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Medicines Management Team Frequently Asked Questions _FAQs_

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Medicines Management Team Frequently Asked Questions _FAQs_ Powered By Docstoc
					September 2002
  ALLOCATION OF CIPHER NUMBERS TO GEMS & MEDIC-CALL: Until now, GPs writing
  prescriptions for one of the out-of-hours services were required to write the cipher number for
  the patient’s registered GP on the prescription. This entailed finding the appropriate number
  and handwriting it on pre-printed GP10 forms.

  Commencing in September 2002, both GEMS and Medic-Call will have their own unique
  cipher number pre-printed on GP10s. This will not only reduce bureaucracy but also allow
  analysis of prescribing patterns for these ‘practices’ including the impact on the volume and
  nature of prescribing (e.g. short courses of antibiotics).

  During the course of this financial year the costs attached to these prescriptions will be
  monitored. There is no plan to alter prescribing budgets at this stage. GPs should note that
  some re-adjustment at practice level may be necessary if there are prescribing savings
  released at the end of the financial year 2002-2003.

  It is anticipated that the data collected during this year will help inform the prescribing
  allocation for GEMS and Medic-Call in 2003-2004.



                        Medicines Management Team:
                     Frequently Asked Questions (FAQs)

  QUESTIONS:

  A prescription pad has been lost / stolen. What should we do?
  A young patient not in any risk group is asking for a flu vaccine. Is this appropriate?
  Been asked by a patient to prescribe a cream not listed in the BNF. What should I do?
  Been asked to prescribe sunblock for a child. Is this appropriate?
  Can drugs for malaria prophylaxis be prescribed on the NHS?
  Can I give a foreign visitor NHS treatment?
  Can I prescribe gluten free foods on the NHS for someone with autism?
  Can I prescribe herbal products on the NHS?
  Can I prescribe homeopathic products on the NHS?
  Can I prescribe Viagra for someone outwith the Schedule 11 categories if a consultant asks
  me to?
  How are prescribing budgets set?
  How can I access the latest decisions of the ADTC?
  How can I find out what generic drugs are in Part 7 of the Drug Tariff and their current costs?
  How do I contact the MMT?
  How do I request a visit and prescribing report from the MMT?
Is there any guidance on what length of treatment can be prescribed on one prescription?
Patient wants script for rehydration sachets in case they are ill while in holiday. Is this
appropriate?
Patient who lives abroad for 9 months of the year wants the full year’s drugs prescribed on
the NHS. Is this appropriate?
Should drugs for nursing homes be prescribed for weekly dispensing?
Should flight socks to prevent DVT be prescribed on the NHS?
Should GPs prescribe donepezil (Aricept®) or other drugs for Alzheimer’s disease?
Should I prescribe drugs outwith their licence when asked to do so by a specialist?
Should I prescribe non-formulary drugs when asked to do so by a specialist?
Should I prescribe unlicensed drugs when asked to do so by a specialist?
Should we inform you of any patients getting shared care protocol drugs?
What drugs are nurses allowed to prescribe?
What drugs have shared care protocols?
What information is needed to write a controlled drug script properly?
What is GGHB policy on prescribing NRT or bupropion (Zyban®) for smoking cessation?
What is the GGPCT policy for prescribing savings?
What is the GGPCT policy on prescribing of naltrexone?
What is the policy on NHS prescribing of IVF drugs for patients undergoing private treatment?
What is the practice pharmacist scheme and how do I get more information?
What is the symbol that needs to be added to Dianette scripts for them to be considered a
contraceptive and not attract a prescription charge?
What travel vaccines can be given on the NHS?
When should I prescribe on a stock order (GP10A) form rather than a normal prescription
(GP10)?
When should patients get a private prescription instead of a NHS prescription (GP10A)?
Where can I find details of the weight management policy including prescribing of sibutramine
(Reductil®) and orlistat (Xenical®)?
Where can I find the restrictions for prescribing Viagra on the NHS?
Where can I get a list of community pharmacies?
Where can I get an up to date copy of the Glasgow Formulary?
Where can I get copies of the Summary of Product Characteristics (SPC, formerly Data
Sheet) for a drug?
Where can I get information about my prescribing costs against budget?
Where can I get information on prescribing in the LHCC?
Where can I get SPA data?
Where can patients get pre-payment certificates?
Who are the members of the MMT?
Will I get funding for prescribing expensive drugs?
Will I get funding for prescribing shared care protocol drugs?

