Glossary, Annexes, and References

Glossary
Annex A
Annex B
References

Glossary

Repeat prescription: Repeat prescriptions are medicines taken by patients on a regular basis and are authorised to be prescribed repeatedly for a specified length of time. This is a partnership between the patient and the prescriber. The patient does not have to consult the prescriber at each repeat request.

Repeat medication check (authorisation): A check that the medication(s) for a single condition (e.g., asthma) or multiple allied conditions (e.g., cardiovascular diseases) were clinically checked and authorised as suitable repeat medication(s), and for how long.

The medication(s) would have ideally been clinically checked within a patient consultation or via a desktop review.

The authorisation for each medication should be either time-limited by setting the date of the next authorisation (e.g., a maximum of 12 months) or limited by the number of repeats allowed. The quantity of medication should be synchronised with the number of days issued (e.g., 56 tablets if prescribed one tablet twice a day and on a 28-day cycle) or made clear it is for use as required (e.g., 60 sachets for PRN use if repeat medication is needed).

This review should be clearly visible within the repeat medication section of the clinical record system.

Repeat prescribing system: This is the process via which the practice operates their repeat prescribing functions.

Repeat prescribing processes: In a repeat prescribing system, there are many separate processes that make up the prescription journey from request to collection. These are further defined in section 2 but may include:

Requesting a repeat prescription
Generating a repeat prescription
Prescription review
Authorising a repeat prescription
Prescription signing
Prescription being sent to nominated community pharmacy
Nominated pharmacy dispensing the prescription
Person receiving or collecting the prescription
Ongoing monitoring and medication review, medication adherence.

Medication review: A holistic, clinical review of all medications for all of a patient’s conditions, ensuring any long-term condition/Quality and Outcomes Frameworks (QOF) reviews and/or relevant blood tests for safe prescribing have been undertaken or are scheduled at the required intervals.

This can be undertaken as a desk-based review, but ideally should be face to face or via a telephone or video consultation.

All the repeat medication should be time-limited by setting the date of the next repeat authorisation or limited by setting the number of repeats allowed.

The review should be clearly visible within the repeat medication section of the clinical record system, and ideally all authorisation durations should be synchronised to coincide with the next medication review.

A systematized nomenclature of medicine clinical terms (SNOMED CT/read code) for a medication review should be recorded in the clinical record and include a clear date when the next medication review is due.

Structured medication review (SMR): An SMR has been defined by NICE as a structured, holistic, and personalised review of a patient's medicines with the objective of reaching an agreement with the patient (or their advocate) about treatment; optimising the impact of medicines; minimising the number of medication-related problems and reducing waste.

It is an evidence-based review of the person's medicines that would normally be carried out by a clinical pharmacist or doctor taking into account all aspects of their patient’s health.

SMRs were introduced as part of the 2020/21 Network Contract Direct Enhanced Service (DES) Specification for PCNs to deliver to key, priority groups of patients.

Ideally an SMR should be undertaken face to face with the patient but can be via telephone or video call.

All the repeat medication should be time-limited by setting the date of the next repeat authorisation, or by setting the number of repeats allowed.

This review should be visible within the repeat medication section of the clinical record system, and ideally all authorisation durations should be synchronised to coincide with the next medication review.

A SNOMED CT (read code) for a structured medication review should be recorded in the clinical record, allowing visibility for all and including a clear date when the next SMR is due (SNOMED code 1239511000000100 SystmOne Read Code Y282b).

Synchronisation: Synchronising the quantities of medicines on a prescription with the aim of ensuring that they all run out at the same time.

Electronic repeat dispensing (eRD): eRD allows a prescriber to authorise and issue a batch of repeatable prescriptions for up to 12 months with just one digital signature.

Electronic prescription service (EPS): The EPS allows prescribers to send prescriptions electronically to a dispenser, such as a pharmacy, nominated by the patient.

This makes the prescribing and dispensing process more efficient and convenient.

EPS is already widely used in primary care with over 95% of all prescriptions now being produced electronically.

Dispensing practice: A practice, often rural in nature, whose patients are allowed to request that their medications are dispensed from the practice, as they live too remotely from a community pharmacy.

