Managed repeats

Managed repeats

The provision of regular medicines to patients is facilitated by a variety of different mechanisms and these repeat medication services offer benefits, choice and flexibility to patients.

In recent years, there has been much discussion by Clinical Commissioning Groups (CCGs) and general practices around medicines waste and the mismanagement of non-NHS repeat medication services such as “managed repeats”. Whilst a “managed repeats” service is not part of the Essential Services set out in the Community Pharmacy Contractual Framework nor is it in the terms of service, community pharmacy contractors regularly offer this type of service as a matter of goodwill and without charge to their patients, particularly those who are vulnerable, time poor and/or require assistance.

CCGs in some areas have now introduced measures that restrict community pharmacies from supporting patients to request repeat prescriptions and contractors are concerned about the unintended consequences these changes may have.

There is always scope for continuous improvement in systems and processes, but 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. PSNC recommends that electronic Repeat Dispensing (eRD) should always be the preferred option for the prescribing/management of repeat medication and, where general practices are keen to use that option, contractors should support patients to move from managed repeats to eRD.

Medicines waste

In October 2016, PSNC published PSNC Briefing 054/16: Medicines Wastage and Prescription Duration which summarises information on prescription duration and medicines wastage. This Briefing also highlights literature on the environmental impacts of waste medicines which are not disposed of correctly.

The 2010 report Evaluation of the Scale, Causes and Costs of Waste Medicines, produced by York Health Economics Consortium and School of Pharmacy University of London, estimated:

“…that the gross annual cost of NHS primary and community care prescription medicines wastage in England is currently in the order of £300 million per year” 

The report also makes clear:

“…not all of it is avoidable, or the result of poor practice. This study estimates that less than 50 per cent of medicines waste is likely to be cost effectively preventable.”

The report also suggests:

“…that in welfare terms significantly greater returns could be generated by better medicines use, as opposed to waste reduction per se. Improving adherence in medicine taking can improve health outcomes. The estimated opportunity cost of the health gains foregone because of incorrect or inadequate medicines taking in just five therapeutic contexts is in excess of £500 million per annum…”  

Guidance and resources

PSNC has been supporting Local Pharmaceutical Committees (LPCs) to help inform constructive local discussions about repeat medication services and the resources below may be of use in that endeavour.

Guide to pharmacy management of repeat medication requests (PSNC and Pharmacy Voice)
A briefing outlining common queries, shedding some light on pharmacy processes and discussing a number of important considerations regarding the most talked about proposals that CCGs have put forward – the “Coventry model” and the “Luton model”. This briefing should be of interest to pharmacy contractors, general practices, CCGs, Local Medical Committees (LMCs), LPCs, local patient groups and Healthwatch.

Prescriptions report (Healthwatch Kent)
Report on work undertaken to explore patients’ views on the management of repeat prescriptions, following the introduction of changes to repeat ordering processes by one Kent CCG. The report is likely to be of interest to pharmacy contractors, general practices, CCGs, LPCs, LMCs, local patient groups and other Healthwatch organisations.

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