At least two thirds of all prescriptions generated in primary care are for patients needing repeat supplies of regular medicines, and since 2005 repeat dispensing has been an Essential Service within the community pharmacy contractual framework. Under the service pharmacies will dispense repeat dispensing prescriptions issued by a GP and will store the documentation if required by the patient. They will ensure that each repeat supply is required and seek to ascertain that there is no reason why the patient should be referred back to their GP.
Click on a heading below for more information.
Increasing use of the service - Contract changes in England from 1st March 2015
Despite the benefits that the service can bring to patients and the NHS, uptake of it has been very low, in part due to lack of engagement by GP practices. In order to increase the benefits being gained by patients and the NHS from this service, it was agreed in September 2014 that from 1st March 2015 there will be a new requirement in the CPCF for pharmacies to give advice to appropriate patients about the benefits of the repeat dispensing service.
This is part of a broader programme to increase use of the service, which will also engage GP practices and other stakeholders such as Clinical Commissioning Groups (CCGs).
PSNC, NHS Employers and NHS England have all agreed to undertake activities to support the uptake of the repeat dispensing service recognising that the driving force is general practitioners’ prescribing behaviour:
- NHS England agreed to ask their Local Professional Networks (LPNs) for pharmacy to work with CCGs, Local Medical Committees (LMCs) and Local Pharmaceutical Committees (LPCs) to encourage increased use of repeat dispensing by GPs;
- PSNC agreed to encourage LPCs to support this local activity; and
- NHS Employers agreed to reconvene the professional relationships working group to discuss with PSNC and the General Practitioners Committee (GPC) of the BMA what can be done to support an increase in repeat dispensing nationally.
Actions for community pharmacy contractors
All pharmacies are encouraged to work with their LPN, LPC and other local partners to support activities to increase uptake of repeat dispensing by prescribers in their area. These could include:
- identifying and notifying prescribers of suitable patients; and
- seeking to transfer patients already using managed repeats to repeat dispensing.
The Terms of Service were amended from 1 March 2015 to require pharmacies to give advice to appropriate patients about the benefits of the repeat dispensing service (appropriate is defined as ‘patients with long-term, stable conditions who require regular medicines and whose condition is unlikely to change in the short- to medium term’). This may be undertaken in a number of ways such as:
- verbally explaining about the service and its benefits to patients; and
- providing patients with a leaflet describing the service when they are collecting a prescription.
Please note this new contractual requirement only applies to contractors in England, not Wales.
Resources and guidance
PSNC Briefing 004/15: Increasing use of the NHS Repeat Dispensing service (February 2015)
From 1 March 2015, a change to the Community Pharmacy Contractual Framework (CPCF) means pharmacies in England are required to give advice about the benefits of the repeat dispensing service to appropriate patients. This PSNC Briefing will assist community pharmacy teams both in meeting this new requirement and ensuring their repeat dispensing procedures are up to date.
NPC guidance on repeat dispensing (this document is now only available on an archive website; the content of the document may not be fully up to date)
Tips on promoting the service:
Pharmacy’s experience of the repeat dispensing service (an article written by PSNC which appeared in P3 magazine)
Pharmacy management of repeat medication requests
In England, the provision of regular medicines to patients is facilitated by a variety of different mechanisms in addition to the Repeat Dispensing service. Some Clinical Commissioning Groups (CCGs) and general practices have raised concerns about medicines waste and the mismanagement of non-NHS repeat medication services such as “managed repeats”; some have considered the introduction of measures that restrict community pharmacies from supporting patients to request repeat prescriptions. Community pharmacy contractors are concerned about the unintended consequences these changes may have on patients, particularly those who are vulnerable, time poor and/or require assistance.
There is always scope for continuous improvement in systems and processes; improving how repeat medication services operate requires local general practices and community pharmacies to work together, to ensure timely and appropriate patient access to their medicines. To help inform constructive local discussions, PSNC and Pharmacy Voice have written a briefing (presented as Frequently Asked Questions) about repeat medication services, where we outline common queries, shed some light on pharmacy processes and discuss a number of important considerations regarding the most talked about proposals that CCGs have put forward – the “Coventry model” and the “Luton model”.
The briefing should be of interest to pharmacy contractors, general practices, CCGs, Local Medical Committees (LMCs), Local Pharmaceutical Committees (LPCs), local patient groups and Healthwatch.
Patient communication materials
The following poster and patient leaflet have been developed by PSNC to be consistent with the new repeat dispensing contractual requirements which have a particular focus on electronic repeat dispensing.
eRepeat Dispensing leaflet (Word)
The below patient leaflet (RD2) and consent form (RD1) were developed by the Department of Health to support the service (hard copies of these resources are no longer available):
Repeat Dispensing Consent Form for the Public (RD1) (for use by GP practices)
Please note, there is no regulatory requirement for GP practices to get written consent from a patient to share information with a pharmacy regarding repeat dispensing prescriptions; this consent can be obtained verbally.
Stakeholder communication materials
PSNC has developed the following template letters which can be used by pharmacies and LPCs to increase awareness of repeat dispensing amongst the relevant stakeholders.
