Duration of Prescriptions and 7 day Prescribing
This is a recurrent issue and something that we are contacted about at the office on a regular basis with GPs and practices asking whether or not there is any obligation to provide prescriptions for seven days of medication. The answer is no - but never say never.
There will be times when a seven day prescription is appropriate e.g. in managing drug addictions or where a patient is starting a new medication and there might be the need for an early dosage change.
With regard to requests for seven day prescriptions from either patients or pharmacists there is no requirement for GPs to comply. The provision of Domiciliary Medication Dosage Systems (DMDS) is included within the essential services component of the pharmacy contract. We are all required by the Disability Discrimination Act (DDA) to make reasonable and appropriate adjustments to our services so as to ensure that a disabled person is not discriminated against. For pharmacists this will include making medication available with suitable instructions or in a suitable container. The pharmacy contract recognises the increased work and costs of meeting this legal obligation and there is an additional payment per prescription item to help with these costs.
The decision of what adjustments are appropriate in each individual case is the responsibility of the community pharmacist. Seven day prescriptions are not a requirement but it must be remembered that if a prescription is written for 28 days then all 28 days will be provided to the patient at the same time. Community pharmacists are only obliged to provide support to patients who are eligible under the act. Ineligible patients have the option of paying themselves for any requested support.
We are frequently asked for guidance on the appropriate duration of prescriptions and thought it would be helpful to set out our advice and also consider the issue of weekly prescriptions and monitored dosage systems (MDS).
We would advise that the appropriate duration of a prescription should be decided by the prescriber, in conjunction with the patient, taking into account the medicine being prescribed, its monitoring requirements, the condition being treated and the individual patient's needs.
We would also advise that a shorter duration is appropriate when a new medicine is first started or when a patient's condition or medicines regimen is likely to change. The quantities on a prescription should reflect the required frequency of dispensing. The quantity (and cost) of wasted medicines is significant and the duration of prescriptions is one factor that affects this.
With regard to the issue of weekly prescriptions the Local Pharmaceutical Committee has produced a useful briefing document on the issue of MDS and the Disability Discrimination Act (DDA). The guidance covers the adjustments that a dispenser (pharmacy or dispensing practice) might be required to make under the DDA and the fact that funding for such adjustments is included in their contract.
It is the dispenser's decision as to what is the appropriate adjustment, not a carer or another healthcare professional. The guidance is available at: http://www.hampshirelpc.org.uk/docs/MDS%20and%20DDA%20Guidance.pdf
The LPC website also has a number of useful resources to help pharmacists assess and support patients with disabilities.
I would like my patient to receive their medicine on a weekly basis (for reasons of safety).
In this situation it is necessary to prescribe weekly prescriptions. The quantity on a prescription should reflect the required frequency of dispensing.
A care home has asked the pharmacist to provide medicines in a MDS and the pharmacist is asking for weekly prescriptions to help cover the cost of the MDS.
We can see no justification for practices to prescribe weekly prescriptions for patients in care homes unless the patient's clinical condition justified a weekly supply. GPs should not prescribe weekly prescriptions as a way of subsidising the cost of MDS and the pharmacist and home can enter into a private arrangement for the supply of medicines in a MDS.
A patient requires an MDS because of their disabilities should I write weekly prescriptions?
The pharmacist is responsible for assessing a patient's needs and making appropriate and reasonable adjustments to their services so that the patient would not be prejudiced against. The supply of medicines in a MDS might be one of the possible adjustments (other examples might be large print labels or a medicines administration record sheet). Funding is included within the pharmacy contract to recognise the additional work and costs of this requirement and therefore weekly prescriptions would not be appropriate (unless clinically indicated).
A patient does not qualify for an MDS, should I write weekly prescriptions?
If the pharmacist has assessed the patient and does not believe they are eligible under the DDA then the patient and pharmacy are free to enter into a private arrangement to provide the support requested