Annex A

Working group membership and approach

The working group was formed of experts, interested professionals and third sector representatives and patients.

Four workshops were held between June 2023 and February 2024.

The working group defined the guiding principles and scope of the toolkit.

The working group defined the five main themes and suggested content for the toolkit.

We would like to thank the chairs and participants for giving their time and for their expert advice.

Imranaaz Adam	Medicines Commissioning Pharmacist, Lancashire and South Cumbria ICB
Professor Tony Avery	National Clinical Director for Prescribing (NHS England)
Shamma Baig	APTUK Equality, Diversity and Inclusion Executive
Wasim Baqir	Senior Pharmacist, National Pharmacy Integration, NHS England
Mike Barstow	Director and Vice-chair, Dispensing Doctor Association
Donna Bartlett	Former APTUK Professional Lead for England
Hazel Baxter	Interim Head of Medicines Optimisation, NHS Derby and Derbyshire ICB
Gill Boast	Practice Nurse facilitator and training programme lead, Staffordshire and Stoke-on-Trent ICB
Emdadh Bokth	Clinical Pharmacist, Tower Hamlets GP Care Group
Lawrence Brad	RCGP representative
Rebecca Bunton	NMP, ANP Hampshire and Isle of Wight
Mary Collier	CQC Regional Medicines Manager
James Davies	Director for England, RPS
Yvonne Dennington	Business Manager England, RPS
Jaz Dhillon	Clinical Pharmacist Interface and Governance, NHS Shropshire
Lisa Drake	Director, Quality and Improvement, Redmoor Health
Manjit Dulay	National Pharmacy Integration Lead, NHS England
Deborah Duval	Managing editor, Kidney Care UK
Richard Fieldhouse	Chairman, National Association of Sessional GPs
Laura Forbes	Pharmacy Technician Newton Drive Health Centre, Blackpool
Rachel Freeman	Age UK representative
Tracey Galt	Lead Medicines optimisation Pharmacy Technician, Nottingham & Nottinghamshire ICB
Gill Gookey	Medicines Safety Lead Pharmacist, Health Innovation East Midlands
Liz Hallett	Community Pharmacy Expert Advisory Group, RPS
Ghulam Haydar	Senior Pharmacist, National Pharmacy Integration Fund NHS England
Heather Holmes	Medicines Policy Lead, NHS England Medicines Value and Access
Clare Howard	Clinical lead, Co-chair, FRPharmS and Fellow of the Royal Pharmaceutical Society
Sundus Jawad	Lead Medicines Optimisation Care Homes Pharmacist, NHS Frimley ICB
Paul Jenks	Community Pharmacy Expert Advisory Group, RPS
Brendon Jiang	Senior Clinical Pharmacist, North Oxfordshire PCN
David Kelly	Lead Pharmacist, Highfield Surgery
Sajida Khatri	Director of Medicines Optimisation, PrescQIPP
Graeme Kirkpatrick	Head of Patient Safety (Advice and Guidance) NHS England
Sheetal Kotecha	Lead Pharmacist Arden PCN, Advanced Clinical Practitioner
Pauline Lockey	Patient Safety Clinical Lead (Medication Safety) NHS England
Anika Mandla	Senior Clinical Policy Officer, RCGP
Michael Mullholland	Co-chair, Honorary Secretary of Royal College of General Practitioners
Nishali Patel	Clinical Lead, Digital Medicines, NHS England
Rebecca Perkins	Clinical Lead NHS 111
Graham Prestwich	Patient representative
Carol Roberts	Chief Executive, PrescQIPP
Elizabeth Rushforth	POD manager NHS Bath and NE Somerset, Swindon & Wiltshire ICB
Claudia Snudden	GP Registrar, National Medical Director's Clinical Fellow, 2023–24
Graham Stretch	PCPA President and Chief Pharmacist Argyle Group
Clare Thomson	Chief Pharmaceutical Officer's Clinical Fellow, RPS 2023-24
Stacey Thomson	Programme Manager, Redmoor Health
Sati Ubhi	Director of Medicines Optimisation & Pharmacy (Chief Pharmacist), Cambridge and Peterborough ICB
Jonathan Underhill	Former Medicines Consultant Clinical Adviser, Medicines Optimisation team, NICE
Kuldeep Virdee	CQC pharmacist specialist
Steve Williams	Lead Clinical Pharmacist, Poole Bay & Bournemouth PCN
Paul Woodgate	Patient representative
Heidi Wright	Policy and Practice Lead (England), RPS