Repeat Dispensing referral form
If pharmacy teams identify patients who are suitable for the Repeat Dispensing service, with the patient’s consent, they could refer the patient to their GP practice. The following referral form can be used to make such a referral:
The referral form should be used alongside the patient consent form:
GP practices can use the following clinical codes to record patient consent for information sharing for the repeat dispensing service:
Patient consent given for repeat dispensing information transfer
CTV3 code: XaKRX V2 code: 9Nd3. SNOMED CT code: 416224003
Information for GP practices
PSNC has jointly published, with NHS Employers and the General Practitioner Committee of the BMA, a briefing document for GP practices on repeat dispensing.
Guidance for the implementation of repeat dispensing (December 2013)
The following presentation can be used in discussions with GP practices in order to demonstrate the similarity of repeat prescribing and EPS repeat dispensing and the additional benefits of using repeat dispensing:
NHS England published Electronic Repeat Dispensing – Guidance in June 2015. This document clearly describes how Electronic Repeat Dispensing works and is aimed at CCGs and GP practice teams. Contractors may want to use the document in discussions with local GP practices about repeat dispensing.
Q. Can pharmacies provide a repeat dispensing service to patients from other Clinical Commissioning Group (CCG) areas?
Yes, as part of the new Terms of Service, community pharmacies must provide the repeat dispensing service to any patients who present repeat dispensing prescriptions at their pharmacy, whether the prescriber is in the same CCG as the pharmacy, or another CCG.
Q. Do I need to let my local NHS England team know that I have completed training to provide repeat dispensing and that my pharmacy is starting to provide repeat dispensing services?
Q. What are the training requirements for repeat dispensing?
The service specification requires the contractor to ensure that he and his pharmacists are competent to provide repeat dispensing services. Pharmacists should also undergo appropriate training, which may, for example, be the CPPE programme and assessment, but could also be a local training pack or a pack produced, for example, by the head office of a multiple. Local workshops are of value, particularly from the perspective of developing relationships between pharmacies and GP surgeries, but attendance cannot be mandated.
Q. Will I only be paid the repeat dispensing payment if I submit repeat dispensing prescriptions each month?
No, the repeat dispensing payments are made to pharmacies automatically by the Pricing Authority every month, whether they have supplied repeat dispensing items or not. Neither the contractor nor the local NHS England team needs to do anything to claim/authorise the payments.
Q. How do the payments for repeat dispensing work?
In addition to the fees and allowances paid for dispensing all prescriptions, pharmacies receive a repeat dispensing annual payment of £1,500 (£125 per month).
This payment is made to contractors automatically by the Pricing Authority every month, whether they have supplied repeat dispensing items or not. Neither the contractor nor the local NHS England team needs to do anything to claim/authorise the payments.
Q. Does the patient need to complete the exemption declaration on both the Repeat Authorisation Form and every Batch Issue?
Patients are required to complete the exemption declaration on the back of each batch issue at the time of dispensing. A patient’s exemption status may change between the first and last dispensing. There is no requirement for patients to also complete the declaration on the reverse of the Repeat Authorisation Form.
Q. Does a repeat dispensing batch issue form have to be an exact duplicate of the repeat dispensing authorising form, e.g. if there are 4 items listed on the authorising form, does the batch issue have to be printed with the same four items on one form, or can two batch issues be printed with two of the items on each form?
The regulations do not require this to be the case so long as the pharmacist is content that the batch issues do relate to the authorising form.
Q. I have dispensed the final batch from a patient’s repeat prescription. How do I submit the authorising (RA) form to the Pricing Authority?
Repeat authorisation (RA) forms should be submitted to the Pricing Authority at the end of the month in which all batch issue forms have either been dispensed or expired or the medication is no longer required.
It is important that forms are sorted for submission in the correct order as detailed on the reverse of Form FP34C. In months where repeat authorisation forms are being submitted, tick the appropriate box on the FP34C Submission Form to indicate this. There is no need to declare the number of repeat authorisation forms submitted.
Q. How long does a repeat prescription remain legally valid?
A repeatable prescription for a non-Controlled Drug has to be dispensed for the first time within six months of the ‘appropriate date’, with subsequent issues valid for 12 months from the signed date. The ‘appropriate date’ is the later of either the date the prescription was signed or the date indicated as the start date.
For example consider a prescription for Salbutamol 100micrograms/dose inhaler requesting 12 months supply, split amongst twelve batch issues (RD forms). If the signed date on the prescription (RA form) is 1st January 2013, then if the patient is to obtain all of their medicine, the pharmacy must have dispensed fully within one year, and therefore by 31st December 2013.
Schedule 2 and 3 Controlled Drugs cannot be prescribed on repeat dispensing prescriptions.
Repeat dispensing prescriptions for Schedule 4 Controlled Drugs must be dispensed for the first time within 28 days of the appropriate date with subsequent issues valid for 12 months from the signed date. Repeat prescriptions for Schedule 5 Controlled Drugs are treated the same as non-Controlled Drugs and must therefore be dispensed for the first time within six months of the appropriate date with subsequent issues valid for 12 months from the signed date.