28 Day Prescribing (To Reduce Waste Medicines)
Guidance
NHS Warwickshire recommends that the majority of repeat prescriptions should be for a maximum of 28 days to help with reducing wastage of medicines and safeguarding NHS resources.
Many drugs are now presented as calendar packs with foil strips of 28 tablets and an individual patient information leaflet. Prescribing more than 28 days’ supply will mean that some patients are issued with multiple packs which may lead to confusion.
It is much easier to monitor compliance and ordering frequency with smaller quantities of medication which could help identify potential problems sooner than for prescriptions issued for a longer period, reducing the risk of patient harm, potential complaints and medicines wastage.
“The Department of Health takes the view that prescribing intervals should be in line with the medically appropriate needs of the patient, taking into account the need to safeguard NHS resources, patient convenience, and the dangers of excess drugs in the home”. For registered patients, items will only be issued as repeats once there is a demonstrated need to continue treatment longer term. The following items will not be prescribed as repeats: antibiotics, sip feeds, treatments for obesity, smoking cessation, dressings.
To avoid inadvertent over ordering, a ’21 day rule’ will be applied on prescribing so that repeat issues are not permitted until at least 21 days have lapsed since the previous issue. Where a repeat is required sooner, if patients are going on holiday, this will go to the GP for authorisation.
What does national published literature reveal?
700million prescription items are dispensed in primary care in England each year, at a cost of approximately £8billion.
The full cost of wastage is difficult to estimate and estimates vary widely. A cautious estimate of the value of medicines returned unused is £100 million annually. However, this figure almost certainly underestimates the full cost of drugs wastage, as it is based only on unused medications that are actually returned. The Department of Health estimates that as much as 10 per cent of all drugs prescribed are wasted – which would mean up to £800 million-worth of drugs are wasted annually in primary care.
What is the experience locally?
NHS Warwickshire conducted a sample waste audit during January 2010 of analysing medicines returned for disposal. During a four week data collection period £7,153 worth of medicine was returned to the 5 community pharmacies. If all 96 pharmacies had taken part roughly £137,335 would have been returned in 4 weeks. If approximately 35% of patients return their waste medicines to a community pharmacy then the estimated wastage sum would be £6,361,357.
Exemption and Prepayment Advise
Patients can get information and advice on exemptions and prepayment certificates from the NHS Business Service Authority
- Telephone advice and pre payment order line 0300 330 1341
- Query Form -
Q: How is this going to happen at Abbey Medical Centre?
A: This will be rolled out over several months starting in December 2013
Q: How will this affect me?
A: You will order your prescription in the normal way, however once the roll out has started you will find an information slip added to your new repeat prescription informing you that the next time you order you will only have 28 day supply.
Q: Why is some of my medication not included on the new 28 day system?
A:It is not practical for all medicines to be prescribed for 28 days. The usual exceptions are listed below:
- Oral contraceptive, Hormone Replacement Therapy or Drugs affecting Bone Metabolism where medicines may be prescribed for longer periods according to pack size or a specific treatment period or in line with practice’s monitoring procedures.
- Drugs liable to misuse should only be prescribed for short periods.
Q: What will happen if I go on holiday and need extra medication until I return?
A: Holiday requests will stay the same as they are at the moment and will go to the GP for authorisation.
Q: Will I have to come to the surgery more often to order my prescriptions?
A: Not necessarily, if you have access to a computer you can register with the practice to use the on-line facilities, which will enable you to order your prescriptions and book some routine GP appointments.