Dispensing

This page contains resources to support pharmacies in delivering Essential Service 1 – Dispensing Medicines.

Branded Generics

7 Day Prescription Guide

Children’s Medicine Advice

MDS / MCA / Compliance Aid Guide

Advising on Missed or Delayed Doses of Medicines

Area Prescribing Committee (APC)

Immunosuppressant Medication Supply for Kidney Transplant Patients – Leeds 

Local CCG Policies

Dressings on FP10

Medicines Information Websites

Medicines Safety

Medicines Shortages

Pharmaceutical Stationery Orders

Prescription Direction

Translation Website for Medicine Instructions

Use of Emergency Salbutamol Inhalers in Schools

 

Branded Generics 

All medication should be prescribed generically unless there is a clinical benefit to patients.  Community Pharmacy West Yorkshire is aware some Medicines Management Teams / GP practices are switching to prescribing branded generics to achieve ‘cost savings’.

To highlight the impact branded generic prescribing has for patients, the NHS and community pharmacy, Community Pharmacy West Yorkshire has produced a letter that contractors can choose to use with the local GP practice teams to explain the impact of ‘branded generics’.  The letter can be found below. We encourage contractors speak with the practice pharmacist/technician and their local GP practice teams to highlight the negative impact branded generic prescribing has for you as a contractor.

Branded Generics Letter

 

Prescribing by Generic or Brand Name in Primary Care

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.

SPS Example medicines to prescribe by brand name in primary care

 

Issues with Branded Generics

CPWY has been given assurances that all places in West Yorkshire (CCGs) 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 eg 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 (CCG) Medicines Optimisation Team to highlighting the issues.

Use the emails below to report branded generics issues to the relevant CCG:

 

7-Day Prescription Guide

The 7-Day Prescription Guide 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.

MDS Contractor Guide

Comprehensive Equality Act and MCA guidance can be found on the PSNC website here: https://psnc.org.uk/contract-it/pharmacy-regulation/dda/.

 

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 2019

 

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.

MCA Briefing – June 2022

 

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.

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.

Paid Carer Support and MCAs

 

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

The Medicines Compliance Aid database, makes recommendations on the suitability of transferring solid dose formulations from the manufacturers’ original packaging into multi-compartment compliance aids (MCAs).

The database can be searched by the brand or generic name of the medicine, although most entries will be based on the brand leader.  Once searched, the product is given a traffic light colour-coded UKMi recommendation as to whether it is suitable or not to be placed in a MCA.

 

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:

https://www.pharmaceutical-journal.com/news-and-analysis/features/are-we-dispensing-too-many-multicompartment-compliance-aids/20206131.article?firstPass=false

RPS – MCA Briefing

 

Medicines Management Policy for Local Authorities

 

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.

Prescription direction can take many forms:
  • 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&I 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, Pharmacy Voice and PSNC statement on prescription direction is available at:

http://psnc.org.uk/wp-content/uploads/2013/07/BMA_PSNC_PV_prescription_direction_guidance_October_13.pdf

https://www.bma.org.uk/advice/employment/gp-practices/service-provision/prescribing/prescription-direction

https://psnc.org.uk/contract-it/pharmacy-regulation/direction-of-prescriptions/

https://psnc.org.uk/dispensing-supply/eps/patient-nomination-of-a-dispensing-site/

 

Suggested actions for you:

 

Patient Advice

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.  Offer them the “Your Prescription Your Choice” form, explaining that it contains information about this problem and gives them the opportunity to report what has happened to them.

4.  Advise them that the back half of the form can be detached and submitted to the appropriate body. They can submit the form themselves, or ask you to do it for them.

5.  You may wish to encourage them to complete the form in the pharmacy, and say that you’ll send their form off for them, along with any other forms that you receive, to save them the cost of a stamp or phone call.  The address for submitting complaints can be found here:  https://www.england.nhs.uk/contact-us/complaint/complaining-to-nhse/.  Please note that any complaints posted to the NHS England Leeds office will be forwarded to the customer contact centre to manage the consent process.