ANSWERS:

A prescription pad has been lost / stolen. What should we do?
Contact Annette Robertson in Primary Care Distribution at Clutha House on 0141 427 8246
or Annette.robertson@glacomen.scot.nhs.uk

A young patient not in any risk group is asking for a NHS flu vaccine. Is this
appropriate or should they give a private prescription?
The advice from SEHD is to give to ‘at-risk’ groups only to conserve stocks of vaccine.
Educate the ‘worried well’ about the risks & benefits of vaccine. If employed, could the
employer’s occupational health service provide vaccine? Flu vaccines are not blacklisted so if
a GP decides to offer it, it should be prescribed on a GP10, not on a private prescription.

Been asked by a patient to prescribe a cream not listed in the BNF. What should I do?
If not in BNF it may not be licensed as a medicine. This should be checked and if not licensed
it is considered to be a cosmetic rather than a medicine and so should not be prescribed on
the NHS. It will then be a Pay & Report item and the GP will have to justify prescribing. If
unable to justify prescribing, the costs may be removed from the GP’s remuneration. See
Glasgow Prescriber March 2002

Been asked to prescribe sunblock for a child. Is this appropriate?
Sunblock falls under the ACBS rules where only certain specific types are considered to be
suitable for prescribing under named conditions. See BNF 43 p560-561 (http://bnf.org) for full
details. The prescription should specify both brand and SPF. See Glasgow Prescriber March
2002

Can drugs for malaria prophylaxis be prescribed on the NHS?
No; guidance from the Scottish Executive (9th March 1995) suggested that these should be
prescribed privately. Many are available for purchase OTC from pharmacies. Note that
treatment of malaria is permitted on the NHS.

Can I give a foreign visitor NHS treatment?
This depends on the country of origin and whether the treatment is due to a condition which
arose during the visit or is for routine treatment. Refer to the Scottish Executive Manual of
Guidance for Overseas Visitors (www.scotland.gov.uk/library/docments-w/guide-14)

Can I prescribe gluten free foods on the NHS for someone with autism?
No, gluten free foods can only be prescribed under the NHS for patients with specific clinical
conditions “For gluten sensitive enteropathies including steatorrhoea due to gluten sensitivity,
coeliac disease & dermatitis herpetiformis." See BNF Appendix 7 (http://bnf.org)

Can I prescribe herbal products on the NHS?
Generally these are not licensed medicines and so not considered appropriate for prescribing
on the NHS. It will then be a Pay & Report item and the GP will have to justify prescribing. If
unable to justify prescribing, the costs may be removed from the GP’s remuneration. See
Glasgow Prescriber March 2002

Can I prescribe homeopathic products on the NHS?
Yes, all homeopathic products are prescribable on the NHS, however as with all drugs the
prescriber must be clinically competent to prescribe as the person signing a prescription
takes full legal responsibility for the actions arising.

Can I prescribe Viagra for someone outwith the Schedule 11 categories if a consultant
asks me to?
No. GPs may only prescribe for those within the specific categories listed HERE. Either the
consultant must prescribe from hospital or the GP should give a private script.

How are prescribing budgets set?
Partly on historical spend and partly using weighted capitation according to the Arbuthnott
formula to take account of medical need. Please contact the MMT directly if more details are
required.

