10. Suggestions to improve repeat prescribing in the future

This toolkit has been designed to encourage and support general practice and community pharmacies to reflect on their repeat prescribing systems so that improvements in medication safety and efficiencies can be made wherever possible.

However, some areas were outside the scope of this working group to address. Examples include changes in commissioning responsibilities or regulatory arrangements.

To ensure the continued safety and efficiency of repeat prescribing systems, we make the following suggestions to improve repeat prescribing in the future:

1. Commissioners are encouraged to consider incentivisation for practices/PCNs and community pharmacies to engage with this work and complete the repeat prescribing self-assessment and action plan.
2. GP and pharmacy system suppliers are asked to provide greater functionality to help to recognise the oversupply and over ordering of repeat medication, particularly for higher-risk medicines, and help practices and pharmacies to identify and address it.
3. We encourage the NHSBSA and NHSE to further develop the oversupply tool to increase functionality to measure the oversupply of higher-risk medicines such as opioids, antidepressants, benzodiazepines and antimicrobials (see box 1).
4. The terms of service for NHS community pharmacies and the Community Pharmacy Contractual Framework could formally enable pharmacy teams to support patients to discuss how they are taking their medicines and raise any concerns with their community pharmacist at the point of dispensing. The development and commissioning of a community pharmacy service to help people who are struggling or unable to manage their repeat prescriptions effectively could be explored. Such a ‘repeat prescription review service’ could meet the needs of the large number of patients who express confusion about what medicines they have been asked to take and how to take them safely. Such a service could be tested to explore its impact on adherence and reducing the ordering of medicines that the patients are no longer taking.
5. eRD requires urgent modernisation to ensure it works smoothly and resolve some of the well-known challenges. In particular, the ability to amend doses in EPS (rather than having to cancel that item) would be a welcome improvement both in efficiency and safety. The improved functionality of the NHS app in relation to eRD tracking and monitoring would be a significant development. More broadly, the improved medicines and prescriptions functionality in the NHS app, especially but not solely in relation to eRD to optimise user experience and safety would be very welcome.
6. A national and accredited course should be made available for non-clinical staff who are essential in supporting the repeat prescribing process and support given to GP practices to enable reception staff to have the time to complete such training.
7. There is a significant need for a greater information to inform the public of, and raise awareness of medication safety, medicines waste and the environmental impact of medicines. A national, public awareness campaign should be considered by national organisations and royal colleges.
8. NHSE should be encouraged to expedite digital solutions to allow hospital discharge information relating to medicines to link into the patient record to create a digital audit trail of any medication changes.
9. Secondary care and specialist services are asked to make very clear to primary care on discharge of a patient from hospital, the reasons for medicines to be prescribed on repeat, the indication and the intended duration of therapy. Any medicines stopped need to also be clearly documented with a reason for the cessation of therapy. Utilisation of the Discharge Medicines Service (DMS) in England is currently not fully optimised. The DMS enables hospitals to digitally share information about medication changes with the patient’s usual community pharmacy and has been shown to reduce readmission rates at 30, 60 and 90 days. Trusts and Community Pharmacies should make the most of this opportunity to reduce avoidable harm.
10. A clinical guideline should be commissioned to pull together, in one place, recommendations on the frequency of medication reviews for all higher risk, repeat medications. This could be a role for NICE or Specialist Pharmacy Services.
11. Commissioners are asked to explore the formalisation and contractualization of protected time to allow for discussion between general practice and community pharmacy. This needs to be set out nationally in relation to the repeat prescription pathway, to ensure that all parties are clear about their responsibilities.
12. The issue of ‘bulk authorisation’ of repeat prescriptions requires a more in-depth, national review. The functionality to bulk authorise repeat medicines has been developed by some but not all of the GP system suppliers. However, the full medico-legal impact and risk of this development is unclear. A minimum set of standards and a risk assessment process for GP practices are urgently needed to ensure that the safety of authorisation of repeat medicines is maintained.