Dispensing & Medicines Safety
This page contains a range of resources related to dispensing and the supply of medication to support pharmacies in delivering Essential Service 1 – Dispensing Medicines. The Dispensing Service Specification can be viewed here and Community Pharmacy England provides further support here.
Advising on Missed or Delayed Doses of Medicines
MDS / MCA / Compliance Aid Guide
Medicines Information Websites
Pharmaceutical Stationery Orders
Use of Emergency Salbutamol Inhalers in Schools
Dispensing Factsheet – April 2024
Community Pharmacy England has prepared a new factsheet to help pharmacy owners maximise their income from dispensing. The factsheet includes top tips to help maximise income or reduce losses when:
- Dispensing.
- Ordering.
- Endorsing prescriptions.
- Submitting claims/prescriptions for payment (including end-of-month MYS declaration).
- Reconciling payments against claims submitted.
The factsheet also links to a wealth of resources available on the Community Pharmacy England website for more information on specific topic areas which can be accessed as needed. See the factsheet here.
Brand / Generic Prescribing
Prescribing medicines by generic name is generally preferred but there are some circumstances when brand-name prescribing is warranted. The Specialist Pharmacy Service (SPS) provides guidance on prescribing certain medicines by brand to ensure supply of the same product. Further details can be found here and examples of drugs best prescribed by brand can be viewed here..
Branded Generics – Information
Issues with Branded Generics
CPWY has been given assurances that all places in West Yorkshire (ICBs) avoid branded-generic prescribing as much as possible. However prescribing data shows the prescribing of branded generic remains, often due to legacy prescribing or ingrained prescribing habits.
If you have branded generic prescriptions for drugs you cannot easily source e.g. stock supply is intermittent or examples where prescribed branded generic costs more than the generic Drug Tariff price then CPWY suggest that you:
- Discuss with the prescriber to request the items are prescribed generically. Highlight to the practice that the Medicines Optimisation teams now avoid the use of branded generics where possible. The branded generics letter for prescribers that outlines the negative impacts of prescribing branded generics, including time, patient safety and financial impacts which can be used to guide your conversation.
- Report these issues to the relevant place (ICB) Medicines Optimisation Team to highlighting the issues.
Use the emails below to report branded generics issues to the relevant ICB:
- Bradford – Meds.opt@nhs.net
- Calderdale – wyicb-cal.medicinesmanagement@nhs.net
- Kirklees – wyicb-kirk.medicines@nhs.net
- Leeds – wyicb-leeds.prescribingteam@nhs.net
- Wakefield – wyicb-wak.medsoptwakefield@nhs.net
7 Day Prescription Guide
The 7 Day Prescription Guide (March 2024) is to assist you in deciding which of your patients may require 7-day prescriptions and will help you in your discussions with GPs.
MDS / MCA / Compliance Aid Guidance
Multi-compartment Compliance Aids (MCAs) also known as MCCAs, monitored dosage systems (MDS), multiple dosage systems, dosette boxes, blister packs and trays are medicine storage devices with compartments divided into days of the week and various times of each day.
Our CPWY MDS Contractor Guide summarises the key points regarding MCAs and addresses the common queries relating to MCAs.
Comprehensive Equality Act and MCA guidance can be found on the Community Pharmacy England website here: https://cpe.org.uk/quality-and-regulations/pharmacy-regulation/equality-act/.
The MCA Notification Form
Use of this form is optional, but it can be used to inform GP practices that an MCA has been started or to request 7-day prescriptions including the rationale for this request.
MDS Notification Form – Updated 2024
Multi-compartment Compliance Aids Briefing
The CPWY MCA Briefing provides advice and support for pharmacies responding to requests from GPs, patients and carers to provide MCAs and dealing with queries relating to the provision of 7-day prescriptions.
Managing Medication Leaflet: A Guide to Assist Health and Social Care Workers in Conversations with People
Supplying medicines in their original packaging is always the first option considered. Repacking some medicines into another system may affect their effectiveness and safety. This leaflet explores the issues with Multiple-compartment Compliance Aids (MCAs) and can be used to facilitate discussions with patients / carers / health professionals requesting that medicines are supplied in an MCA. The leaflet can be found here: https://www.wypartnership.co.uk/our-priorities/primary-and-community-care-services/useful-links-and-resources/managing-medication.
Multi-Compartment Compliance Aid (MCA) Assessment Tool
The University of East Anglia (UEA) have made available a Medication Adherence Support Decision Aid which is available here: https://www.uea.ac.uk/web/groups-and-centres/patient-care-group/medical-compliance-aids/masda.
The UEA Medication Adherence Support Decision Aid (MASDA) recognises that a range of solutions are available to support patients with taking their medication as prescribed, not just MCAs. The MASDA is intended to facilitate discussions between practitioners and patients to personalise these solutions. The decision aid comprises an algorithm that has been informed by a programme of research regarding medication adherence and compliance aids led by Dr Debi Bhattacharya.