How can I access the latest decisions of the ADTC?
See the ADTC website on www.show.scot.nhs.uk/gghb/adtc or for information from the
Scottish Medicines Consortium see www.scottishmedicines.org

How can I find out what generic drugs are in Part 7 of the Drug Tariff and their current
costs?
See the ISD website for the previous 3 months’ Drug Tariff price information:
http://www.show.scot.nhs.uk/isd/primary_care/Drug_Tariff/pcare_drugsTariff_7.htm

Modified release drugs are not included on the Drug Tariff. Where different bioavailability
profiles may cause problems e.g. calcium channel blockers, prescribing should be by brand.
Some companies promote specific branded generics to reduce costs. Consider whether a
modified release is required

How do I contact the MMT?
Trust Headquarters
Greater Glasgow Primary Care Trust,
Gartnavel Royal Hospital,
1055 Great Western Road
Glasgow G12 0XH
Tel 0141 211 0327 Fax 0141 211 3826.
e-mail Jacqueline.richardson@glacomen.scot.nhs.uk

How do I request a visit and prescribing report from the MMT?
Contact Jackie Richardson on 0141 211 0327 or by e-mail on
Jacqueline.richardson@glacomen.scot.nhs.uk

Is there any guidance on what length of treatment can be prescribed on one
prescription?
There is no clear guidance on this however increasing the amount supplied on one
prescription is likely to lead to increased wastage. Prescribers should ensure that the
patient’s condition is unlikely to change sufficiently to warrant medical intervention within that
time and that quantities are suitable for the type of drug e.g. do not prescribe very large
quantities of drugs liable to abuse or for rapidly changing conditions. One or two month
supply is probably optimal for most drugs.

Patient wants NHS script for rehydration sachets in case they are ill while in holiday. Is
this appropriate?
No, a private prescription should be issued for medicines for a patient who intends to take the
medicine abroad in circumstances where the medicine is required solely in respect of an
ailment that will then be occurring for the first time, or has previously occurred, but from which
the patient is not suffering at the time of going abroad;. See Glasgow Prescriber May 2002
and the LMC website (http://www.glasgow-lmc.co.uk/)

Patient who lives abroad for 9 months of the year wants the full year’s drugs
prescribed on the NHS. Is this appropriate?
No as the patient is not ordinarily resident in the UK so not entitled to NHS treatment except
for what occurred in course of visit. Refer to the Scottish Executive Manual of Guidance for
Overseas Visitors (www.scotland.gov.uk/library/docments-w/guide-14)

Should drugs for nursing homes be prescribed for weekly dispensing?
There was a letter from the Chief Medical Officer in August 1997 which stated that GPs
should not feel obliged to ask for instalment dispensing on prescriptions where this is merely
to help administration within home. GPs are free to do so if they see there is a clinical need
for this.

Should flight socks to prevent DVT be prescribed on the NHS?
No. These are not in the Drug Tariff and have different compression levels from Drug Tariff
hosiery. Patients can buy these in pharmacies or at airports. See Glasgow Prescriber
February and July 2002

Should GPs prescribe donepezil (Aricept®) or other drugs for Alzheimer’s disease?
Glasgow has an agreed Shared Care Protocol which allows specialists to make a diagnosis
and initiate treatment. After three months, prescribing can be passed back to primary care if
the GP is in agreement. See Glasgow Prescriber January 2002.

Should I prescribe drugs outwith their licence when asked to do so by a specialist?
Only if you are sure that it is appropriate and that you have enough information to assume
clinical responsibility. Remember, the person signing the prescription takes responsibility for
the effects and the liability is greater when prescribing outwith the licence. See Glasgow
Prescriber March 2002.

Should I prescribe non-formulary drugs when asked to do so by a specialist?
Have options on the Formulary been tried and proved ineffective / unsuitable or are there
reasons why Formulary choices are unsuitable? If so and you are happy to take clinical
responsibility for prescribing there is no reason not to accept the specialist’s
recommendation. However, where you feel there are more appropriate options, you are under
no obligation to act on such a recommendation. Effective communication with the specialist is
vital to ensure continuity of treatment.

Should I prescribe unlicensed drugs when asked to do so by a specialist?
Only if you are sure that it is appropriate and that you have enough information to assume
clinical responsibility. Remember, the person signing the prescription takes responsibility for
the effects and the liability is greater when prescribing an unlicensed drug. If in any doubt ask
the specialist for more supporting information before making a decision. See Glasgow
Prescriber March 2002.

