Prescriptions

POLICY ON PATIENTS ON PROLONGED STAYS OUTSIDE THE UK

Medication and Phonecalls

MEDICATION WHILE TRAVELLING ABROAD

A limited supply of repeat mediation can be supplied (maximum 3 months, may be less). ‘Just in case’ medications may sometimes be prescribed but may attract a charge payable at the pharmacy as the NHS does not cover treatment for conditions that may occur while abroad.  Please note some frequent Q&A below.

1) Can my GP prescribe extra medication while I go abroad?

If you need medication for a stable, long-term health condition, your GP can only supply a maximum supply of up to 3 months.

However this depends on

• How long your GP thinks you need to continue your medication

• How often your treatment needs to be reviewed

In that case your doctor may be only able to supply an amount for less than 2 months. This is because a doctor remains clinically responsible for a patient as long as they are prescribing for them, and they may also be infringing local laws and regulations by treating patients who are not in the UK.

2) What if I am abroad for longer than 3 months?

Your GP can only prescribe a maximum of 3 months treatment, and you will need to make arrangements to get more at your destination. This may be by:

• Registering with a doctor in the country you are visiting

• Buying the medication from a pharmacist while you are away

If a person is going abroad for more than 3 months then only a sufficient supply of his/her regular medication can be provided to enable them to get to their destinations and find an alternative supply. This is the maximum a person is entitled to under NHS care if they are leaving the country for more than three months. In fact some Health Boards instruct their GPs to remove patients from their lists who are abroad for more than 3 months.

NHS prescriptions should never be obtained by relatives or friends on behalf of patients who are currently abroad, irrespective of factors such as owning a house in the UK or paying UK taxes. Patients are also responsible for ensuring that any drugs they take into a country conform to local laws. Take medicine in or out of the UK - GOV.UK (www.gov.uk)

3) What if I offer to pay for my prescription?

The GP still remains medico-legally responsible for this prescription (see above).

4) Can I get medication in case I am ill abroad?

E.g. in case I get diarrhoea, in case I get reactions to mosquito bites, as period might be due.

If the GP does agree to prescribe medication in case you are ill abroad, as this is not covered by the NHS it may be on a private prescription which you will have to pay for at the pharmacy.

PATIENTS PHONING FOR ADVICE WHILE ABROAD

GPs are not legally covered to treat patients who are not currently in the UK, even via a telephone consultation. They could also be breaching local laws and professional regulations of the country where the patient is currently staying. Therefore while patients may call to book appointments, get results etc, they will not be able to have a phone consultation, in any form, from a GP.

Information is taken from the, BMA website, nhs.uk website, other government websites and represents current government and legal advice.

Am I right, that as an NHS patient my GP must prescribe for me whatever I want?

Under the NHS regulations your GP must prescribe for you any drugs that he or she feels are needed for your medical care. A patient is entitled to drugs that the GP believes are necessary, not those which the patient feels should be prescribed. GPs are responsible for all prescribing decisions they make and for any consequent monitoring that is needed as a result of the prescription given.

It is likely that most, if not all, the drugs you need are available through the NHS, however there can be exceptions. Some drugs will only be offered on the NHS to patients suffering from specified conditions. Similarly, some products other than drugs, such as gluten free foods or sun blocks, are listed as ‘Borderline Substances’ and may only be prescribed at NHS expense in defined circumstances. Other drugs or substances cannot be prescribed at all on the NHS, these include Evening Primrose Oil, many vitamins, bath preparations, cough syrups and expensive brand names of some drugs.

May GPs charge for issuing a private prescription?

GPs may write private prescriptions for patients which they may wish to do for drugs not available through the Drug Tariff. However, GPs may not normally charge their registered patients for providing such a prescription, although a dispensing doctor may charge for dispensing the prescription.

The only occasions when a doctor may charge for a private prescription are:

1. For drugs which are being issued solely in anticipation of the onset of an ailment whilst outside the UK, but for which the patient does not require treatment when the medicine is prescribed.
2. For drugs issued for the prevention of malaria. (Swallownest Health centre does not offer Malaria prevention prescribing you will need to use a travel clinic to obtain these)

Can my GP refuse to give me a prescription that my consultant asked them to provide?

Yes, your GP may refuse because the person who signs the prescription is legally liable for the prescribing and the consequent effects of that drug. Some drugs which may be very familiar to consultants in a specialised area of medicine can be potent drugs of which a GP will have little experience (for example many cancer drugs or specialised treatment for diseases such as rheumatoid arthritis – the group called ‘biologicals’). Where a GP considers that it is inappropriate for them to issue a prescription on the advice of a third party, responsibility for provision will rest with the doctor making the recommendation.

