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"Why GP surgeries struggle with prescription tasks"

Updated: May 31, 2023

Many GP surgeries struggle with prescription tasks. We have seen that this problem exists amongst a lot of GP surgeries that we have worked with in the past. And the key common problem that we see amongst these GP surgeries that struggle with prescription tasks, is that the reauthorisation process is not standardised.

For example, if a patient has a number of regular medications on their repeat prescription list, you might find that at the surgeries, due to their lack of organisation, the repeat medications are not synchronised or aligned on the repeat template. All the medications have different review dates, and reauthorisation dates or reauthorisation numbers. The medication reviews are not done in a timely manner. And when the medication review is done, the clinician who is conducting the medication review for whatever reason is not conducting the medication review of the repeat prescription effectively enough.

During this medication review, they are missing the opportunity at this appointment to request all the outstanding monitoring, align all the prescriptions on the repeat medication list and synchronise them so that all the medications can be requested at the same time, rather than sporadically. Sometimes there are things on repeat that can be removed because the patient is either no longer using it or only orders it once in a blue moon. And there might be things on the acute medication list which should be moved over to repeat. For example, you might have patients who have been initiated on new hypertension therapies and rather than the GP adding it onto the repeat list, they are hoping to follow up with them in a few weeks with the intention of moving it over to repeat then. However, they may then have had the review with another clinician who has forgotten to move it over to repeat or it may be that the GP themselves has forgotten to move it over. And then what you find is for the next five or six months, the patient is having to request that medication from acute and in some cases, unfortunately, the patient even goes without it because they forget to order it. And because it's not on their repeat list, no one at the surgery can easily spot that either.

This lack of organisation sometimes occurs because the regular GP partner has left and no one is being vigilant about the organisation of the repeat medications. It could also be due to a lack of training, a lack of experience or just a lack of understanding of how the repeat reauthorisation process works.

The key solution to this problem is to get organised. One of the best ways to do this is during the medication review. In this review, all the medications and conditions should be reviewed and any outstanding monitoring should be requested. All the repeat medication should be aligned and synchronised so that everything can be ordered at the same time - you shouldn't have medications that have a 28-day, 56-day and 84-day duration all on the same repeat template. And most importantly, set the same reauthorisation review date for all the medications.

When this is done correctly, and all the appropriate follow-ups have been completed with satisfactory results, the patient does not have to be reviewed until the next review date, whether that's in six months or in most cases 12 months. If the repeat medications on the repeat templates are organised in this manner, a clinician only needs to review the repeat template once a year and no further reauthorisations are required in a patient who is stable.

On the other hand, if this is not done properly and you have a patient with several items on repeat and regular acutes being requested, the patient may be getting in touch with the surgery not only every month but sometimes more than once a month. So rather than having only one contact a year with this patient, you're having more than 12 contacts a year. This significantly takes up valuable clinician and admin time when it could have been resolved during an effective and thorough medication review.

An effective and thorough medication review with a patient who has more than five or six medications can be conducted in a 15 - 20 minute consultation, and an appropriately trained clinical pharmacist can do this very well. Pharmacists are notorious for attention to detail and they understand the repeat prescription process very well because they of course have experience with prescription management from their community pharmacy background. Clinical pharmacists are also very good at understanding condition and medication monitoring requirements so they can effectively ensure that all outstanding monitoring and reviews are completed.

Furthermore, a repeated dispensing service can be offered to the patient. If this is set up for the correct patient - the ideal patient for this is someone who is stable and is unlikely to have any medication changes until the next review- the prescription requests that don't need reauthorisations can be avoided too, which means the prescription clerks will have fewer requests to process too.

You can also set up post-dated prescriptions for weekly prescriptions.

Organising timely medication reviews and reauthorising the repeat medication appropriately, will result in a significant reduction in the number of prescription tasks by up to 12-fold.

Key takeaways to reduce the number of prescriptions tasks:

  • Organise timely medication reviews by appropriately trained clinicians

  • Review all the medication & conditions during a medication review

  • Request all outstanding monitoring

  • Synchronise and align all the medication on the repeat medication template- ensuring all prescription durations are the same

  • Add regular medication from the acute medication list to the repeat medication template

  • Set up patients on repeat dispensing if appropriate

  • Utilise the post-dating prescriptions function for weekly prescriptions

Do you need help with medication reviews or processing prescription tasks? All our pharmacists are trained to high standards and adopt a proactive approach. We are passionate about long-term efficiency and get a buzz out of helping surgeries to get organised.

We also have SystmOne & EmisWeb software training, including a module on setting up repeat dispensing in your practice that you can use to train your staff.

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