1. Batch Prescribing Repeat Dispensing
How it can benefit patients and practices...

2. Did you know….
Two thirds of prescriptions issued in primary care are repeat prescriptions.
80% of NHS medicine costs for primary care.
410 million repeat prescriptions generated every year – equivalent to an average of more than 200 per GP per week.
80% of all repeat prescriptions could eventually be replaced with repeat dispensing.
This is equivalent to 2.7 million hours of GP and practice time in England and Wales.
Two thirds of prescriptions issued in primary care are repeat prescriptions.
•This accounts for 80% of NHS medicine costs for primary care.
•There are up to 410 million repeat prescriptions generated every year – equivalent to an average of more than 200 per GP per week.
•330 million or 80% of all repeat prescriptions could eventually be replaced with repeat dispensing.
•This could save 2.7 million hours of GP and practice time.

3. Monthly repeat prescribing system – Current Process
GP decides to issue prescription which can be repeated X times
Patient’s record in GP clinical system contains authority for X repeats of the medication before review by GP
Patient (or pharmacy on patient’s behalf) requests the issue of a repeat prescription from GP practice
Practice staff print repeat Rx and GP signs it. One less repeat Rx available to patient before review by GP
This is how Repeat ordering currently happens across Wales.
-Patient/pharmacy orders medication
-Rx Clerk reprints medication available on repeat
-GP signs prescription
-Patient/Pharmacy collects Rx and dispenses medication for patient
Patient (or pharmacy on patient’s behalf) collects the repeat Rx from the GP practice
Pharmacy dispenses repeat Rx
Patient collects repeat medicines from pharmacy

4. Batch Repeat Dispensing (BRD)
GP decides to issue prescription which can be repeated X times
Repeat dispensing used in GP clinical system to prescribe.
Patient (or pharmacy on patient’s behalf) collects the Batch Rx from the GP practice
X repeat Batch Rx’s for regular medication are printed and ready at surgery
This is Batch Repeat Dispensing Process
The prescriber produces a repeatable prescription and a set of identical ‘batch’ forms
The number required is equal to the number of times the prescription is to be repeated and this is to be indicated on the form, for example, 1 of x, 2 of x
Each repeatable prescription can be dispensed at regular intervals, for example, monthly for a period of up to 12 months (13 issues in 12 months)
a dispensing interval does not have to be set by the prescriber, so that the pharmacist has maximum flexibility to make a professional decision when to dispense the next supply for the patient. This is of particular benefit for patients who may be travelling or if the prescription is for seasonal medicines or ‘when required’ medicines
Patients will call at their chosen pharmacy for their continued supply of medicines without the need to reorder prescriptions during the life of the repeatable prescription
The outstanding repeats left on the prescription can be cancelled and the remaining batch issues destroyed as and when required, to respond to changes in medicines, clinical condition or patient circumstances
The batch forms can be stored securely at the pharmacy or retained by the patient
The duration of the repeatable prescription can be aligned to a patient review, monitoring procedure or other clinical and administrative functions of the practice
At the point of dispensing each instalment, the pharmacist will be responsible for checking patient adherence and other clinical factors that are relevant to the appropriateness of the continued supply, for example, whether there are any problems the patient may be encountering with their medicines, whether the patient has recently been in hospital or had changes made to their medication regimen. Any issues of concern to the pharmacist will be reported to the practice.
Pharmacy dispenses repeat Rx X times over the time interval decided by GP keeping the batch secure.
Patient collects repeat Rx from pharmacy X times over the time interval set by the GP until review needed

5. BRD benefits for GPs Participating in the BRD service means that:
Patients with stable, chronic conditions who are up to date with reviews only need to visit the practice once over the time interval decided by the GP.
An initial batch of 6 months scripts and subsequent 12 month script batches reduce admin related transactions relating to supply of medication.
Patients will only need to visit the practice for clinical reviews at time intervals decided by the GP.
PRN medication waste can be managed by the items being ordered either by a batch of prescriptions with a longer time intervals between issues, acute scripts or though My Health Online
General practice staff
The number of visits to the practice or telephone calls by patients requesting and collecting repeat prescriptions is reduced. The average practice would have 2000 patients who could be suitable for Repeat Dispensing. These patients would have multiple medications, often unsynchronised meaning repeats are requested several times during a month. Repeat Dispensing allows the pharmacist to synchronise the medication without causing any waste. If a patient is contacting the practice just twice a month to request medication, that’s 4,000 interactions with the practice per month or 48,000 per year. Repeat Dispensing could bring this down to just 2000 interactions per year.
The administrative work associated with paper repeat prescribing processes is reduced.
Fewer paper prescription requests are lost, therefore improving data protection and information governance.
Administrative work of filing and storing prescriptions which are waiting to be collected by the patient, carer or pharmacist is reduced.
Footfall at the GP surgery from prescription collection services and patients is reduced.
Reducing waste and Saving money:
PRN medication can be supplied on a RD form on a lower frequency, or the patient is encouraged to use My health online.
The national repeat dispensing evaluation conducted by Manchester University reported that repeat dispensing can produce savings in drug costs since items not actually needed by the patient are not dispensed. The study suggested that the savings are in the region of £550 per 1,000 repeat dispensing batch issues dispensed compared to traditional prescriptions. 55p per RD.

6. Summary Overview
Benefits of BRD for GP practices include a reduction of the interactions regarding medication administration (On average 2000 patients suitable for BRD reduces the twice a month interaction to request medication from 48,000 to just 2000 interactions per year.)
Benefits of BRD for patients include convenience, earlier detection of medicine related problems, a reduction in the amount of unwanted/unneeded medication being held at home.
Benefits of BRD for the NHS include the implementation and provision of the funded BRD service across the country with patient care at its heart, the potential to reduced unwanted/unneeded medication, and the potential to reduce unnecessary requests of regular medication from out of hours services.
Recap of benefits
Less time is spent processing, filing and handing out prescriptions to patients
Reduction in the number of times prescriptions require signing as a single signature is valid for each Batch of repeats.
Only see patients when review is needed, re-authorise for as long as needed before next review and you should not need to interact with that patient unless nessecary  
Reduced medicines waste. PRN medicines aren’t ordered every month by the patient or pharmacy. The pharmacist is obliged to check that all medicines are needed before dispensing.
Earlier detection of medicines–related problems. The pharmacist is obliged to check for any issues before every dispensing. Increased collection intervals will trigger investigation into compliance and adherence.
Reduction of patients requesting regular medication from out of hours services, as they will have access to their regular repeat dispensing prescriptions at the pharmacy.

7. What are your Next Steps?
Review BRD Tool Kit and Nominate BRD Champion
Review BRD Action Plan to set time scales & realistic targets.
Host/attend engagement event with all prescribers, admin team and local pharmacies to agree processes, communication routes, and nomination/ enrolment criteria.
Complete training needs assessment and ensure whole team engaged and competent with patient journey and processes.
Start delivering the BRD service by identifying suitable patients
at medication reviews
Opportunistically in the practice or pharmacies
by advertising in the surgery.
Review the BRD service. Share outcomes and best practice.
Review the BRD Toolkit for Pharmacy or GP teams
Review BRD Tool Kit and Nominate BRD Champion
Review BRD Action Plan to set time scales & realistic targets.
Host/attend engagement event with all prescribers, admin team and local pharmacies to agree processes, communication routes, and nomination/ enrolment criteria.
Complete training needs assessment and ensure whole team engaged and competent with patient journey and processes.
Start delivering the BRD service
Identify potential patients
at medication review
opportunistically
by advertising in the surgery.
Review the BRD service.
Share outcomes and best practice.