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Pharmacists unsure when faced with foreign script, study finds

Practice 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.

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.

Are you clear on what you should do with foreign prescriptions?

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Gerry Diamond, Primary care pharmacist

I just refuse to dispense foreign written prescriptions as I cannot be fully confident of their legality, comprehend that I would interpret them fully and usually advise they get a Rx from a UK registered prescriber.

Leon The Apothecary, Student

I agree with Gerry, every pharmacist I have worked with will not dispense foreign prescriptions as we cannot be 100% sure and would be a risk to dispense. No, every time we would refer to what was the old NHS direct OOH service or one of the walk-in centres.

C W, Dispensing assistant

How can pharmacists be expected to accurately translate a script written in another country? Great if the pharmacist or other staff speaks the language the script is in, but in the interests of patient safety, the prescription should be either translated professionally or the patient see a UK based GP.

max falconer, Superintendent Pharmacist

Do EU regs permit us to charge more for a non UK based prescription? If I did consider it appropriate to dispense I would apply a surcharge to cover the costs of verifying authenticity. This would take at least half an hour so let's say an extra £20 (reducing by about £1 every year as pharmacist rates decline!). Also consider making this charge in advance of dispensing, as I am sure in the majority of cases verification would be impossible, especially outside office hours. I wouldn't even consider dispensing a prescription not written in English as I have no knowledge of other languages.

Really? Wow, Superintendent Pharmacist

Max, you can charge whatever you like as long as the patient is willing to pay it.

I read an article on this a few years ago and most EU countries do not have online databases like the GMC website so the only absolute way to verify the prescriber is to call their respective 'GMC'.

This article does not highlight that even if all of the rules are adhered to it is still at the pharmacists discretion to dispense the item or not.
Also, given the regulatory environment we are in; would you take the chance or the easy way out and say no?

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