repeatable prescriptions
•   batch issues relating to medicines or appliances which have been provided, and



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Repeat Dispensing Pharmacy Protocol (continued)
•    if requested to do so, batch issues relating to medicines or appliances which have not
     yet been provided.

Until such time as s/he is required in accordance with the Drug Tariff, to send the repeatable
prescription or batch issues to the PPA.

Communication Procedure
• A local communication protocol must be in place between practices and local
  pharmacies. Communication should follow locally agreed policies.
• All paperwork associated with repeat dispensing should be stored for a minimum of two
  years.

Interview and Counselling
• Counselling of the patient must be carried out at each repeat dispensing to ensure the
    patient:
        has an understanding of their medication
        is compliant
        is not experiencing any side effects
        re-enforce health promotion issues
        check any recent over the counter purchases
        refer patient back to GP for any new problems, using the appropriate method of
        communication
        if a patient is unable to collect their prescription, and wishes to send a representative,
        they must contact the pharmacy to enable the pharmacist to conduct an interview or
        counsel the patient over the telephone.

It is the responsibility of the pharmacist to inform patients when they require a further
repeatable prescription and batch issues.

•   At the second to last prescription the pharmacist must refer the patient back to the
    practice for a medication review and remind the patient that any blood monitoring
    requirements should be done a week before their review.
•   At the last batch issue the pharmacist must check with the patient that they have had
    or arranged an appointment with their GP. Remind the patient that they have no further
    batch issues (Appendix J).

Incident Reporting
Incidents should be reported using the pharmacy SOP.                       The PCT encourages direct
reporting to the Medicines Management Team:
North Yorkshire and York Primary Care Trust
The Hamlet
Hornbeam Park
Harrogate              Tel: 01423 815150
HG2 8RE                Fax: 01423 859600
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Repeat Dispensing Practice Protocol
Practice Procedure
• The practice must have access to computer systems and software that will produce
   repeatable prescriptions and batch issues as specified in the regulations.
• Repeatable prescriptions and batch issues must be computer generated. Handwritten
   prescriptions will not be accepted by the pharmacy. Handwritten amendments or
   additions to computerised repeatable prescriptions will not be accepted.

Consent
• Written consent must be obtained from patients wishing to participate in the scheme. A
  copy of the consent form should be kept with the patient’s notes or scanned for
  paperless practices.
• A record must be kept in the patient’s notes of the pharmacy nominated by the patient.
• Patients to be given the choice:

   1. leave the repeatable prescription and batch issues with the practice for collection by
      the pharmacy of the patient’s choice or
   2. take the repeatable prescription and batch issues to the pharmacy of their choice
      who is participating in the scheme. It is strongly recommended that the patient
      leaves the batch issues with the pharmacy.

Recommendations
• GPs are recommended not to specify dispensing intervals, thereby allowing pharmacists
   to use professional judgement to dispense appropriately for situations e.g. holidays.
• Prescriptions should be for 28 days or as agreed in the practices’ ‘Repeat Prescribing
   Policy’.
• ‘PRN’ medicines should be issued on separate repeatable prescriptions and batch
   issues.
• After the initial medication review a diary date must be entered onto the computer with
   the date of the next full clinical medication review.
• 28-day supplies require thirteen batch prescriptions to cover a twelve-month period.

Exclusion Criteria
• The scheme cannot be used for ‘7 days’ prescriptions.
• Patients who are prescribed controlled drugs (including Schedule 1, 2 or 3) will not be
   eligible for the scheme. ( Appendix H)
• ‘Bulk’ prescriptions cannot be included in the scheme.
• ‘Red’ drugs are excluded from the scheme.
• Patients who are absent from this country for a period of more than two months should
   not be included on the scheme.




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Repeat Dispensing Practice Protocol (continued)
Communication procedure
• A local communication protocol must be in place between practices and local
  pharmacies. Communication should follow locally agreed policies.
• The GP or practice must notify the nominated pharmacy immediately if there are any
  changes to the patients’ medication:
     change of dosage
     change in medication
     change in administration times
     or if a patient leaves the practice
     or if a patient dies
     if a patients does not wish to participate in the scheme any longer.

   Communication should follow locally agreed policies.

Incident Reporting
Incidents should be reported using the pharmacy SOP.                       The PCT encourages direct
reporting to the Medicines Management Team:

North Yorkshire and York Primary Care Trust
The Hamlet
Hornbeam Park
Harrogate            Tel: 01423 815150
HG2 8RE              Fax: 01423 859600




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Participating GPs and Practices
 Practice                       Contact                Address                             Tel/Fax/Email




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Participating Pharmacies
                                                                                                   Initiated
 Pharmacy             Contact              Address                         Tel/Fax/Email
                                                                                                   Service?




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Appendix A: Consent Form
For ordering details, see page 30.




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Appendix A: Consent Form (continued)




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Appendix B: Patient Introduction Leaflet
For ordering details, see page 30.




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Appendix C: Compliance Card
This form should be photocopied onto white card. A master copy can be found at the back
of this document.




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Appendix D: Repeat Dispensing Log
This form should be photocopied (back to back) onto white paper. A master copy can be
found at the back of this document.




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Appendix E: Pharmacy Repeat Dispensing
Referral Form
This form should be photocopied onto white paper. A master copy can be found at the back
of this document.