Guiding principles

A good repeat prescribing system is essential to ensure the safe, efficient and convenient dispensing of prescription medications to patients who require ongoing treatment. There is no current national guidance that sets out the requirements of a good repeat prescribing system for primary care teams.

The RCGP/RPS repeat prescribing toolkit will therefore aim to:

Set the expected standard but allow for flexible local arrangements
Demonstrate best practice
Be positive not punitive
Be safe
Be efficient
Facilitate patient access to repeat medication in a timely manner.

Over-arching principles:

All recommendations made in the toolkit will be developed by a working group, which includes patients taking repeat medication and primary care teams involved in operational roles around repeat prescribing
Recommendations made will empower and support patients to access medicines that have been authorised as a repeat prescription
Repeat prescribing systems will be made safer, more efficient and less open to abuse
Repeat prescribing systems should minimise the risk of over-prescribing
The toolkit will distinguish between the clinical, technical and administrative functions as well as the elements of repeat prescribing that the patients/carers have a role in
The toolkit will set out good practice standards but remain flexible in its framing to enable local systems to engage with it and work out how to meet these standards within the context of their local situation (patient demographics, workforce capacity and capability, etc.)
Elements of these recommendations will be developed in collaboration with patients and should be clearly communicated to patients on publication
- The patient communication work will include the promotion of an equal partnership between patient, prescriber and dispenser so that all roles and responsibilities are clear and rooted in the principles of good, shared decision making
The toolkit will take account of the different needs of different patient groups, such as older patients, patients with frailty, those in care homes, the needs of carers, those living in deprived populations, those living in rural areas and those significantly underserved by general practice or community pharmacy
Where possible, digital solutions that have proven to be safe and effective should be prioritised over manual processes. However, the toolkit must recognise that not all patients are digitally literate
The toolkit will take account of the needs of different care settings such as care homes and the different levels of care support that patients receive in the community.

The scope was further defined according to the table below:

In scope	Out of scope
Describe what a good repeat prescribing system looks like	Monitored dosage systems
Include baseline data and measurement	Appliances and acute prescriptions
Provide a process map of the pathway	Original pack dispensing
Describe the right people for the right job, at the right part of the process	Mandates about the length of repeat prescriptions – 28- vs 56-day supply
Describe a training matrix for staff involved in repeat medication processes (needs to be flexible for local capacity and capability)	Mandates about the use of digital pathways as the only option for patients and carers
Ensure it is applicable for different settings and support this with good practice examples	Detailed guidance for specific medicines
Ensure there are links to community pharmacy (making the most of contractual opportunities)	Guidance about specific timing of monitoring requirements for high-risk medicine or medicines with a monitoring requirement
Signpost to other resources and e-learning materials	Exacting standards that are unachievable in the current climate
Produce a patient/carer partnership framework	Guidance in relation to ‘bulk authorisation’ of repeat medicines
Outline a general practice self-assessment tool	Medicines shortages

Summary of consultation and engagement

The professional and patient engagement activity included:

Members of the working group over four workshops with defined aims and objectives
Examples of good practice: over 30 submissions received from different professional groups
Meetings with stakeholders
Webinars held with stakeholder groups
Workshop with RPS conference attendees
Consultation and final recommendations received from:
- Members of the RCGP/RPS repeat prescribing toolkit working group
- RCGP clinical advisers’ network
- RPS primary care expert advisory group
- RPS community pharmacy expert advisory group
- RPS digital pharmacy expert advisory group
- RCGP prescribing advisory group
- Patient representative groups – National Voices, Age UK
- NHSE stakeholders.