Other examples of Assessment Tools can be found here and here.
Community pharmacy teams are reminded that:
- The decision to supply MCAs is that of the pharmacy; not the prescriber, patient or carer.
- The decision should be based on a robust, individual patient assessment by the pharmacy to assess patients who may fall under the Equality Act 2010 and to make ‘reasonable adjustments’ where necessary as to how medication is dispensed.
- Pharmacies are not obliged to dispense free MCAs for patient, carer or prescriber convenience or to help improve compliance for patients who do not otherwise qualify under the Equality Act 2010.
Paid Carer Support to Patients and Multi-compartment Compliance Aids (MCAs)
Community Pharmacy West Yorkshire has produced this document to assist pharmacies with dealing with requests for MCAs from carers funded to support patients.
NICE Quick Guide for Home Care Managers Providing Medicines Support
The NICE Effective record keeping and ordering of medicines quick guide for home care managers providing medicines support can be accessed here.
The guide includes information on record keeping, ordering medicines and what to expect from other health care professionals and includes the following statement:
“If a home care service is supporting a person to manage their medicines, the pharmacist or dispensing doctor should supply medicines in their original packaging.”
CQC Frequently Asked Questions: Should Multicompartment Compliance Aids (MCAs) be used in Care Homes? – document which concludes that ‘MCAs are not the only option; they are only one of a range of aids to help people take their medicines’ can be accessed at the following link:
CQC Multi-compartment Compliance Aids in Care Homes
Patient Safety Resource on MCA Deliveries
The cross-sector Community Pharmacy Patient Safety Group (CPPSG) resource which includes best practice about delivering medicines. Click here to view the resource about safe delivery of medicines.
UKMi Medicines Compliance Aid Database
Specialist Pharmacy Service (SPS) offer information on the stability of solid dosage forms being transferred out of their original packaging through their MCA Stability Tool. This can be found here: https://www.sps.nhs.uk/home/
MCA – Evidence
There are no high-quality published evidence to assess the impact that MCCAs have on medicines adherence or patient safety.
MDS Specialist Pharmacy Services MCCA (MDS) Briefing
Are we dispensing too many multicompartment compliance aids? PJ article:
Medicines Management Policy for Local Authorities
- Bradford: https://www.bradford.gov.uk/adult-social-care/policies-and-reports/bradford-medication-support-guidance/
- Calderdale: Calderdale Domiciliary Care Medication Policy
- Leeds: https://www.leeds.gov.uk/care-quality-team/managing-care/managing-medication
- Kirklees: https://www.kirklees.gov.uk/beta/adult-social-care-providers/domiciliary-care-medication-guidance.aspx. Password needed but can easily be requested following information on Kirklees page.
Multiple Compartment Compliance Aid (MCA) Podcast
In this #WYMedicinesSafety podcast, Claire Kilburn, Lynne Precious and Ruth Buchan talk about medicines compliance aids. They explain what medicines compliance aids are, and why there are often better options to help people manage their medicines: https://on.soundcloud.com/xCrh.
Managing Complaints about Prescription Direction
Patients are entitled to make their own decisions about where they want their prescriptions to be dispensed; therefore, if a patient prefers to use a particular pharmacy, the NHS Constitution requires that this preference is respected.
A prescriber must not seek to persuade a patient to nominate a dispenser recommended by the prescriber and that ALL contractors comply with patient choice. Prescription direction undermines a patient’s right to have a free choice between any community pharmacy, and damages trust and cooperation between healthcare professionals.
- Staff within GP practices seeking to influence and direct patients to specific pharmacies.
- Staff within pharmacies nominating patients to their pharmacy without gaining clear patient consent.
NHSE and the General Medical Council and General Pharmaceutical Council (the professional regulators) all have a role in stepping in to challenge cases of prescription direction. They generally need to hear from patients before they will take action.
If you suspect that prescription direction is happening in your area please inform Community Pharmacy West Yorkshire by emailing brief details to: info@cpwy.org. NB: DO NOT include patient details!
Relevant Links
The BMA and Community Pharmacy England statement on prescription direction is available at:
https://cpe.org.uk/quality-and-regulations/pharmacy-regulation/direction-of-prescriptions/
https://cpe.org.uk/digital-and-technology/eps/nomination-patients/
Suggested actions for you:
- Look at information on the Community Pharmacy England website: https://cpe.org.uk/quality-and-regulations/pharmacy-regulation/direction-of-prescriptions/.
- Display the NHS England poster on Freedom of Choice. See link to poster under the Background and NHS England poster section: https://cpe.org.uk/quality-and-regulations/pharmacy-regulation/direction-of-prescriptions/.
