1. Pharmacy Technician Pilot : Wendy Bagnall Medicines Management Technician Chris Blunt Practice Manager

2. Background Repeat prescription requests account for a large proportion of practice staff time each day. Usually dealt with by a receptionist or member of the admin staff looking at each request and producing a prescription. May require clinical input if not straightforward. This causes a delay in the production of the prescription and also takes up valuable GP time

3. Aims To ascertain whether using a pharmacy technician to process repeat prescription requests will reduce the amount of time GPs need to spend on them. To determine if pharmacy technicians can identify any safety concerns and make any necessary interventions To determine if using a pharmacy technician to process the prescriptions will result in any efficiencies

4. Summary of Project The pharmacy technician works at the practice for four hours a day from 9am to 1pm. While at the practice she undertakes some or all of the following duties; Assess all non- straight forward repeat prescription requests identified by practice staff Resolve queries where possible and produce a prescription to be left for the GP to sign Pass on any queries that the technician is unable to resolve to the practice pharmacist or duty doctor

5. Undertake any housekeeping tasks identified by practice staff. E.g. – Removing duplicate or unwanted items from the patient’s current medication record. – Checking medication review dates – Aligning medication to ensure that all repeat items can be ordered together – Ensure that any necessary blood tests have been undertaken Undertake any other work identified by the practice or the CCG Medicines Management Team

6. Evaluation The project will be evaluated with regard to – Impact on GP workload – Efficiencies realised – Evidence of safety interventions – Practice staff feedback on impact on the repeat prescribing system

7. Interim Results

10. Interventions Request received for Co-careldopa. Clinic letter stated that the patient was recently diagnosed and the dose was to be reviewed with a view to increasing- providing the patient hadn’t experienced adverse side effects or a marked improvement. Relatives contacted – confirmed that the patient had had no side effects or substantial improvement.

11. Interventions Increased dose of Sinemet had already been added to the medication list as advised in the clinic letter. Prescription produced for new dose and a note detailing actions of technician left for the duty doctor. Previous lower dose tablets removed from the patient‘s active medication list. Patients pharmacy contacted and asked to retrieve any remaining lower strength medication.

12. Relatives contacted to request anti-coagulation book During the discussion relative mentioned issues with dose of Risperidone. Patient’s Risperidone dose had recently been increased to 500microgram BD but relative was adamant that they had actually been receiving 1mg BD. The issue had already been discussed with a Doctor and the relative was reassured that the dose on the practice system was definitely 500microgram BD. Request for Warfarin- NH resident

13. Nursing home contacted to confirm dose being administered but there seemed to be some confusion. Nursing home receives medication for their patients in a blister pack format so supplying pharmacy was contacted. The Pharmacy had supplied an extra container with the afternoon dose of Risperidone. They then changed the blister pack to reflect the new dose but did not remove the extra container

14. The nursing home had two containers of the medication both stating a dose of 500microgram BD and they had been administering both to the patient to make the total dose the patient was receiving 1mg BD. Technician requested that both the nursing home & the pharmacy removed the extra container and that the MAR chart was changed to reflect the dose intended by the surgery. Intervention recorded in patient’s record.

15. Clinic letter Dermatology Clinic letter received. Change of dose to existing medication required. Patient contacted and confirmed she understood the new dose.

16. Clinic letter Patient also expressed concern over a recent eye clinic appointment and changes to her regime. Confirmed with patient that she had had 2 eye drops discontinued and 2 new eye drops commenced. Confirmed her levels of supply & produced prescriptions as appropriate. Reminded her that her medication review was due the following month.

17. Practice View Saves the GPs two hours a day. Improved Speed of processing patient’s prescribing queries Technical Point of reference for clinical and administrative staff

18. Practice View Better (and more frequent) explanations being given to patients concerning medications etc. Potential for significant Cost savings on practice budget