Many thanks to contributions and case studies from:

Topic	Area/organisation
QI improvement in primary care	Primary and Community Transformation and Improvement team
Me and My Medicines campaign	Leeds, supported by the Health Innovation Yorkshire and Humber
I manage my meds	University of Leeds, University of Bradford and the Yorkshire and Humber Patient Safety Translational Research Centre
SMR resources	Health Innovation Network Polypharmacy Programme
Are your medicines working for you?	Health Innovation North East and North Cumbria
Medicines waste	NHS Dorset
Medicines Monitoring	Symphony Healthcare
Prescription re-alignment	Easington Primary Care Network
QI with repeat prescriptions	Citrus Health Primary Care Network
Antimicrobial stewardship	UKHSA and NHSE teams including leads for antimicrobial stewardship in the East of England
PCN Opioid resources	Health Innovation Wessex
Opioid quality improvement	Joined up care Derbyshire and Health Innovation East Midlands
Care home resources	NHS Coventry and Warwickshire ICB
Safer prescribing of antipsychotic medication	London Clinical Networks and Yorkshire and Humber Clinical Networks
Patients at risk of falls	National Falls Prevention Coordination Group
Resources to support the implementation of eRD	Health Innovation Wessex
North of England Care System Support (NECS)	National Pharmacy Integration Lead, NHS England
Use of ONS in frailty	BDA Optimising Nutrition Prescribing Specialist Group

Annex B

Repeat Prescription Systems in England – Literature Search & Summary

Scope

The RPS and RCGP’s proposal to address Recommendation 7 of the National Overprescribing Review proposes the production of a national toolkit to aid repeat prescribing/dispensing and reduce overprescribing. The SRT were approached to assist with a literature search on, “the best practice guidance for all repeat prescribing systems in England.” The agreed scope of this literature search included the following stages:

Conduct a literature search on relevant databases, utilising key search terms
Conduct a search for other relevant evidence, such as guidance documents, on repeat prescribing in the UK
Collate and summarise the results from the literature search in a clear format
Provide further guidance/advice on literature review writing if, and when, necessary.

Methodology Overview

SRT conducted searches using multiple databases (PubMed, Cochrane Library, and Google Scholar), as well as using standard search engines.

Only the results published between 2013 and 2023 are included in the final reporting. Once collated, the search outputs were reviewed and filtered for relevance and quality before the final information was compiled.

Outputs

The collated resources are grouped into the following categories: (a) research articles, (b) guidance and/or evaluation documents, (c) and grey literature. The documents are ordered by their original publication date, starting from the oldest and working to the most recently published resources.

Research Articles

Between 2013 and 2023, there were a limited number of publications directly related to repeat prescribing processes and/or eRD in the UK. Therefore, we expanded our search to include those which discuss the repeat prescription of specific medicines and repeat prescriptions and/or eRD in other countries.

Notably, publications which discuss the appropriateness and effectiveness of long- vs. short-term prescriptions all conclude that there is not enough available evidence to support that providing short-term prescription courses improves outcomes, despite previous UK recommendations.

