Repeat Prescription - 48 hours notice & have to be re-authorised? NHS lost the plot?

[T4NKG1RL]

The assessment process takes into account everything from lifestyle to compliance. Informed consent requires that you are told pluses and minuses in terms which you, as an individual understand.

 

Take Dr Brown, he gets a repeat prescription request form Mrs Jones. She wants another 6 months supply of the 'pill'. He doesnt need to see her to know that at 35 and smoking 20 a day on her records with a weight of 20 stones when he last saw her that he needs to call her in before she gets that prescription repeated. He will however be confident that Mr Right, who saw the practice nurse for a blood test last week will need his usual prescription for Warfarin to keep him nice and stable. Point is he doesnt operate in isolation, he works with a team which has the patient as the central player.

 

The coach doesnt need to get into the showers with the players to know they're going to be sweaty after the match.

[T4NKG1RL]

btw, am enjoying the ping pong and having to articulate in print which I'm out of practice at!

[MrShed]

OK I see that, but surely a repeat prescription is not given indefinitely anyway? Is it not given for a specific amount of times? In which case you would give Mr Right say 12 months worth on his RP, and Mrs Jones 6 months worth.

 

And yes love a bit of lively debate are you a GP by any chance TG?

[bottomburp]

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[MrShed]

Ah that would be better how I meant to articulate my post bb!

[MrShed]

To put it another way, your "diagnosis in absentia" only works as well as the last PHYSICAL visit. There is no benefit in renewing the RP each time, because as BB rightly says, she is still, as far as the GP knows, in the same condition as the last visit(as the GP CANNOT know any better), and based upon that physical condition the GP has already authorised 3, 6, 9 months worth.

[T4NKG1RL]

I get my repeat prescriptions in supplies of 2 months at a time so yes I do understand the repeat prescription process. My GP knows, as do I, that I have a chronic illness for which there is no cure but it can be controlled with drugs. Although I will need drugs for the rest of my life, it does not hold that I will need the same drugs or that those drugs I take currently will not be replaced by something new and improved, thus a GP has a duty to ensure that my treatment is regularly reviewed and appropriate. How he decides frequency will depend on many factors, my continued stable health being only one of them. For every drug prescribed there are actions and interactions, contraindications etc. With every year that passes, with pretty much ANY chronic illness, there is deterioration in conditon. So, put simply, what seems fine now, may be found to be very very bad for me in future.

I cannot fathom anyone being prescribed a 12 month supply of drug in advance. I have access to 12 months of repeat prescriptions but that means I will have my treatment assessed 6 times in that time. A 12 month prescription of drugs in advance would risk no montoring at all with potentially catastrophic consequences!

[T4NKG1RL]

btw I'm a nurse not a GP

(I work for a living lol)

[MrShed]

Oh I absolutely agree TG. But surely in that case instead of being issued a 12 month "fake" repeat prescription, why does he not give you a 2 month "proper" repeat prescription? That is what I do not get. When you currently go in each 2 months, do you see the doctor each time?

[bottomburp]

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[T4NKG1RL]

BB, I'm not being sarky but have you discussed your frustration with your GP?

 

As an aside the pill is issued usually as a six month supply on 1 prescription and I have never known it to be issued one month at a time.

I have never known it to be issued as a repeat prescription either because after 6 months , GP or family planning want to check a patient's BP at least.

Ergo, face to face meeting between patient and GP once every 6 months seems reasonable. (I used that analogy as a stereotypical but obvious reason for not advanced prescribing long term and perhaps it wasnt the best one I could have used).

 

The repeat prescription format used at my surgery is a detachable section on my prescription which (obviously) I detach! (and pin to my noticeboard at home) prior to submitting the signed-by-the-GP prescription part to the chemist for filling. The detachable part has check boxes for me to indicate to my GP those drugs with which I need resupplying and I then drop it at my convenience to my GP in a timely manner when supplies are running low. This piece of paper, which is renewed every time I re-request, has a sentence which reads 'may be repeated for x more times' below each drug. This indicates to me, my practice receptionist and my GP when it gets to 0 that I need a check up and my meds to be reviewed if they havent been already. It also reminds me and them of how long it is since my last check up. I do get 2 months supply of my drugs at a time.

I dont usually need to see my GP every 2 months, I drop my request in to the GP surgery every 2 months. I know that I need to be reviewed at least annually by my GP although I am also supported by my practice nurse and the rest of the multi-disciplinary team through my GP practice.

 

My point is that we may believe we know what would work better/easier/be more streamlined in theory for ourselves individually, and we may be experts in our knowledge of a particular area of health/illness but this may simply not be the case for other patients. Indeed if it were so straightforward, then why would any GP make their own jobs so long winded and complicated?

 

Simply put, a 10 mile round trip once a month/3 months/6 months to have a validated prescription which you know has meant your GP has at very least considered you and your health seems, in comparison, a minor inconvenience.

