To: All Torbay GP practices

Date:- 27th March 2006

Dear Colleague

Guidance on medicines assessment and compliance support for patients cared for in their own homes

You may be aware that there has been an issue locally regarding the use of monitored dosage systems being ‘funded’ by 7-day prescriptions. We have been in discussions with the Local Medical and Pharmaceutical Committees and all parties agree that funding MDS through 7-day prescriptions is not appropriate, unless there is a clear clinical patient need.

You may also be aware that a new pharmacy contractual framework was introduced last April. Part of the contract empowers pharmacists to undertake assessments on patients having difficulties taking their medicines and, if they are eligible under the Disability Discrimination Act, making reasonable adjustments to help them take their medicines. This is part of the “core” contract, an essential service. The sum of 5.5p per item dispensed was included in the contract to contribute funding towards this service.

However, for those clients who are not eligible under the DDA, there are currently no requirements – or funding. On this basis, we will be commissioning an enhanced service from community pharmacies to undertake assessments on those who appear to have difficult taking their medicines but are not DDA eligible and making reasonable adjustments to help these patients as well.

We have tried to bring together the issues on this area in the attached guidance. I would like to take this opportunity tobring your attention to the following particular points of interest:

  • For support with taking medicines, the decision of whatadjustments are appropriate in each case is the responsibility of the pharmacist. Pharmacists cannot be “directed” to make a specific adjustment e.g. provision of a monitored dosage system (MDS). If a prescriber has a patient who they think is having problems in taking their medicines, the patient should be referred to their own community pharmacist for assessment.
  • Monitored dosage systems (MDS) are not generally the solution to compliance problems. They are likely to be appropriate only for a very small number of patients and more appropriate adjustments are likely to be preferable. These could include large containers, screw/wing caps, labelling medicines in a more legible way, providing a reminder/tick chart, signposting, conducting a medicines use review, and medicines administration regime charts.
  • Torbay LMC will be actively and strongly discourage prescribers to issue 7-day prescriptions unless there is a clear clinical need for medication supplies to be limited to 7days. There may still be instances though were there is a clinical or concordance necessity for a vulnerable patient to be supplied a prescription for less than the 28 days routinely recommended.
  • Because of delays in getting this guidance out, which have been caused for a number of reasons, Torbay Care Trust ask that practices are initially flexible about ceasing 7-day prescriptions. This is to allow pharmacies time to sign up to the new enhanced service and begin the process of undertaking the assessments of existing clients. We ask that practices allow some flexibility at the start of the new arrangements; the ideal situation would be if practices agree to cease 7-day prescriptions to fund MDS for new patients from the beginning of May and transfer existing patients whose MDS is funded by 7-day scripts from the beginning of June.

If you have any queries on this matter, please do not hesitate to contact Shivaun Gammie or myself.

Yours sincerely

C. Branson

Christine Branson

Assistant Director of Primary Care

c.c.Andy Paton and Dr Peter Jolliffe, Torbay and Devon LMC

Sue Taylor, Chief Officer, LPC

Mandy Seymour, Julie Hickey, Alison Newell, Dawn Collier, David Harborne, Helen Toker-Lester, Care Trust health and social care (“zone”) managers

Paul Mears, Director of Operations

Adrian Jacobs, Director of Primary Care

Lucy Mays, CARRIE team

Paul Foster, Chief Pharmacist, South Devon Healthcare Trust

Amanda Gulbranson-Brown, Chief Pharmacist, Devon Partnership Trust

Partners in Care