Julia Gaffney and Paisley Ifould

22nd November 2011

Prescribing – why do we need to know about it?

Prescribing costs makes up 10% of the NHS budget 80% of this is spent by primary care

What constitutes a medicine?

Medication Reviews

NSF for older peopleall people over 75yrs should have a med r/v every 12/12Those taking 4 or more meds every 6/12

QoF – medication r/v within 15 months forAll pts on 4 or more medsAll pts being prescribed meds on rpt

Prescription ExemptionsUnder 1616-18 and in full time educationOver 60 yearsPresecribed free of charge contraceptions valid medical exemption certificateValid maternity exemption certificateNamed on a PPC (prescription pre-payment certificate)You or your partner are receiving income support/job

seekers allowanceNamed on a HC2 certificate (help with health costs)Has a valid war pension exemption certificate

Medical Exemption certificate

- Apply using FP92A -Lasts for five years then needs renewing - Valid for a month before your application is received but to claim back px charges incurred during that period must have valid reciept (form FP 57 from the chemist)

Medical Exemption certificate

Medical Exemption Certificatea permanent fistula (for example caecostomy, colostomy,

laryngostomy or ileostomy) requiring an appliance or continuous surgical dressing

a form of hypoadrenalism (for example Addison's disease) for which specific substitution therapy is needed

diabetes insipidus or other forms of hypopituitarism diabetes mellitus, except where treatment is by diet alone hypoparathyroidism myasthenia gravis myxoedema (hypothyroidism requiring thyroid hormone

replacement) epilepsy requiring continuous anticonvulsive therapy continuing physical disability that prevents the person from

going out without help from another person. Temporary disabilities do not count even if they last for several months

If you are undergoing cancer treatment

Maternity Exemption

Maternity exemption

Available as soon as pregnancy certified by doctor or nurse

Runs till 12 months after expected date of baby’s birth

Can apply for extension if baby born late

Prescription pre-payment certificate Useful if you are paying for more than 4 px in 3

months or 14 in twelve months.Cost – current px charge - £7:40

3 month PPC – £29:10 12 month PPC £104:00

Can pay in one lump sum or monthly sum by DD available

The journey of a prescription....

Repeat prescriptions

70% of prescribing is repeat px – ie when GP’s px without seeing the pt –

NHS MK support repeat px for 28 or 56 days

Emergency Supply Of Medicines

Emergency Supply Of MedicinesRequested by Public Requested by

Prescriber

Requested By Public

Prescription Only Medicines (Human Use) Order 1997 allows exemptions from the Prescription Only requirements for emergency supply to be made by a person lawfully conducting a retail pharmacy business provided…

Requested By PublicInterview

Immediate need impractical to obtain prescription Previously prescribedDose appropriate

Requested By PublicQuantity

5 days30 daysSmallest pack sizeOCPOral antibiotic liquid

Requested By PublicPharmacist records in prescription book

Date of supplyDrug name, quantity, form and strengthPt name and addressNature of emergency

Requested By PublicContainer label

Date of supplyDrug name, quantity, form and strengthPt name and addressPharmacy name and address“Emergency Supply”“keep out of the reach of children”

Consider the medical consequences of NOT supplying the medicine

Advise patients how to obtain essential healthcare if unable to make an emergency supply

Requested by Prescriber

DoctorDentistNursePharmacistOptometrist

Requested by Prescriber

Unable to furnish script immediatelyWill complete it within 72hrsMedicine supplied in accordance with prescribers

directions

Requested by PrescriberPharmacist records in prescription book

Date of supplyDrug name, quantity, form and strengthPractitioner name and addressPt name and addressDate on prescriptionDate prescription received

Private Prescriptions

Choice

Eligibility

Certain medications

Prescribing gluten free productsOn ACBS formulary- allowed to be prescribed only

for pt with:Gluten sensititivtyDermatitis hepatiformisCoeliac disease

The type of product is not restricted but amounts allowed to be prescribed per month are

Prescribing unlicensed or off label medication

“A practitioner prescribing an unlicensed product does so entirely on his own responsibility, carrying the total burden for the patient’s welfare and, in the event of an adverse reaction, may be called upon to justify his actions. Under these circumstances, it may be advisable for the practitioner to check his position with his medical defence union before prescribing such unlicensed products.”

ANY QUESTIONS?