Author/Organisation	Publication Date	Geographic Location	Source Type	Major Themes	Evidence Summary
Petty DR, Zermansky AG, Alldred DP	19 February 2014	UK wide	Research article	NHS, repeat prescriptions,	An investigation into the scale of repeat prescribing and to whom the medicine is prescribed to in the UK. Seeks to understand the current data and common uses as our current evidence is outdated.
Price J, et al.	31 March 2017	Lambeth, London	Research article	Patient safety, risk management	Original research investigating the efficacy of a risk management model designed to identify, measure, and reduce repeat prescription risks which result in preventable harm in primary care settings. 62 unique repeat prescription risks were identified on 505 occasions, uncovering important safety concerns in primary care.
Grosset KA, Deary E, and El-Faragy N	20 November 2017	Glasgow	Research article	Repeat prescribing, patient-centred	Quality improvement study which used the ‘Always Events’ concept to improve repeat prescribing in a deprived, inner-city general practice setting in Glasgow. Researchers found that the Always Event approach allowed them to elicit important feedback from patients to identify a weakness in the repeat prescribing system, which was simple to rectify and led to an improved, more efficient service. Correction following the articles’ release can be found here.
Martin A, Payne R, and Wilson ECF	12 March 2018	England	Research article	Longer vs. shorter prescription durations	This study sought to estimate the cost-effectiveness of 3-month vs. 28-day repeat prescriptions from an NHS perspective. Overall, 3-month prescriptions were associated with lower costs and higher QALYs than 28-day prescriptions. However, the quality of the evidence-base on which this modelling is based is poor. Any policy rollout should be within the context of a trial such as a stepped-wedge cluster design.
King S, et al.	28 March 2018	United Kingdom	Research article	Longer vs. shorter prescription durations	This systematic review explores the existing evidence relating to the impact of differing prescription lengths on clinical and health system outcomes. Currently, there is insufficient evidence to determine whether longer vs. shorter prescription durations are preferable for improving clinical and health system outcomes; however, several studies suggest longer prescriptions may improve medical adherence. Suggests the UK recommendations to provide shorter prescriptions are not substantiated by the current evidence base.
Cardwell K, et al.	5 July 2018	Ireland	Research article	General practice pharmacists	A non-randomised pilot study that plans to use a mixed-methods approach. Four GP practices will be purposively sampled and recruited. A pharmacist will join the practice team for 6 months. They will participate in the management of repeat prescribing and undertake medication reviews (which will address high-risk prescribing and potentially inappropriate prescribing, deprescribing and cost-effective and generic prescribing) with adult patients.
Lillis S, et al.	30 September 2019	New Zealand	Research article	Repeat prescribing practice	Survey was launched to gather the opinions and insights of GPs on repeat prescribing policies and practices. This research found that patient convenience and time efficiency were the most commonly cited reasons for repeat prescribing and registrars had low awareness of their practice’s policy on repeat prescribing.
Davidson S, Thomson C, Prescott G	March 2020	UK	Research article	Benzodiazepine, repeat prescription	This study aimed to investigate whether patients on repeat diazepam prescription had their prescription reviewed to reduce and to stop the repeat prescription wherever appropriate, and whether these changes were sustained at 24 months. The researchers used a minimal intervention strategy to reduce diazepam use in a semi-rural general practice. Patients with a current prescription for diazepam were invited to visit their general practitioner for a review.
Lillis S and Lack L	22 December 2020	New Zealand	Research article	Improving repeat prescribing policy	A workshop-led study designed to improve GPs’ understanding of repeat prescribing policy and understand the current issues with the repeat prescribing process which may put patients at risk. The workshop identified several issues, including a lack of patient understanding of appropriateness of repeat prescribing, a lack of protected time for medicine reconciliation and the task of repeat prescribing, too many personnel and steps in the process, and a lack of clarity over responsibility for repeat prescribing.
Savickas V, et al.	10 February 2021	UK	Research article	Pharmacy services, general practice	A cross sectional study which explored services provided by all UK GPPPs (pharmacists/pharmacy technicians), including the types of services, perceived benefits, and barriers to role development. Study was conducted using a SurveyMonkey questionnaire. Ninety-one complete responses were received (81 pharmacists; 10 technicians). Over 80% of pharmacists provided clinical services, such as medication reviews or management of long-term conditions. More pharmacists within CPGP pilot managed repeat prescribing requests. Overall, General practice pharmacy professionals deliver clinical and non-clinical services which may benefit patients, general practice, and the healthcare system.
Alghadeer S, et al.	25 September 2021	Saudi Arabia	Research article	Pharmacists’ perspective on repeat prescribing	Study exploring assess pharmacists' perspectives toward the repeat prescription process and identify the issues related to repeat prescriptions in refill clinics at tertiary hospitals. Results found that the repeat prescription service might be associated with issues that lead to preventable adverse effects, especially among the elderly who are prone to such effects.
Tse Y, et al.	November 2022	UK	Research article	Complex prescriptions, repeat prescriptions, paediatrics	In the UK, medicines for chronic conditions in children and young people (CYP) are typically initiated within secondary or tertiary care, with responsibility for ongoing supply often then passed to the child's general practitioner (GP) and community pharmacist. The patient should then be reviewed in regular specialist clinics, with two-way communication for any changes in medications or clinical status undertaken between primary and secondary/tertiary care. This arrangement allows long-term medications to be obtained close to home. This is often messy, with families regularly needing to source medicines from the GPs and others via hospitals or homecare services. In addition, these arrangements are not uniform, they vary across different areas of the UK and depend on individual GP or hospital prescriber acceptance.
Chu A, et al.	22 December 2022	England	Research article	Junior doctors, electronic prescriptions, training & resources	Mixed methods study investigating the views of junior doctors towards electronic prescribing, training, and feedback, how ready they are to receive feedback and how the prefer to receive feedback on electronic prescriptions.
Jennings AA, Guerin N, and Foley T	23 October 2023	Cork, Ireland	Research article	Antipsychotics, repat prescribing	This study looked to use an expert consensus process to identify the key components of an antipsychotic repeat prescribing tool for use with people with dementia in a general practice setting. A modified eDelphi technique was employed. The development of repeat prescribing tool provides GPs with practical advice that is lacking in current guidelines and will help to support GPs by providing a structured format to use when reviewing antipsychotic prescriptions for people with dementia, ultimately improving patient care.