- If any patients complain that their prescription has been diverted to a specific pharmacy then suggest the patient makes a complaint to the West Yorkshire ICB. The West Yorkshire ICB much more likely to take action following a patient complaint. Information on how to complain can be found under the Patient Advice section below.
- If there is evidence that a professional may have acted inappropriately, concerns can be reported to the relevant professional body: the General Medical Council, or the General Pharmaceutical Council.
Patient Advice
From 1st July 2023, the complaints procedure has changed to reflect the transfer of primary care service to the NHS West Yorkshire Integrated Care Board (ICB). An updated letter can be found below explaining this change and includes the new contact details for complaints.
Primary Care Complaints Letter – Corrected Version 28/06/2023
If you become aware that a patient has been subjected to prescription direction:
1. Explain that doctors and pharmacists across the country have agreed that this is not the right way to behave – patients should always be free to choose their pharmacy, and no-one should seek to undermine that right.
2. That if certain GPs or pharmacies locally are behaving in this way, that this needs to be reported so that something can be done to stop it.
3. Due to the changes as detailed in the letter above, you must now contact the West Yorkshire Integrated Care Board (ICB) instead of NHS England. Please contact them by:
- Email: wyicb.complaints@nhs.net
- Telephone: 01924 552 150
- In writing: Complaints Team, West Yorkshire Integrated Care Board, White Rose House
West Parade, Wakefield WF1 1LT
Please respect the right of patients not to complain if they are uncomfortable in doing so. Please also recognise that you should treat any interactions with patients on this topic as confidential.
Patients can explain they wish to be treated anonymously and do not wish for their details to be shared outside of the West Yorkshire ICB.
Advising on Missed or Delayed Doses of Medicines
Medicines and Falls
The document below is intended to provide information and guidance on medication review for people at risk of falls. A number of medicines can cause or contribute to falls and these are sometimes referred to as falls risk increasing drugs (FRIDs). This document highlights FRIDs and also highlights medicines that cause or contribute to fractures.
Medicines Safety
The Community Pharmacy England patient safety information page provided a summary of patient safety notifications (previously referred to as alerts and recalls), advice and guidance relating to patient safety, and a link to the MHRA monthly drug safety updates. See https://cpe.org.uk/quality-and-regulations/clinical-governance/patient-safety-incident-reporting/patient-safety-information/.
West Yorkshire and Harrogate ICS Medicines Safety Information
A dedicated page on the ICS website offers information and guidance on medicines safety.
Community Pharmacy Patient Safety Group
The Community Pharmacy Patient Safety Group provides a forum for community pharmacy organisations to openly share and learn from each other when things go wrong, as well as from other sectors and industries and it is their Report, Learn, Act, Review principles which we at Community Pharmacy West Yorkshire actively promote.
The Community Pharmacy Patient Safety Group has a website which includes lots of helpful resources for community pharmacy teams – see https://pharmacysafety.org/
Fire Risk with Emollient Use
Warnings about the risk of severe and fatal burns are now being extended to ALL emollients, whether paraffin-based or not. See latest (Dec 18) MHRA guidance here.
Patients treated with emollients must be made aware of the potential fire risks associated with these products. This includes paraffin-based emollients (regardless of strength) AND paraffin-free emollients and includes products used for washing and showering.Patients who smoke or use a naked flame may cause clothing, bedding or bandages to catch fire as dressings and clothing soaked with the emollient can be easily ignited. Community pharmacy teams have an essential role to play in advising patients not to smoke; use naked flames (or be near people who are smoking or using naked flames); or go near anything that may cause a fire while emollients are in contact with their medical dressings or clothing.
When dispensing/selling emollient products all patients should be advised that:
- Emollients are an important and effective treatment for chronic dry skin conditions and people should continue to use these products. However, there is a fire risk associated with the build-up of residue on clothing and bedding and patients must take action to minimise the risk
- Patients should be told to keep away from open or gas fires or hobs and naked flames, including candles etc. and not to smoke when using emollient products because clothing or fabric such as bedding or bandages that have been in contact with an emollient or emollient-treated skin can rapidly ignite.
- There is a fire risk with all paraffin-containing emollients, regardless of paraffin concentration, and it also cannot be excluded with paraffin-free emollients. A similar risk may apply for other products which are applied to the skin over large body areas, or in large volumes for repeated use for more than a few days
- Washing clothing or fabric at a high temperature may reduce emollient build-up but not totally remove it.
Warnings, including an alert symbol, are being added to packaging to provide a visual reminder to patients and those caring for them about the fire hazard. Please also take care to ensure that any flammability warnings on the product are not covered up.
Patients should be given both verbal and written information on the potential fire risks. It is recommended that a record of information provided is kept on the PMR and communicated on regular occasions.