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 NHSE&I.  The NHS England complaints process can be found here: https://www.england.nhs.uk/contact-us/complaint/complaining-to-nhse/.

 

Your Prescription, Your Choice

If any of your patients complain about undue pressure to use a particular pharmacy, you can use the Your Prescription, Your Choice Leaflet to help them to easily register a complaint.

 

Advising on Missed or Delayed Doses of Medicines

 

Medicines Safety

The PSNC 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://psnc.org.uk/contract-it/essential-service-clinical-governance/patient-safety-incident-reporting/patient-safety-information/.

 

CPWY Medicines Safety Newsletters

Please see our Medicines Safety Newsletters below.  If you wish to receive future editions of the Medicines Safety Newsletter please click here to sign up to our mailing list.

Medicines Safety Newsletter: Issue 1 – October 2017

Medicines Safety Newsletter: Issue 2 – February 2018

Medicines Safety Newsletter: Issue 3 – June 2018

Medicines Safety Newsletter: Issue 4 – January 2019

Medicines Safety Newsletter: Issue 5 – July 2019

 

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

 

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

PSNC has produced a patient factsheet that can be used to highlight explain the issue to patients affected by a shortage: https://psnc.org.uk/wp-content/uploads/2019/01/PSNC-Patient-Leaflet.pdf.

A briefing for prescribers / CCGs (produced in Feb 2019) is available below.

Medicines Shortages Briefing for Prescribers

 

Stock Shortages: Communication with Prescribers

Stock shortages continue to be a significant problem and effective communication with prescribers is essential to reduce delays obtaining alternatives for patients.  Proactive, well-planned communication also helps to reduce the workload of pharmacy and surgery teams and to maintain positive relationships.  Information about effective communication along with forms to be used to suggest suitable alternatives for surgeries and for dealing with more general problems can be found below.

Stock Shortages: SBAR Guide – July 2019

Reporting Shortages

Reporting shortages to PSNC is essential to help PSNC in their concession conversations with the Dept. Health and Social Care.  Please report any supply issues by using the online reporting form. Alternatively, you can report any concerns about drug availability at Drug Tariff-listed prices by contacting PSNC via telephone on 0203 1220 810 or by emailing info@psnc.org.uk. You can email in copies of wholesaler invoices as evidence to medicines.shortages@psnc.org.uk or fax 0207 278 1127.

Further details regarding How the price concession system operates can be found in this PSNC briefing: https://psnc.org.uk/dispensing-supply/psnc-briefings-dispensing-and-supply/psnc-briefing-067-18-psnc-briefing-067-18-how-the-price-concession-system-operates/.

 

Major Suppliers Online Stock Availability Information 

Due to the ongoing problem of stock shortages, it is increasingly necessary to spend time checking for out of stock information with wholesalers.  The major three wholesalers, AAH, Alliance and Phoenix, all have current stock information on their websites.  These can be accessed instantly and are continuously kept up to date.  They are linked to individual pharmacies’ account numbers so can also be used for ordering and in some cases can track those lines with on-going problems.

These can be set up in a couple of minutes with a desktop icon on all your terminals for one click access.  The document below has comprehensive instructions to help you set these up.

Major Suppliers Online Stock Availability Information – July 2019

 

SPS Medicines Supply Tool

Use this tool below to find the latest information on supply issues, actions to take, alternatives to use, and expected resolution dates. The content has been provided by DHSC and CMU.

SPS Medicines Supply Tool

Any individual with an NHSmail account can register with SPS.

 

Translation Website for Medicine Instructions

CPWY advise that if a pharmacy contractor is thinking about using this type of solution, they should:
  • Get some advice from their indemnity insurers to confirm that their cover includes the use of such a tool – pharmacy contractors may also want advice about any wider issues of negligence from their insurer.
  • Ensure that any necessary due diligence is considered.
  • Note that tools that address language barriers may support person-centred care.
  • Consider that use of translation tools require additional pharmacy time and resource which are not remunerated.
  • Understand the use of any translation or language tool is optional.
  • Understand it remains the professional decision of each pharmacist as to if they use any tools to assist with translation.
As a representative body, CPWY cannot endorse any particular product or solution.