Should we inform you of any patients getting shared care protocol drugs?
No, the prescribing data does not have any attached patient information so it is not possible
to tie prescribing to specific patients. The costs of all shared care protocol drugs are
monitored automatically.

What drugs are nurses allowed to prescribe?
There are two different classes of nurse prescribers: District Nurse / Health Visitor Nurse
Prescribers and Extended Nurse Prescribers. Each has their own formulary which can be
found in the Scottish Drug Tariff Part 8 or in the BNF (http://bnf.org)

What drugs have shared care protocols?
See Glasgow Formulary Appendix 2
(http://www.show.scot.nhs.uk/gghb/adtc/GGHBFormulary/form.htm)

What information is needed to write a controlled drug script properly?
There are specific requirements which can be found in the BNF (http://bnf.org):
    • Must be handwritten, signed and dated by prescriber
    • Must state the form and strength (i.e. MST Tablets 10mg not MST 10mg)
    • The total quantity (or number of dose units) must be in words and figures
    • The dose MUST be stated (mdu or as directed is not acceptable)
For specific information on writing methadone prescriptions, see Glasgow Prescriber July
2002.

What is GGHB policy on prescribing NRT or bupropion (Zyban®) for smoking
cessation?
Either may be prescribed where clinically appropriate and the patient has demonstrated a
motivation to stop smoking. See http://www.show.scot.nhs.uk/gghbpharmacy/ for full details

What is the GGPCT policy for prescribing savings?
There is a prescribing savings policy which allows for the distribution of up to £1million of
savings between those practices contributing to that saving. The money is distributed
proportionately to the amount each practice contributed to the overall saving. Half the money
allocated goes to the practice and the other half to the LHCC. For further details contact Dr
Norrie Gaw, Assistant Medical Director, GGPCT.

What is the GGPCT policy on prescribing of naltrexone?
This drug is not included in the Glasgow Formulary and an appeal was turned down early in
2002. The DoH Orange guide recommends that if naltrexone is being used in relapse
prevention, it should only be initiated by specialists or specialised generalists in this
technique. Care should only be transferred to GPs if there is a shared care arrangement
between the specialist and patient’s GP. Currently, no such shared care arrangement exists
in Glasgow. GPs may wish to pass any requests back to the specialist services.

What is the policy on NHS prescribing of IVF drugs for patients undergoing private
treatment?
NHS Greater Glasgow has agreed that patient can be funded for up to four cycles of IVF on
the NHS. Anyone getting full NHS treatment will be supplied by drugs from the hospital;
where patient are getting private treatment the GP may be asked to prescribe drugs. GPs are
not obliged to prescribe these drugs on the NHS. For full details see Glasgow Prescriber
September 2000.

What is the practice pharmacist scheme and how do I get more information?
This scheme places pharmacists within a GP practices to provide medication review clinics or
other forms of prescribing support. For more details please contact Alister MacLaren or
Richard Lowrie on 0141 211 0263/5 or by e-mail
Richard.Lowrie@gartnavel.glacomen.scot.nhs.uk
Alister.McLaren@gartnavel.glacomen.scot.nhs.uk

What is the symbol that needs to be added to Dianette scripts for them to be
considered a contraceptive and not attract a prescription charge?
All scripts for Dianette which do not contain the female symbol (♀) are considered to be for
the treatment of acne and so are subject to a prescription charge (currently £6.20).

What travel vaccines can be given on the NHS?
See Glasgow Prescriber May 2002

When should I prescribe on a stock order (GP10A) form rather than a normal
prescription (GP10)?
In general, items for individual patients should be ordered via a GP10 prescription form.
GP10A forms are according to their cover sheet, intended for “items for the immediate
treatment of patients...and for administration by the doctor in person.” Paragraph 3 of the
GP10A cover note states that “These forms must not be used for any other purpose...e.g.
must not be used for individual prescriptions…” The use of stock orders was never intended
to circumvent the necessity for patients to pay the appropriate prescription charges.