Further Resources
- Emollients: NEW Information – December 18
- Video – Fire hazards of Paraffin-based Skin Products – For use of Health and Care Professionals
- BBC health – http://www.bbc.co.uk/news/uk-39308748
Peanut Allergy
Following the recommendation from the MHRA that patients known to be allergic to peanuts should not use medicines containing arachis oil, the South West Yorkshire Area Medicines Safety Group developed the following useful peanut allergy bulletin.
Medicines Shortages
Community Pharmacy England has produced a patient factsheet that can be used to highlight and explain the issue to patients affected by a shortage: Medicines Supply Factsheet. The Community Pharmacy England website also has further resources to help you manage stock shortages, including:
- Links to report a medicine shortage or a pricing issue
- Monthly updates of shortages for Primary and Secondary Care via the Specialist Pharmacy Service (SPS) website
- Manufacturer stock availability updates
- Guidance on SSPs
CPWY has produced a briefing for prescribers that asks for understanding and support of the significant problems that community pharmacy contractors are facing with regards medicines shortages. This briefing also explains some of the issues and the impact they are having. Medicines Shortages Briefing for Prescribers – December 2023
Local ICB Policies
WY ICB Medicines Classification / Guidelines including Area Prescribing Committee (APC)
https://www.westyorkshire.icb.nhs.uk/documents/medicines-guidelines
The APC website may be a useful resource for pharmacy teams, particularly if dispensing a drug not commonly seen in primary care. The website also hosts local prescribing guidelines, such as the local antibiotic formulary, wound management formulary and details of RAG classification identifying drugs that should not be prescribed in primary care. There are some great resources on the website, including respiratory resources (inhaler technique videos, inhaler leaflets for patients) and a wide array of antimicrobial resources.
This includes developing prescribing guidelines for use across these areas and RAG (Red, Amber, Green) classification of drugs that may be used in primary and secondary care. RAG classification defines where the responsibility for prescribing between primary and secondary care lies and is intended to encourage appropriate shifts in prescribing between hospital clinicians and GPs. For example, drugs which have been classified as RED are hospital only and should not be prescribed in primary care.
Area Prescribing Committee – APC
South West Yorkshire APC (Bradford, Calderdale, Kirklees and Wakefield) Antibiotic Formulary
The SWYAPC antibiotic guidelines are on their website here https://www.swyapc.org/primary-care-antibiotics/
There is not a single formulary document but the APC have approved local use of the NICE/PHE managing common infections guidance to assist antibiotic prescribing choice.
Other relevant links on the SWYAPC site include:
The most recent antibiotic awareness campaign resources and links: https://www.swyapc.org/antibiotic-awareness-antibiotic-resources-for-clinicians/
Patient facing antibiotic awareness page: https://www.swyapc.org/antibiotic-awareness/
Pharmaceutical Stationery Orders
NHSE supplies, including NHSE stationery, pre-printed forms, needles and syringes, should be ordered through PCSE Online.
Use of Emergency Salbutamol Inhalers in Schools
From 1st October 2014 the Human Medicines (Amendment) (No. 2) Regulations will allow schools to keep a salbutamol inhaler for use in emergencies.
The Department of Health has written guidance for schools which will be of interest as schools are advised to discuss the use of inhalers and spacers with their community pharmacist.
The guidance can be found here.
Medicines Information Websites
Below are a few websites commonly used in practice by medicines information services that are free to access and may be of use when dealing with enquiries within community pharmacy
- Electronic Medicines Compendium – https://www.medicines.org.uk/emc/ – For information on the SPC of individual products
- BUMPS – http://www.medicinesinpregnancy.org/ – useful summaries for patients and their carers about various medicines used in pregnancy.
- UKMi Drugs in Lactation – http://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1 – West Midlands Medicines Information service database on use of various medicines during breastfeeding.
- Palliative Care Guidelines Plus – http://book.pallcare.info/ – information on medicines management issues commonly encountered in palliative care.
- Green Book Online – https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book – Information on vaccines/schedules from DoH, useful for vaccine related enquiries.
- BNF – https://bnf.nice.org.uk/
- SPS for medicines and breastfeeding https://www.sps.nhs.uk/articles/information-resources-for-advice-on-medicines-and-breastfeeding/
Information on any aspect of drug therapy can be obtained from the Regional Medicines Information Centre in Newcastle 0191 2824631.
Children’s Medicines Advice
- Great Ormond Street Hospital for Children website: www.gosh.nhs.uk/conditions-and-treatments/medicines-information
- Medicines For Children: https://www.medicinesforchildren.org.uk/
- Swallowing Tablets Leaflet: https://flipbooks.leedsth.nhs.uk/LN003942.pdf
Last Updated: 24th April 2024