A friend’s GP wrote them a similar prescription on a consultant’s advice, why won’t mine?

I think this is discriminatory. Each GP will make prescribing decisions based on what they are or are not prepared to take clinical responsibility for. Some doctors might have special training or knowledge of a particular area of medicine which makes them comfortable to prescribe and monitor a drug where many GPs would not. Clearly, a GP should be aware of their limitations as well as their skills and must ensure that they are not prescribing beyond their knowledge or their ability to ensure patient safety. GPs are not obliged to provide every possible medical service to their patients, only those for which they have been contracted for, and these contracting arrangements may vary between practices

What is a shared care agreement?

Sometimes the care of a patient is shared between the two doctors, usually a GP and a specialist. There should be a formalised written agreement/protocol setting out the position of each, to which both parties have willingly agreed, which is known as an ‘shared care agreement’. It is important that patients are involved in decisions to share care and are clear about what arrangements are in place to ensure safe prescribing. In some cases, a GP may decline to participate in a shared care agreement if he or she considers it to be inappropriate. In such circumstances the consultant would take full responsibility for prescribing and any necessary monitoring. Guidance covering these issues (Responsibility for prescribing between primary and secondary/tertiary care) was published in 2018 on the NHS England website.

I live abroad for six months of the year and my GP has refused to give me a prescription.

The NHS accepts responsibility for supplying ongoing medication for temporary periods abroad of up to three months. If a person is going to be abroad for more than three months then only a sufficient supply of his/her regular medication should be provided to enable them to get to the destination and find an alternative supply. NHS prescriptions must never be obtained by relatives or friends on behalf of patients who are currently abroad, irrespective of such factors as owning a house in the UK or paying UK taxes. Patients are responsible for ensuring that any drugs they take into a country conform to local laws

Information is taken from the, BMA website, nhs.uk website, other government websites and represents current government and legal advice.

Please make every effort to do your part in helping and supporting the NHS by buying Over the Counter medication.

In 2019, the cost of the prescriptions dispensed in the community in England was £9.08 billion. This was an increase of 2.81% (£248 million) from £8.83 billion in 2018.

The overall number of prescription items dispensed in the community in England in 2019 was 1.12 billion. This was an increase of 0.98% (10.9 million) from 1.109 billion in 2018.

Many of the items which are included within these prescription are available ‘over the counter’ meaning that you can purchase these items yourself in pharmacies and other outlets, without the need for a prescription. Normally the price of these over the counter drugs is much much lower than what you would have to pay for a prescription fee. If more patients are able to self-medicate simple ailments, patients and the NHS can both save a drastic amount of money.

Here is a list of some of the most common drugs that you can buy much cheaper in supermarkets, pharmacies, or even in discount stores:

• Paracetamol
• Aspirin
• Antihistamines

A number of ailments also have a variety of over the counter treatments which are much cheaper to purchase yourself than via prescription. In order to save an estimated £560 million, the NHS will no longer prescribe medications for the following minor conditions for which over the counter medication is readily available at low cost:

• Dandruff
• Dermantitis
• Dry Skin
• Earwax
• Excessive Sweating
• Hay Fever/Seasonal Rhinitis
• Head Lice
• Insect bites and stings
• Mouth Ulcers
• Nappy rash
• Ringworm and Athletes Foot
• Sunburn
• Sun Protection
• Teething/mild toothache
• Threadworms
• Travel Sickness
• Warts and Verrucae
• Minor conditions associated with pain, discomfort and fever (such as sprains, headache, period pain and back pain)

Shortages of medicines are becoming an increasingly frequent issue that can hinder GP practices efforts to prescribe medicines and for patients to get their prescription dispensed in a timely manner.

Medicines supply issues can occur due to a number of unforeseen events and may be down to a combination of factors, which are outside of General Practices control.

Firstly, it is important to ascertain if the “currently” unavailable medicine will become available before the patient will actually need it. Due to the intermittent supply chain, many medicines availability can change throughout the week and in some circumstances daily. Community pharmacies are best placed to be able to provide any expected re-supply dates.

Patients should be encouraged to try several pharmacies (not of the same chain) to fulfil their prescription as different pharmacies use a range of wholesalers and distributors. The patient may wish to ring pharmacies in advance of attending to ascertain availability.

Some manufacturers of certain medicines (e.g. epilepsy, inhalers, adrenaline pens etc) advice patients that “if your pharmacy can’t get this medicine from their usual supplier, you can ask them to order direct from us, the manufacturer”. This should be checked as a viable option.