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Appendix F: GP Repeat Dispensing Referral Form
This form should be photocopied onto white paper. A master copy can be found at the back
of this document.




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Appendix G: EMIS/Protechnic Exeter Instructions
EMIS
Batch Issue Prescription                                To issue repeat prescription :
                                                        Press : I for issue
                                                        Select items : A, B, C etc
                                                        Select :A for b(A)tch issue
                                                        Type in chemist as appropriate
                                                        Dispensing Interval? : enter for none, or 1M,
                                                        2M if required. (not recommended)
                                                        Number of Issues: default 6 but can change
                                                        to whatever appropriate. (next med rev date).
                                                        Enter.
Prescriptions printed. 1st copy ‘RA’ (authorisation) to be signed by GP.
Further copies, ‘RD’ as many as requested:1 of 6, 2 of 6 etc. Do not sign.
Staple together on far right (‘repeat request’ slips).


Chemist
Name of chemist required on patients                    NOTE on consultation screen:
record.
                                                        Press A: add
                                                        Press P: problem
                                                        Press 8BM4 or type in repeat dispensing.
                                                        Enter
                                                        Type in name of designate Pharmacy of the
                                                        patient’s choice.
                                                        Press F8 to file.




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Appendix H: Drugs not included in the scheme
List of Controlled Drugs and hypnotics and anxiolytics drugs not included in the scheme.


Schedule 1              Schedule 2              Schedule 3
                                                Barbiturates
                        Diamorphine
Cannabis                                        (excluding
                        (Heroin)
                                                Secobabital)
Lysergide (LSD)         Morphine                Buprenorphine
                        Pethidine               Diethypropion

                        Secobarbital            Flunitrazepam

                        Glutethimide            Mazindol

                        Amphetamine             Meprobamate

                        Cocaine                 Pentazocine

                        Methadone               Phentermine

                        Oxycodone               Temazepam

Schedule 4 and Hypnotics and Anxiolytics (require risk vs. benefit assessment)
As the long-term prescribing of hypnotics and anxiolytics is discouraged, serious
consideration must be given to patients prescribed these medicines as to their suitability.
However, if the balance for patient benefit favours inclusion and the patient meets all other
inclusive criteria, then they may be incorporated onto the scheme.

Diazepam                            Oxazepam
Nitrazepam                          Zaleplon
Lorazepam                           Zopiclone
Lormetazepam                        Zolpidem

Chlordiazepoxide                    Loprazolam

Alprazolam                          Buspirone




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Appendix I: Record of destroyed batch issues
form
This form should be photocopied (back to back) onto white paper. A master copy can be
found at the back of this document.




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Appendix J: Penultimate Prescriptions
(Repeat Dispensing Scheme)
This leaflet should be photocopied onto pink paper. A master copy can be found at the back
of this document.




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Appendix K: Locum Agreement Form
This form should be photocopied onto white paper. A master copy can be found at the back
of this document.




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Appendix L: Repeat Dispensing GP Practice
Standard Operational Procedure




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Appendix M: Repeat Dispensing Community
Pharmacy Standard Operational Procedure




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Appendix M: Repeat Dispensing Community
Pharmacy Standard Operational Procedure (cont)

                                Repeat Dispensing
                              Community Pharmacy
                          Standard Operational Procedure
                                   (continued)
   Sorting and submission of forms to the PPA
   FP34C (Pharmacy Contractor)
   1. Complete one invoice only per month.
   2.   Prescription forms must be sorted as follows:
        2.1 Into patient charge group, i.e. exempt, paid and paid at old rate.
        2.2 Within each group into the following order, starting from the top:
             2.2.1     Forms referred back from previous month(s).
             2.2.2     Forms FP10 MDA by prescriber surname.
             2.2.3     Forms FP10D.
             2.2.4     Forms FP10P/NC or SS with PN indicator by prescribing nurse surname.
             2.2.5     Forms FP10P/NC or SS with CN indicator by prescribing nurse surname.
             2.2.6     Forms FP10P/NC or SS with SP indicator by prescriber surname.
             2.2.7     Forms FP10SS/NC Hospital Forms.
             2.2.8     (Repeat Dispensing) First Batch issue forms(s) (FP10SS) i.e. 1 of x by
                       prescriber.
             2.2.9     (Repeat Dispensing) Batch issue form(s) (FP10SS) e.g. 2 of x, 3 of x,
                       etc. by prescriber surname.
             2.2.10 All other FP10 forms by prescriber surname. (NB any prescribers with
                       fewer than 20 forms can be placed into a miscellaneous section at the end
                       of each group.)
   3.   All of the following forms must be kept separate from the FP10 prescriptions (submitted
        for processing and reimbursement as in paragraph 2) and collated by form type as
        follows:
        3.1 Repeat Authorising forms.

   Pharmacies will need to submit the legal repeat authorising prescription when all batch
   issues have been dispensed, it has expired, or the medication is no longer required.
   These will need to be submitted in a separate bundle to the PPA the month after they
   are no longer required by the pharmacy for dispensing.



   Please note:
   If a batch prescription is no longer valid because the patient does not need the item or items,
   the GP has ceased treatment or it is no longer covered by an authorising prescription, then in
   ALL cases you must destroy the relevant batch issues and not submit the to the PPA .




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