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GPs and patients in favour of pharmacy repeat dispensing

Professor David Wright: Chronic disease management more effective when combined with repeat dispensing

Both GPs and patients are “positive” about the repeat supply of medicines through community pharmacies, according to an evidence review of pharmacy services.

GPs reported a reduction in workload and there was evidence of improved patient adherence as a result of the scheme introduced in 2002, according to the review's author.

However there is a “wide variation” of uptake of the service by clinical commissioning groups (CCGs), David Wright, professor of pharmacy practice at the University of East Anglia, pointed out.

Payment for this service is fixed at £1,500 per community pharmacy per year, which Professor Wright suggested does not incentivise pharmacists and GPs to increase the service uptake.

“Whilst it is the GP who is expected to consent patients for the service, community pharmacists and GPs could be incentivised to work together to achieve better implementation rates,” he said in the report published last month.

In October, a C+D investigation revealed that four in 10 CCGs were planning to stop pharmacies from ordering repeat prescriptions on behalf of patients.

Combine services

Professor Wright suggested that pharmacists’ role in chronic disease management is already “well-recognised”, but could be “more effectively delivered” if it was combined with repeat dispensing.

He referenced the Dispensing Doctors' Association 2014 recommendation that pharmacists should assume responsibility for patients with hypertension who are prescribed three drugs or fewer and are controlled.

“With summary care records now being rolled out, it would seem appropriate to commission the recommended pilot,” Professor Wright stressed.

Learn from NMS implementation

Looking at other pharmacy services, Professor Wright concluded that “the new medicine service (NMS) is likely to be effective and cost effective".

The NMS, introduced in 2011, was based on a similar telephone based service – which was “very likely to be cost effective” – and implemented alongside a government commissioned “definitive study” to ascertain its efficacy and cost-effectiveness, he pointed out.

Professor Wright suggested that any new service introduced to the sector should follow the same process. However, evidence supporting the successes of NMS may have been enhanced if the trial had been piloted, he added.

And, “whilst GPs were found to be more receptive to the NMS [than medicines use reviews], the same inter-professional barriers to effective implementation were identified", he warned.

Pharmacy flu service ‘cheaper’ option

Since the introduction of nationally funded pharmacy flu service in 2015, uptake of the vaccination has increased, as has patient choice. The service has been delivered at a “lower cost” than traditional routes, Professor Wright said.

Pharmacies delivered more than 595,000 flu jabs in total in 2015-16, figures that were exceeded in just three months of the start of the 2016-17 service.

Professor Wright suggested that a “cost-minimisation analysis would favour the community pharmacy route", if similar outcomes were achieved.

However, he recognised that GPs who are paid to provide flu jabs would be “less supportive” of pharmacies taking on this role.

“All new community pharmacy based services must be designed to facilitate greater collaboration between community pharmacists and GPs,” Mr Wright added.

This is the last of C+D’s three-part analysis of Mr Wright’s evidence review. Read the first and second articles.

What service would you like to see nationally funded?

Dodo pharmacist, Community pharmacist

They just axed the repeat dispensing payment as part of the single activity fee - do keep up. So now there is no incentive.

Valentine Trodd, Community pharmacist

Perhaps the C+D should write an article on the single activity fee...;jsessionid=339DB903F4EBBAE6AA25B9A1DDBF0F36?name=What+is+the+Single+Activity+Fee%3F&id=44747

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