If it is determined a medicine is unavailable:

• The prescription containing the unavailable medicine should be asked to be returned to the GP practice so that the “item” (not necessarily entire script) can be cancelled. This will ensure the GP practice record is up-to-date and the pharmacy may re-download this prescription if there are other items to dispense
• Where possible an alternate drug from local guidelines should be used
• Where the alternative drug from local guidelines is not available (or there is no alternate drug) other options may be considered in discussion the practices Medicines Management Team support

We are aware that prescribers may also be asked to prescribe an alternative, recommended by the pharmacy, if there is a supply issue.  This will need to be considered on a case-by-case basis and in-line with local medicines guidelines. Despite the recommendation, it is the prescriber’s responsibility to ensure the recommended alternative meets local guidelines and is the most appropriate alternative for the patient.

The Medicines Management Team are available for advice and support for the practice.

We require 72 working hours to prepare a repeat prescription, so please place your order well before your existing medicines are used up.

After many years of accepting repeat prescriptions over the telephone, we have taken the difficult decision to terminate this service from Friday 13th July 2018.

We are advised by NHS England to encourage patients to sign up to online access. The evidence for the benefits of online interactions between patients and their GP's continues to grow, the key benefits amongst many others being:

• • Improved access to patient care

• • Increased patient satisfaction overall

• • Improved communication between patients and practices

• • Reduction of DNA's

• • Reduced travel for patients

• • Reduced administration workload for practice staff

The most important reason for this decision is safety. We are getting increasing numbers of inconsistencies between what the patient says they have ordered and what has been requested by the medical receptionists.

The Practice is getting busier and busier with more people on repeat medication for ever increasing complex conditions. We made the difficult decision to stop the taking of prescriptions over the telephone so as to minimise the risk of a potential error causing a significant event. We hope in making this change it will free up our phone lines for patients contacting us for other urgent or important queries and also allow our medical receptionists to process repeat prescription requests.

We understand that this might not be popular with some patients but we hope that you will understand that your safety is of paramount importance.

When requesting a repeat prescription, please make it quite clear which medicines you require. Leave details of your request in the prescriptions box at the bottom of the stairs, or post them to us. If you want us to post your prescription to you, please provide a stamped addressed envelope.

Alternatively you can order online on the System Online Website. First time users are required to call in person at reception with appropriate identification (photo identification plus a document with name and address e.g. bank statement but not utility bills) to complete a simple registration.

Electronic Prescribing (EPS)

From the 12th April 2016 the surgery has participated in the Electronic Prescribing Service (EPS). To reduce paper and save time you will be able to have your prescriptions sent to the pharmacy of your choice. For more detail click on the following link EPS Fact Sheet

Medication Reviews

Patients on repeat medication will have their medication reviewed at least once a year. This may result in a message asking you to see a GP or a Nurse. Please ensure that you book an appropriate appointment to avoid unnecessary delays to further prescriptions.

Prescriptions Charges and Exemptions

Extensive exemption and remission arrangements protect those likely to have difficulty in paying charges (NHS prescription and dental charges, optical and hospital travel costs).

The NHS prescription charge is a flat-rate amount which successive Governments have thought it reasonable to charge for those who can afford to pay for their medicines.  Prescription prepayment certificates (PPCs) offer real savings for people who need extensive medication.

NHS charges

These charges apply in England only. In Northern Ireland, Scotland and Wales prescriptions are free of charge.

• Prescription (per item): £9.35
• 12-month prepayment certificate (PPC): £108.10
• 3-month PPC: £30.25

If you will have to pay for four or more prescription items in three months, or more than 15 items in 12 months, you may find it cheaper to buy a PPC.

• Telephone advice and order line 0845 850 0030
• General Public - Buy or Renew a PPC On-line

There is further information about prescription exemptions and fees on the NHS website

Repeat Prescription requests from Community Pharmacies

As of the 1st April 2017 we NO LONGER accept any repeat prescription requests from community pharmacies on behalf of patients. Patients (or their carer, nominated family member/friend) must order repeat prescriptions directly from the GP practice themselves. Collection of prescriptions from GP practices by community pharmacies on behalf of patients will not be affected.

The 27 practices who have made or are making this change, with the full support of NHS Rotherham CCG, have carefully considered all options, engaged extensively with key stakeholders (patients, carers, patient participation groups and voluntary groups) and decided to take this action to reduce medicine waste.

The most efficient and safest way is to order your prescriptions using the on-line order service. If you are not yet registered for this call at our reception with some form of photographic identification and we will organise this facility for you.