- Adherence to NWL integrated formulary
- Strive to prescribe cost-effectively and clinically safe with guidance from HCCG medicines management team
- OptimiseRx changes and patient messages
- New prescription policy
- New patient policy
- 28 day prescribing policy
- 48 working hour repeat request turn-around
NWL integrated formulary
When prescribing medication the surgery clinicians will aim to adhere to the agreed North West London integrated formulary choices and respect the comments made of each drug. This includes using the cost effective alternatives listed and where necessary have a shared care agreement with secondary care in place before prescribing. Where a medication is not on the NWL IF a suitable alternative is to be offered first line. Where a consultant has asked for prescription of a medication off the formulary a letter is to be written to the consultant as soon as possible advising this and asking the medication to be changed in line with formulary where possible. Red list drugs are not to be prescribed from General Practice at all. Medications for Specialist initiation must be prescribed initially from the consultant and stabilised and tolerated before taking over prescribing. Where shared care arrangements are required monitoring will be in secondary care unless specified otherwise.
Cost-effective, clinically safe prescribing
When audits/quick wins/newsletters give advice on guidelines for safe and cost-effective prescribing the surgery will aim to review the medication switch advised as soon as possible. The patients will be contacted where necessary and seen for review if appropriate. Where necessary, messages will be given to patient using SMS, the right hand side of prescription or letter as appropriate.
OptimiseRx changes and patient messages
We agree to try where possible to follow the guidance from OptimiseRx and where appropriate make the advised drug changes. Patients will be advised if this is a repeat medication change. Messages to patients will be printed on the right hand side of the prescription. Where EPS2 is used it will also be put in the message to pharmacy to ensure they pass on the message. Where online request has been made the use of secure messaging will also be employed. Patients will be asked to contact the surgery if there is any problem.
New prescription policy
Where a new medication has been suggested by a hospital doctor this will be reviewed and changed to follow the NWL IF where appropriate. If the medication is not within the clinician’s frame of competence a request will be sent for the initial prescribing to be from the hospital outpatient department. If a new medication has been put on hospital prescription it will only be changed to FP10 from the surgery once the medication has been shown to be well tolerated and at a stable dose. This applies to both NHS hospital prescriptions and private prescriptions. Patients can be advised that the prescribing Clinician has to maintain responsibility for initiating the medication and thus their prescription paper must be used. This must be very strictly adhered to for NWL IF ‘specialist initiation’ only medication.
New patients
When a prospective new patient applies for registration they should be advised to ensure they have arranged an adequate repeat prescription where possible with their current GP. This ensures that they do not run out before having a review appointment. Patients on several medications should have a review with a GP preferably within the first 4-6 weeks and should always have had a NPC with the nurse. Where possible, changes should be made on review to bring prescriptions in line with other policies including 28days and NWL IF.
28 Day prescription policy
In line with national and local recommendation we will aim to prescribe repeat prescriptions on a 28 day basis to reduce wastage and medication errors. This also makes it easier to keep repeat medications in sync. This should be especially adhered to where patients receive their medication with exemption from payment for prescriptions. Other patients may request up to a maximum of 56 days unless special circumstances (eg. Going abroad) requires more. No patient will be issued with more than 84 days medication in any one time. Patients travelling abroad for more than 3 months can be given enough to cover 3 months but should make arrangements for repeat prescriptions locally when abroad.
48 working hour repeat turnaround
Patients will be advised that all repeat requests must allow a 48 working hour turnaround. This includes for the EPS2 system. Requests must be in writing or electronic format via the online access system. All required medications needs to be listed in full to avoid errors and wastage. No repeat requests should be made verbally without the specific authorisation of the duty doctor.