Chris Lancelot: Repeat dispensing fails to meet its promise

In theory, repeat dispensing ought to be an out-and-out success. In practice, it's a nightmare.

For those who have not tried it, repeat dispensing differs from repeat prescribing in that the computer prints out a set number of issues in one batch. The patient takes these to the chemist, who dispenses them at the time intervals indicated. By reducing the administrative workload, repeat dispensing should be a winner.

Only it isn't. It succeeds only when there are only a small number of items; where they all start and end together; when no other routine prescriptions are being used - such as hypnotics, controlled drugs or PRN medication; when there are no alterations to the drug regimen; and no occasions when a patient fails to pick up all the drugs on an individual scrip - perhaps if they can't afford all the prescription charges that day.

Unfortunately, life isn't simple. Because of the limitations of the repeat dispensing regulations, many patients end up on a mixture of repeat dispensing, repeat prescribing and acute prescribing, with all the confusion this brings.

In addition, repeat dispensing prevents the practice from re-authorising patients' medications to a specific review date - by far the best way to keep regular prescribing in order - and can mess up the QOF calculations.

It also seems to tie pharmacists in knots: I've lost count of the times I have had to ring a pharmacy to find out why a patient has been told there are no more prescriptions available when there are several to go.

Repeat dispensing has turned out to be cumbersome and confusing, and the DoH needs to change the rules. Instead of printing a numbered sequence of prescriptions, why can we not issue a single prescription for all repeating medication, with a joint end (review) date, stating the maximum number of times each individual drug can be dispensed during that period?

Then the GP can keep the review date the same for all repeated items; PRN medication can safely be included; and patients can pick up a reduced number of items without losing the right to have the rest dispensed later.

It would be a simple solution to a messy problem.

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