When should patients get a private prescription instead of a NHS prescription
(GP10A)?
NHS patients should always be given treatment on a NHS prescription form unless:
   • The item is blacklisted (e.g. Propecia®)
   • The item is only prescribable under the NHS for certain groups of patients (e.g.
      sildenafil (Viagra®))
   • There is national guidance that prescribing should not be on the NHS (e.g. malaria
      prophylaxis)

Where can I find details of the weight management policy including prescribing of
sibutramine (Reductil®) and orlistat (Xenical®)?
This policy has yet to be finalised and ratified by the ADTC. Once this happens full details will
be publicised through Glasgow Prescriber.

Where can I find the restrictions for prescribing Viagra on the NHS?
See Glasgow Prescriber November 2001 and October 199 for full details. List of conditions
can also be found in the BNF and Scottish Drug Tariff Part 15
GPs can issue GP10 prescriptions (must be marked SLS) for men:
•   With diabetes, multiple sclerosis, Parkinson’s Disease, poliomyelitis, prostate cancer,
    severe pelvic injury, single gene neurological disease, spina bifida or spinal cord injury.
• Receiving dialysis for renal failure.
• Who have had radical pelvic surgery, prostatectomy or kidney transplant.
• Receiving treatment for erectile dysfunction on the NHS on 14th September 1998.
Anyone outwith these categories can only receive private prescriptions from their GP. Those
deemed to be suffering from severe distress caused by their impotence can be prescribed
treatment by a hospital specialist. All prescriptions (including any repeats) should be issued
by the hospital service; prescribing cannot be transferred to the GP.

Where can I get a list of community pharmacies?
See the Glasgow Pharmacy website for a list of community pharmacies by post code:
http://www.show.scot.nhs.uk/gghbpharmacy/

Where can I get an up to date copy of the Glasgow Formulary?
The ADTC website http://www.show.scot.nhs.uk/gghb/adtc/ always has an up to date copy.
Paper copies are sent out in August each year.

Where can I get copies of the Summary of Product Characteristics (SPC, formerly Data
Sheet) for a drug?
Go to the Electronic Medicines Compendium http://emc.vhn.net/ where you can register and
then receive access to SPCs and Patient Information Leaflets. The eMC provides free access
to up-to-date, comprehensive and reliable information about prescription and over-the-
counter medicines available in the UK.

Where can I get information about my prescribing costs against budget?
ISD automatically send information to each practice about their prescribing costs and
performance against budget on a monthly basis. Information about all practices within the
LHCC is sent to a nominated individual in that LHCC.

Where can I get information on prescribing in the LHCC?
Contact the MMT for access to detailed prescribing information for the LHCC

Where can I get SPA data?
Doctors can request SPA data from ISD by filling in the form found at the back page of SPA
Level 1 data which is sent to each GP automatically each quarter.

Where can patients get pre-payment certificates?
These certificates can now be bought at community pharmacies as well as being available
from Clifton House.

Who are the members of the MMT?
Dr Andrew Power, Head of Medicines Management
Margaret Mackie, Medicines Management Adviser
Audrey Thompson, Medicines Management Adviser
Jenny Carroll, Medicines Management Adviser
Jackie Richardson, Administrative Assistant to the MMT
Ruth Edwards, Prescribing and Information Analyst
                  Please contact all above on 0141 211 0327

Alister MacLaren, Primary Care Lead Clinical Pharmacist
Richard Lowrie, Primary Care Lead Clinical Pharmacist
Practice Pharmacists
Karen Bowers, Administration Assistant
                  Please contact all above on 0141 211 0279

Vicki Welch, Nutrition Adviser to Primary Care. Please contact on 0141 427 8245
Will I get funding for prescribing expensive drugs?
Where practices notify us of drugs which will be prescribed for specific patients that are
estimated to cost over £5,000 per annum, consideration will be given to providing funding out
of any funds remaining in the contingency fund. It is the responsibility of the practice to inform
us of the drug, dose, expected cost and start and finish dates of prescribing.

Will I get funding for prescribing shared care protocol drugs?
There is a long standing agreement that expenditure on shared care protocol drugs will be
monitored automatically. This is carried out once each year and any additional costs will be
met from the contingency fund.

				
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