Julia Gaffney and Paisley Ifould 22 nd 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 people all people over 75yrs should have a med r/v every 12/12 Those taking 4 or more meds every 6/12 QoF – medication r/v within 15 months for All pts on 4 or more meds All pts being prescribed meds on rpt

Prescription Exemptions Under and in full time education Over 60 years Presecribed free of charge contraceptions valid medical exemption certificate Valid maternity exemption certificate Named on a PPC (prescription pre-payment certificate) You or your partner are receiving income support/job seekers allowance Named 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 Certificate a 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

Requested 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 Public Interview Immediate need impractical to obtain prescription Previously prescribed Dose appropriate

Requested By Public Quantity 5 days 30 days Smallest pack size OCP Oral antibiotic liquid

Requested By Public Pharmacist records in prescription book Date of supply Drug name, quantity, form and strength Pt name and address Nature of emergency

Requested By Public Container label Date of supply Drug name, quantity, form and strength Pt name and address Pharmacy 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 Doctor Dentist Nurse Pharmacist Optometrist

Requested by Prescriber Unable to furnish script immediately Will complete it within 72hrs Medicine supplied in accordance with prescribers directions

Requested by Prescriber Pharmacist records in prescription book Date of supply Drug name, quantity, form and strength Practitioner name and address Pt name and address Date on prescription Date prescription received

Private Prescriptions Choice Eligibility Certain medications

Prescribing gluten free products On ACBS formulary- allowed to be prescribed only for pt with: Gluten sensititivty Dermatitis hepatiformis Coeliac 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?