Improving access to prescriptions with a practice pharmacist Dr Duncan Petty Prescribing Support Services Ltd Research Pharmacist, University of Bradford Research fellow, Institute of Health Sciences, University of Leeds

Session objectives By the end of this session delegates will : Understand the need for new models of prescription management Understand how a practice pharmacist can manage repeat and acute prescription requests Know how a practice pharmacist can add value to the current repeat prescribing system

Current Situation Prescription management performed by GPs – Repeat prescription re-authorisation – Repeat prescription queries – Request by patients for acute items – Medicines reconciliation on discharge – Management of risky prescribing Dosette boxes DMARDS, NOACs, Warfarin, transplant drugs etc

Task 1 In groups discuss how well these functions are currently performed. – Consider whether they need to be improved – If so what aspects of the current way of doing things needs to change

Task 2 In groups discuss what aspects of prescription management could be undertaken by a suitably qualified practice pharmacist

Overall aim of role of prescription management To manage functions concerning the prescribing, monitoring, review of medicines (that will free up General Practitioners’ time).

Scope Manage medicines at transfer of care Triage of letters and correspondence Manage repeat prescriptions reaching review Manage request for medicine by patients Management of changes to patients on Multi Compartment Aids (MCA) e.g. Dosette box Management of high risk medicines

Manage medicines at transfer of care Medicines reconciliation and follow up of queries with providers and patients Medication review to determine appropriate medicines post discharge Communication to vulnerable patients to explain changes Generation of prescriptions for items required more urgently Manage requests and recommendations for medicines from outpatients

Implement a medicines optimisation care plan Implement new prescriptions for under/untreated conditions e.g. bisphosphonates following hip fracture Make appointments for follow-up monitoring and dose titration Make referrals to GPs and other primary care staff when information in hospital communication suggests input e.g. request for a further referral or investigation by GP

Triage of letters and correspondence Aim – to reduce amount of correspondence that GPs need to see – Screen all letters arriving at practice to determine who needs to see them e.g. Level 1 – no action required by any staff Level 2 – needs practice pharmacist action only e.g. medicine reconciliation Level 3- needs referral to nurse or nurse practitioner Level 4 – needs to be seen by a GP

Manage repeat prescriptions reaching review Review of prescriptions reaching review date – Re-authorisation where evidence in the record of a recent review. – Invite for monitoring tests before re-authorisation – Medication review either face to face or via the telephone/facetime

Manage request for medicine by patients Telephone or face to face consultations with patients wanting a: – new medicine – previously issued acute medicine – medicine recommended by a specialist or other

Management of changes to patients on Multi Compartment Aids (MCA) e.g. Dossette box Review of any changes occurring for MCAs Update of repeat prescription and quantities Communication with pharmacy to notify if change is: – Immediate (same or next day) – In next 7 days – At next MCA refill

Management of high risk medicines Monitoring and re-authorisation of high risk medicines such as: – DMARDs – Non vitamin K antagonists (e.g. rivaroxaban) – Transplant drugs

Practice Pharmacist activity over a 6 month period in a 10,000 patient surgery

Prescription management could be improved: – Safer systems for monitoring and recall of high risk medicines – Pro-active rather than re-active management of medicine requests – Using repeat prescribing re-authorisation as an opportunity to ensure long term conditions are monitored and managed. – Using repeat prescribing re-authorisation as an opportunity for formulary management.