Guidance and/or Evaluation Documents

Many local NHS Trusts/local authority areas have produced local guidance documents on repeat prescription and/or how to transition to electronic repeat dispensing (eRD) and Electronic Prescription Services (EPS). Although there are variations in the scope of the documents, many of the local guidance documents are similar in content. Despite the independent publication, many of the documents seem to be variations of the same guidance, with minimal changes between regions.

A few nationally applicable resources are available from sources such as NHS England, NHS Digital, and GMC which some local publications are based on.

Several publications were produced in 2020 as a result of the COVID-19 pandemic and the new-found need to incorporate electronic dispensing and automated processes. Despite the additional motivation for the development of these publications, there are few differences to the pre-existing guidance documents – the context and background is different, but the overarching themes remain the same.

Author/Organisation	Publication Date	Geographic Location	Source Type	Major Themes	Evidence Summary
NHS England	May 2015	England (national doc)	Guidance document	eRD	A comprehensive guidance document designed to enables prescriber and dispensers to use the functionality of eRD effectively.
NHS Luton Clinical	July 2015	Luton	Best practice guide	Repeat prescribing, clinical responsibilities, quality control, medication review	A resource produced to help with the provision of high quality, safe and effective repeat prescribing. It provides tools to help practices and should be used as a working document. User can decide which sections are the most relevant at a particular point and then use the tools provided to make improvements to your systems.
PrescQIPP Commissioning Group	March 2016	Not specified	Guidance Document	Repeat prescriptions, national guidance, electronic prescription service (EPS)	Guidance and advice for prescribers, practice managers, practice staff, community pharmacists and medicines management teams etc., on developing, implementing, and reviewing repeat prescribing systems. It includes information on repeat prescribing policies, managed repeat prescriptions from community pharmacies, repeat dispensing and electronic prescribing.
NHS Digital	13 November 2018	Online	eRD guidance	eRD	The EPS Team at NHS Digital have developed this toolkit to help prescribers and dispensers make the most of eRD. You can jump to different topics using the navigation above and clicking the previous and next buttons at the bottom of the screen. Throughout the toolkit you will find downloadable information which you can share, including guides for prescribers and dispensers.
NHS Shropshire Clinical Commissioning Group	26 June 2019	Shropshire	Repeat prescribing guidelines	Repeat prescriptions, GP practices	Extensive document with guidelines on the repeat prescription process, how to start repeat prescriptions, how to order/request a repeat prescription, reviewing and authorising repeat prescriptions, and risk management. Also provides guidance and advice for prescribers on how to ensure on-going good quality, safe and cost-effective repeat prescribing that minimises medicines waste. This document applies to all members of staff working at GP and includes stages in the EPS. Includes an action plan template.
NHS Yorkshire Clinical Commissioning Group, Medicines Management Team	01 May 2020	North Yorkshire	Protocol document	eRD	Protocol document developed for NY CCG employed Pharmacists and Medicines Optimisation Technicians. Designed to provide clarity about the procedures for undertaking repeat dispensing arrangements within North Yorkshire. The protocols are produced by the NY CCG MM team for use by their employed MM team members. They can be adopted for use by other healthcare staff working in GP practices across.
Wessex Academic Health Science Network	May 2020	Wessex	Handbook	eRD	A handbook designed to act as a ‘quick reference guide’ and a point of reference for staff in GP practices and community pharmacies to help resolve common problems and make the most of the NHS electronic Repeat Dispensing (eRD) service.
NHS England	04 June 2020	England (national)	Letter	COVID-19, eRD	Letter sent to formally notify GPs, community pharmacists and their commissioners of temporary changes to the need for patient consent (using the powers granted by the National Health Service (Amendments Relating to the Provision of Primary Care Services During a Pandemic etc.) Regulations 2020 during the COVID-19 response) to maximise use of the electronic repeat dispensing (eRD) system. Information provided on successful eRD roll out and required action at the time.
