Agenda item - Formal Member Involvement

Please Note: Following consideration of the preceding items 12-16 inclusive, a formal callover will take place in respect of the remaining items on the agenda.

16(a)   Petitions

16.1    There were none.

16(b)   Written Questions – Prescription Ordering Service

16.2    The Chair, Councillor Moonan, explained that one written had been received from Councillor Bagaeen (set out in the circulated addendum). Councillor Bagaeen had given his apologies for the meeting and a copy of the approved response provided by the CCG would be sent to him separately.

16.3    Councillor Bagaeen had asked:

“When I went into Boots to enquire about my own repeat prescription I was handed a leaflet from the CCG proclaiming a ‘new and convenient way to order your repeat prescription’. This was news to me and I bet will be news to many more people currently using the repeat prescription system. In my view, the CCG has failed miserably to advertise this service and the content of this leaflet should have certainly been advertised more to users. To make things worse, I got contradictory information from the pharmacist at Boots and from my GP surgery about the operation of the service. I attach the leaflet I was given. Please can the CCG explain the new prescription ordering service that they have introduced for ordering repeat prescriptions and how they have advertised it locally.”

16.4    The Chair gave the following response which had been provided by the CCG:

“Two thirds of prescriptions issued in primary care are repeat prescriptions. These repeat prescriptions account for nearly 80 per cent of NHS medicine costs for primary care. The management of these prescriptions and the time involved in processing them can be significant.  Nationally up to 410 million repeat prescriptions generated every year – equivalent to an average of more than 200 per GP per week.  In the South Place (Brighton and Hove and High Weald Lewes Havens CCGs), 7.95 million prescriptions were issued in 17/18 at a total cost of £63.4 million. Around 60% of patients received at least one item on prescription, and it is estimated that around 47% of the population are currently on repeat medicines. 

Poor repeat prescribing processes play a major role in generating waste; factors driving such waste include over-ordering of prescriptions by patients themselves and patients ordering their repeat medicines via community pharmacy.  In the latter case, the pharmacy contractor will order the prescriptions on behalf of the patients with anecdotal evidence suggesting a lack of robust checks on current medicines needs.  So called “managed repeats” often lead to requests for unnecessary repeat medicines and inevitably medicines waste. Additionally, general practice staff expend considerable amounts of time, processing, querying and issuing repeat prescriptions. 

In November 2017, High Weald Lewes Havens CCG launched Prescription Ordering Direct (POD). Following the success of POD in HWLH and a trial in a small number of practices in Woodingdean, approval has been given to roll out the service across Brighton and Hove. We plan on the roll out being complete by the end of 2019. POD is an additional route to ordering repeat prescriptions. Paper and online requesting is still available. ‘Managed repeats’ by community pharmacy is no longer available for most patients but can still be provided if it will benefit a specific patient for example, a housebound patient.

The service allows patients to request repeat prescriptions via a call centre hosted by the CCG, with the call handler verifying each item requested. In addition to the financial benefits of reduced waste, it is evident that the service has affected the use of medicines in a much broader sense through:

·       Improved safety of medicines use and prescribing.

·       Improved quality of medicines use and prescribing.

·       Reduction in practice and community pharmacy workload, enhanced primary care resilience and workforce optimisation.

·       Improved patient outcomes and experience.

·       Additionally, community pharmacies report better workflow management in the dispensary.

The team of call handlers have access to a registered pharmacy technician and pharmacist who can respond appropriately to clinical questions from the call handler or the caller.

Examples of activities undertaken by the service include:

·       Acting as a point of control to prevent over ordering and stockpiling (particularly important from the perspective of high risk or controlled drugs).

·       Empowering a patient centred approach in taking responsibility for medicines use.

·       Adjusting prescribed quantities to align prescriptions (synchronisation)

·       Action incoming medicines requests from secondary care (this is reactive and ad hoc);

·       Dealing with prescribing queries and rapidly able to action the response as appropriate.

·       For some practices, approximately 20% of prescription requests are handled by POD, reducing workload for practice prescription administration staff. The clinical input from pharmacy technicians and pharmacists also has a positive impact on GP workload.

POD is rolled out on a practice by practice basis, advertising approach is agreed with the practice and includes distribution of specific patient leaflets and posters in the practices and pharmacies. We have also engaged through Patient Participation Groups where possible, who have been supported implementation as well as a useful forum for feedback to further enhance the service.

With respect to receiving differing information from different providers, this is unfortunate but without knowing the detail we are unable to comment, but are happy to follow this up with further information so we can clarify understanding.”

16(c)   Letters

16.5    There were none.