 

Did you know that according to the DoH, if you have a disability, prescriptions can be filled and delivered to your door by arrangement between your GP and your pharmacist?

 

Sorry for hogging this board today, I guess I had a bad bout of the verbals!

[MrShed]

But I still say that the GP has NOT considered me, as I have not seen him and I have not been assessed! By you going those 2 monthly intervals, you are gaining nothing. Yes clearly, yearly checkups with your GP and you ARE being assessed, but unless you are actually assessed by your GP (or a nurse) then I fail to see any benefit whatsoever in getting those prescriptions signed off every two months - there is no consideration from the surgery for definite, it is just another paperwork task unless you are assessed by a medical professional!

 

And you aint hogged em as much as me today....think I've made like 100 posts today or something!!!

[T4NKG1RL]

Put simply, if I believe my GP has not given me due consideration or has in any way neglected my care I will sue his ass off.

Given amongst other inquiries, the Shipman inquiry and the need for transparency and accountability, will you trust that it really isnt all about causing the patient aggro?

 

If you take the vast numbers of patients attached to each GP practice, a reminder (in the form of a repeat prescription) to go have a look at Mr Right's notes, check when he was last seen by a doctor, how his blood tests and ongoing assessments by other members of the practice team are and only then sign off that a continued short term supply of his meds is appropriate, keeps a vast proportion of patients safe.

 

That this type of assessment differs from the olden days when GP's did as they pleased with little accountability and could run amok with patients health and never have to justify actions or defend civil and criminal action is an improvement if you ask me.

[bottomburp]

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[T4NKG1RL]

As I said before, you don't have to be physically present to be assessed.

 

And,yes, although the planned care is for you to keep taking your meds for the next 6 months before your GP will physically want you to be present so he can carry out face-to-face asessment and get explicit information from you rather than the implicit (which your repeated request for drugs give), this doesn't forego his continued assessment of you, or your ability to request a face to face in the meantime. You dont see the radiographer when they click the button for you go have an xray, would you assume they didnt assess you whilst it was being done?

 

A prescription is much more more than just a signed piece of paper. The legal accountability & responsibility that accompanies the prescription of any drug which cannot be dispensed over the counter is enormous!

If any doctor gets it wrong, at best you sue, at worst you die.

[bottomburp]

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[T4NKG1RL]

Surely that is potentially far more dangerous than if someone had the type of repeat prescription that I remember? Six months supply of the pill that could end up in the wrong hands?

 

That is irrelevant to this discussion, any medication 'in the wrong hands' is dangerous.

 

Your opinion about someone with Diabetes being on the same meds for 'years' is so inaccurate I'm simply going to suggest that it is clear to me that you have limited knowledge of general chronic disease treatments.

 

With that in mind, as I see it, a person without formal medical/pharmaceutical training should not be able to self prescribe or dictate the way in which their meds are dispensed.

 

Question by all means the tailored treatment which you receive or its frequency but using limited personal experience as a basis for expecting a change to a system which benefits a large part of the society in which we all live seems, well actually , it seems lame. I suggest actually talking to your GP and pharmacist about the prescription and dispensing regulations they have to satisfy legally and ethically and then maybe a better informed suggestion as to how to improve patient safety as well as patient convenience may be achievable.

 

The pharmacist doesnt need to know your GP or you personally to know exactly how every drug he dispenses works and what ailments they are prescribed for for. The pharmacist is only too aware of the actions and interactions of all the drugs he has to supply. Thats is why his specialism is pharmacological and not general practice.

 

I feel that my part in this discussion has now concluded. Despite my efforts to explain a small part of the holistic nature of assessment, or the consideration of the multi-disciplinary team in general practice prescription, I dont think progress here is possible.

[bottomburp]

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[demon_x_slash]

Hmm. I get the pill on a repeat prescription, three months' worth at a time. I write to my GP, enclose the repeat form and an SAE, and he posts it back to me. I have neither had my blood pressure taken nor even seen him for anything else for at least two years now. *slightly uneasy* Should he have asked to see me every six months then?

[bottomburp]

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[b00geyman]

As a Nurse I was intrigued by this topic, actually I was looking up the reclaim charges but saw NHS !!!.

Follow this link...NHS repeat dispensing schemes in England : The Department of Health - P&G: Medicines pharmacy and industry

 

All I can say is times have changed and not always for the better, too much legislation from Tony and his pals, I wish they would remember KISS, Keep It Simple Stupid, everything just gets so complicated when it doesnt need to. Hope the link may explain why, how etc. cheers from Sunny Scotland

[demon_x_slash]

According to various other posters you have no cause for concern because he's assessing you even though he hasn't seen you! Marvellous isn't it - GPs can assess you without any form of contact! May be they're telepathic?

 

Yes, you should be concerned and yes you should go and see your GP and you should be doing it (going to your GP that is) every year at the very least and preferably every six months.

 

But, hey, since I'm not a medical person what the **** do I know - according to those who are?

 

Hmm. Think I need to make an appointment next month...

[bottomburp]

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