Wessex Academic Health Science Network	November 2020	Wessex	Mixed methods evaluation report	Evaluation of eRD	An evaluation of electronic repeat dispensing services in Wessex: exploring the perceptions and experiences of those working in GP, community pharmacy and people who receive medication by electronic repeat dispensing. To explore the perceptions and experiences of eRD from those working in General Practice and Community Pharmacy and people who receive their medication by eRD in Wessex. Evidence has shown the majority of reported eRD to be helpful, specifically with reference to the themes of convenience and time saving. On the other hand, respondents from the General Practice and Community Pharmacist reported challenges in using eRD.
General Medical Council	05 April 2021	N/A	Repeat prescribing and medicine and device management guide	Safe prescribing	Guidance document to help ensure the practice of safe prescribing. Covers what needs to be considered when prescribing unlicensed medicines, repeat prescribing, and when responsibility for your patient is shared. It also informs on how to work safely when you are not the patient’s regular prescriber.
NHS Cheshire Clinical Commissioning Group	23 September 2021	Cheshire	Repeat prescribing guide	Patients and carers, pharmacy, GP practices	Guidance document addressing patient and carer involvement in repeat prescribing, GP practice processes and patient led ordering of repeat prescriptions, pharmacy involvement in repeat prescribing, and Care Home processes.
West of England Academic Health Science Network	December 2021	West of England	Guidance programme	eRD	An online pack of electronic Repeat Dispensing (eRD) resources to help practices and community pharmacists implement eRD. The West of England AHSN worked in partnership with South West AHSN to deliver the following webinars.
NHS Digital	15 June 2022	N/A	Guidance webpage	eRD, prescriber & patient benefits	Overview of the benefits of eRD, which could replace an estimated 80% of all repeat prescriptions. How the system works, the benefit for prescribers and patients, and several documents on how to maximise the benefits of eRD are also included in the guidance.
South West Academic Health Science Network	25 October 2022	Cornwall, Devon, Somerset	Evaluation & insight report	eRD	The report sets out findings and a set of recommendations from activities delivered by the South West AHSN to understand Electronic Repeat Dispensing and increase its usage in the region. The eRD report forms part of the South West AHSN’s Technology-enabled Workforce programme, which seeks to optimise digital interactions to improve patient outcomes and workforce benefits. It is designed to be of use and interest to those involved in delivering and supporting uptake of eRD.
NHS South Yorkshire Integrated Care Board, Doncaster Place	October 2022	South Yorkshire	Guidance document	eRD, SystmOne (TPP)	Guidance document designed to provide clarity about the procedures for undertaking repeat dispensing arrangements within South Yorkshire.
South West Academic Health Science Network	01 November 2022	South West England	Report	Uptake of eRD	New report exploring the use and uptake of eRD across the South West. It is designed to be of use and interest to those involved in delivering and supporting uptake of eRD.
Pharmaceutical Services Negotiating Committee	18 November 2022	N/A	Guidance webpage	eRD background, training resources	Provides background on the origin of eRD, how it works, and shared resources for pharmacists, GPs, and patients. An FAQs section is included.
Community Pharmacy Lincolnshire	07 December 2022	Lincolnshire	Resource webpage	Repeat dispensing	Links to relevant training and resources and guidance (below) for community pharmacies in Lincolnshire to review their processes and training on eRD to ensure all teams are aware of their responsibilities.
The Barkantine	Not specified	N/A	Guidance webpage	eRD	Guide which covers eRD background, benefits for patients, and a step-by-step set-up guide.
NHS Business Services Authority	Not specified	England (national doc)	Resource & guidance document	eRD	National guidance and resources on Electronic Repeat Dispensing. Includes video developed by NHS Business Service Authority and NHS Digital for pharmacies to explain the high-level process behind eRD. Includes process for requesting eRD data, eRD reports, information for patients, pharmacies, and GP practices.
NHS Business Services Authority	Not specified	England (national doc)	Guidance dashboard	EPS, eRD	Dashboards provide information on the EPS and eRD, allowing GP practices, Integrated Care Boards (ICBs), and other bodies to: see variation in EPS and eRD prescribing across GP practices, within an ICB, and across ICBs See trends and variations in EPS and eRD dispensing across dispensers, and within ICBs Help prioritise potential areas of activity Help monitor the impact of initiatives to increase EPS and eRD utilisation The dashboards support local interventions to drive the growth of EPS and eRD so stakeholders can understand the potential benefits of EPS and eRD.
NHS Business Services Authority	Not specified	Wessex	Guidance document	Transitioning to eRD	Report uses data from observations in 2 practices in the Wessex area to highlight the benefits of transitioning from paper-based repeats to electronic repeats, focusing on the potential benefits that moving to eRD can offer.

