Transcript Prescribing Regulation

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 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 16
 16-18 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,
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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
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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 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?