Lecture 5

The supply of prescription only medications - on private prescriptions

Private Prescriptions

• written by doctors or dentists working outside of NHS

• patients find these HCP via recommendations or advertisement

• includes private hospitals eg. BUPA, Medi-centres and single practices

• patients pay for initial consultation and any tests

• patients pay for prescription to be written

• patients pay for medicines to be dispensed and any fee pharmacy may change

Private prescriptions - repeats

• repeatable prescriptions are prescriptions against which medicines can be dispensed more than once

• can be repeated as indicated by the prescriber

• if the number of repeats is not stated, then they can only be repeated once

• benefit for patient: patient doesn’t have to pay fees for GP and only for pharmacy

• NHS prescriptions and prescriptions for schedule 2 or 3 CD are not repeatable

  • only exception to this is a prescription for an oral contraceptive — can be dispensed six times within six months

• for other repeatable prescriptions, the first dispensing must be made within 6 months of the appropriate date, following which there is no legal time limit for the remaining repeats

  • ask patient if medication is still relevant

POM Records

All supplies of a POM must be recorded except when:

• Supply is on an NHS script or any script for an Oral contraceptive

• a separate record (record of all sales of 2-CD med.) is made in the controlled drugs register (medicines with the legal class of CD POM)

• sale or supply is by wholesale dealing and the order or invoice relating to the sale is retained for 2 years

Private Prescription Records

• private prescriptions for a POM must be retained for two years from the date of the last sale or supply. Records must be made in the POM register

• this register can be paper or electronic

• the entry must be made at the time of the supply or within 24 hours

Record Requirements:

• supply date

• prescription date

• medicine details - name, quantity, formulation, and strength

• prescriber details - name and address

• patient details - name and address

*For second and subsequent supplies on a repeat prescription only require date of supply and reference to the first entry

Records in the pharmacy

Signed Orders (instruction/request from pharmacy, GP to obtain medication for their own practice):

• for POM:

  • record in POM book unless is wholesale transaction where no record required but signed order must be retained for 2 years

• NHS prescriptions

  • GSL, P, POM — no records legally required

  • CD POM (Schedule 2) — CD register entry legally required

• Private prescriptions

  • GSL and P — POM book entry for good practice

  • POM — record in POM book legally required

  • CD POM (Sch. 2) — CD register entry legally required

    • OCC (oral contraceptive) — POM Book record made for Good Practice

Fate of a Prescription

• NHS prescriptions are sent each month to the NHS Business Service Authority (NHSBSA) for payment

• they check electronically and manually every prescription in order to pay the pharmacy

• Eg: FP10

  • retain until the end of the calendar month, sort and send to NHSBSA

Private:

• GSL or P — endorse and return to patient

• POM — retain in Pharmacy for 2 years unless from the date of the last sale or supply

• If repeatable, return to patient until final supply made. Then retain for 2 years

• CD in general — retain in pharmacy for 2 years. ‘Repeats’ not allowed

• (except private prescriptions for CD POM (sch. 2) & CD No Reg POM (sch 3) Send to NHSBSA. This will be covered in the second year) — gov. wants to monitor those CD bc they could be dangerous and look at prescribing trend of these drugs

Administration of POMs

No person shall parenterally (injection) administer a POM unless they are an appropriate practitioner or acting in accordance with an appropriate practitioner

However, there are exemptions

Administration exemptions

• some parenteral medicines can be administered in an emergency by any person

• further exemptions apply to the administration of smallpox vaccine or administration of smallpox vaccine or administration linked to medical exposure (including radioactive medicines)

• specific classes of persons (such as midwives and paramedics) for specified parenteral POMs under certain conditions

Administration

• medicines legislation does not restrict who can administer a non-parenteral POMs (ie. oral, inhaled, topical or rectal dosage forms, etc.)

• yet, generally in healthcare settings, the person administering the medicine should only do so with:

  • prescription

  • patient-specific direction (PSD)

  • patient group direction (PGD)

• … and be appropriately trained