Grey Literature

There were limited number of publications or online resources discussing repeat dispensing and/or eRD.

Author/Organisation	Publication Date	Geographic Location	Source Type	Major Themes	Evidence Summary
National Institute for Health and Care Research	14 March 2018	UK	News article	Prescription duration, economic modelling, health outcomes	Covers the British Journal of General Practice’s research, and other related research, which suggests that people with long-term conditions should be able to receive prescription durations longer than 28-days.
National Institute for Health and Care Research	17 April 2018	UK	Blog post	Repeat prescriptions, patient safety, prescription length, GPs, community pharmacy	Reviews the current repeat prescription process and how to best balance patients’ needs and reducing medicine waste. The pros and cons of short-term and long-term prescriptions from a patient, GP, and pharmacy perspective. The recent economic modelling exercise which showed longer prescriptions are more cost effective could impact GP practices, dispensing fees, and patient-practitioner interactions. The evidence does not align with the current 28 day prescribing policy, but it is possible that reconsidering this approach could improve patient care and prescription costs.
University of Bristol	2018	England	Research webpage	Duration of repeat prescriptions	A study commissioned by the NIHR Health Technology Assessment Programme in which researchers looked into the clinical and cost-effectiveness of longer versus shorter duration prescriptions for long-term medication, to see if there was evidence to support or change current guidance. The study included: A systematic review of relevant existing research A cost analysis of medication wastage using GP prescribing data from across England An economic decision model, to predict the costs and effects of differing levels of adherence to medication, depending on prescription duration.
Yorkshire & Humber AHSN	Not specified	Yorkshire & Humber	Webpage	eRD	Yorkshire and Humber AHSN's electronic repeat dispensing information webpage. Includes links to resources which will support the roll out of eRD.

References

¹ NHS Business Services Authority (2023). Prescription Cost Analysis – England – 2022-23. Available from: www.nhsbsa.nhs.uk/statistical-collections/prescription-cost-analysis-england/prescription-cost-analysis-england-2022-23. (Accessed 11 January 2024).

² Department of Health and Social Care (2021). Good for you, good for us, good for everybody: A plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions. Available from: www.gov.uk/government/publications/national-overprescribing-review-report. (Accessed 11 January 2024).

³ National Prescribing Centre, NHS (2004). Saving time, helping patients: A good practice guide to quality repeat prescribing. Available from: https://www.yumpu.com/en/document/view/11429810/repeat-prescribing-saving-time-helping-patients-a-good-practice-.

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