July 2013 / Bridport Road
Dorchester
To all:
Community Pharmacies / Dorset
DT1 1TS
Tel: 01305 213 614
Fax: 01305 213 543
Dear Colleague
RE: Patients who need repeat medication when GP practices are closed
You will be aware of the considerable media attention that has been devoted to the NHS111 service and the quality of out of hours care across the NHS. In Dorset we are fortunate that we have an excellent service, which integrates Urgent care services, out of hours GPs and NHS111. However the service is under considerable strain when call volumes peak. Analysis of this service has shown that at peak times, especially Saturday mornings, upto a third of calls are for people seeking repeat prescriptions as opposed to needing urgent medical help. The service was never intended to be for routine repeat medicines, but for urgent care.
In order to ensure that the service is able to cope with the urgent cases, we are aiming to remind patients that they should order their prescriptions in plenty of time and then seek help from pharmacists and their practice if they have difficulty in ordering. These patients may benefit from repeat dispensing, managed repeats or other support in ordering prescriptions. We are looking to pharmacies and GP practices to work together to make these systems work. We are auditing data from the service, and asking GPs to look at the reasons patients had to seek repeat medicines in the out of hours period and explore whether it was preventable.
The other group of patients that may seek medicines through calling NHS111 are holiday makers in the area, forgetting or running out of routine medicines. For UK holiday makers they can contact their home GP during working hours and organise a prescription to be posted or with the agreement of the pharmacist, faxed and posted within 72 hours.
We are also reminding patients of the potential to obtain an emergency supply of medicines and referring them to pharmacies to see if that is possible. This will result in a charge, and we are making that clear in our communications.
In order to address the pressure on NHS111 form requests for routine medicines we are undertaking a communications campaign, starting with holidaymakers, referring them to the appropriate place to access medicines, and we see community pharmacy as a key first point of access for advice when patients have run out of their medicines. When GP practices are closed, pharmacies are the most easily accessed health professionals, and with the increasing range of medicines available over the counter, and the minor ailment advice and support, we hope that they are used as a first point of call when patients are accessing medicines. This will reduce the strain on urgent care services and A&E departments, allowing them to treat the urgent cases promptly.
From August, we will refer patients seeking repeat medicines to the nearest open pharmacy to see if they can be helped with accessing their prescription or if necessary obtain an emergency supply. There may be some situations where medicines can safely wait until a GP practice re-opens. This will be up to the advice of the individual pharmacist.
There will be some occasions where the pharmacist working in the out of hours period is presented with a difficult situation of a patient needing medication for conditions such as diabetes, respiratory disease and epilepsy. The Out of Hours service provided by SWAST has provided a number that pharmacists can use to access a health professional for advice. This is …….. Please note this is not for patient access as it will not get them through to someone who can help, but it will allow pharmacists to get through to the out of hours administration system, and then a GP.
If you are aware of specific local or patient issues that contribute to patients not getting their repeat medicines promptly, please liaise with your local GP practices to ensure that repeat dispensing, managed repeats etc are used appropriately to prevent them having an impact on the urgent care services.
A poster to highlight to holiday makers their options when they run out of repeat medication is enclosed, and will be circulated through tourism contacts. We have produced a signposting guide for pharmacists, along with a reminder of the Emergency supply regulations, though pharmacists should make sure they are up to date with the most recent Medicines Ethics and Practice. Please review your current standard operating procedures for signposting to ensure they are aligned with these recommendations.
Following a discussion involving Dorset Clinical Commissioning Group (CCG) and South Western Ambulance Services NHS Trust (SWAST) we are trying to ensure that a consistent message is given to people who need to access a supply of repeat medication urgently. Please do not refer patients to NHS111 or A&E unless they need the urgent medical attention that these services are in place for.
Having a consistent approachshould have positive effects on the wider health community. Thank you in advance for your efforts to support this initiative.
Yours sincerely
Katherine Gough
Head of Medicines Management
Dorset Clinical Commissioning Group