Pharmacists in England have a "limited understanding" of the law on foreign prescriptions, researchers have concluded, after they found that only a quarter were prepared to dispense medication when presented with EU scripts.

Just 16 out of 60 pharmacies were willing to dispense medication when presented with prescriptions issued by Belgian or Finnish doctors, researchers found during mystery shopper tests on pharmacies across cities and rural areas of England.

Although prescriptions issued by healthcare professionals in other parts of the EU are legally valid in the UK, some pharmacists believed they were "unauthorised" to dispense them, according to the study published online in the International Journal of Pharmacy Practice last week (July 12).        

Why pharmacies did not dispense foreign prescriptions (%)

Source: International Journal of Pharmacy Practice, published online, July 12, 2013 (39 of the 44 pharmacies that refused to dispense gave reasons why)

Some pharmacists also believed that prescriptions had to be in English or had to be issued by a UK-recognised prescriber.

The study's findings warranted "a renewed focus" on improving pharmacists' knowledge on the legality of foreign prescriptions and how to handle them, said researchers at UCL School of Pharmacy, London and London School of Hygiene and Tropical Medicine.  

Undercover researchers, posing as English relatives of foreign patients, presented pharmacists with prescriptions for medicines for asthma, myocardial infarction, type 2 diabetes or breastfeeding between January and March 2012.

The prescriptions, for branded medicines specific to the different countries, were in Dutch, Finnish or English and included the prescribers' details.

The authors noted that pharmacists had to understand the language to supply the medicine properly and be satisfied it complies with legal requirements.

However pharmacists were often "unclear" about the exact legal provisions or who to contact, especially after business hours and at the weekend, to validate the prescription. 

Of the 16 prescriptions dispensed, four were in Dutch and the remainder in English and most were either for asthma or breastfeeding. None of the 14 Finnish language prescriptions were dispensed. Some pharmacists gave advice on getting medication dispensed, most of whom suggested the patient visit a local GP for an alternative prescription.

Eight regulators, policy-makers, academics and community and hospital pharmacists were also interviewed for the study.

They agreed that the procedures for verifying the authenticity of prescriptions were not straightforward. They recommended the creation of an online database of all authorised EEA and Swiss prescribers, EU-wide standards on prescription content and dosage and to make it mandatory to include the prescriber's contact details.

A European directive, due to come into force in October, emphasises that European patients are able to seek healthcare in any European member state. It requires the European Commission to bring in measures to help health professionals verify the authenticity of the prescription and prescriber.

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