 

Translabel

Translabel is a website that provides common directions in many different languages on a label format.  This may assist with compliance and support patients in taking their medicines.

https://www.translabel.co.uk/

Any translated label used must not replace the usual pharmacy label, but can be used in addition to it.

Each label is accompanied by a translation validation certificate document.

 

Local CCG Policies

 

Dressings on FP10

We have become aware that some CCGs are implementing a change to the way that dressings are supplied by setting up schemes that allow direct supply of dressings to nursing teams.  These schemes circumvent the usual FP10 route.  This will obviously have an impact on community pharmacy by reducing the number of dressing items prescribed via FP10 route, essentially leaving non-GSL, expensive, infrequently used, part pack dressings on FP10.

Community Pharmacy West Yorkshire does not support the proposed changes but know that it is important that our contractors are informed enabling contractors to make adjustments to stocks held.

Contractors are reminded that the NHS Pharmaceutical Regulations state that “P must, with reasonable promptness, provide the drugs so ordered, and such of the appliances so ordered as P supplies in the normal course of business”.

These CCG schemes will reduce the number of dressing items prescribed via FP10 route, mainly leaving non-GSL, expensive, infrequently used, part pack dressings on FP10. A community pharmacy contractor has no obligation to supply dressings if it is not part of normal business and is quite within the regulations to refuse to dispense a prescription for dressings where they determine this is the case.

 

Bradford and Craven (AWC) CCG

 

Calderdale CCG

 

Kirklees CCG

 

Leeds

 

Wakefield CCG

 

Immunosuppressant Medication Supply Mechanism for Kidney Transplant Patients at Leeds Teaching Hospitals

From August 2021 Leeds Teaching Hospitals are “repatriating” adult kidney transplant recipients. This means that the responsibility for prescribing and supply of post-kidney transplant immunosuppressants to adult patients will be undertaken by the pharmacy team at St James’s Hospital rather than via GP prescribing and FP10.

Immunosuppressant Medication Supply Mechanism – Pharmacy Briefing

Immunosuppressant Medication Supply Mechanism – Sample Patient Letter

 

Area Prescribing Committee – APC

 

Antibiotic Formulary

Leeds Antibiotic Formulary

The Leeds Antibiotic Formulary is accessed through the Leeds Health Pathway:  http://www.lhp.leedsth.nhs.uk/.  To access the relevant antibiotic formulary, follow these steps:

  1. Click the Primary Care Body tab.
  2. Select the relevant body part eg skin and soft tissue, maxillofacial, gentio-urinary by hovering a mouse over the relevant part of the body and clicking.
  3. Look down the list to identify the relevant management of infection guideline.  NB The clinical guidelines are listed after the clinical pathways.
  4. Click the guideline to open and read the guidance.

You need to go to the primary care body map and then click on the body area and a list of the guidelines comes up.

 

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/

 

South West Yorkshire Area Prescribing Committee

The South West Yorkshire Area Prescribing Committee (SWYAPC) coordinates issues of prescribing across Bradford, Calderdale, Kirklees (Greater Huddersfield and North Kirklees) and Wakefield.

Since August 2020 the business of the SWYAPC has continued while working to develop and establish a successor West Yorkshire ICS Area Prescribing Committee which will take over from this committee and the Leeds APC.  This will align prescribing classifications, shared care guidelines and other prescribing guidance for West Yorkshire providing a seamless approach for our patients.

The last meeting of the SWYAPC took place on 7th March 2022.

Access to existing guidance and resources will be maintained on the SWYAPC website until a functional successor website has been developed for WYAPC.

The SWYAPC website (www.swyapc.org) 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.

 

Leeds Health Pathways

The Leeds Health Pathways (LHP) system is the online database for Leeds city-wide clinical pathways (formerly hosted on Map of Medicine), primary care antimicrobial guidelines, LTHT clinical guidelines (including antimicrobial guidelines), and appropriate LCH and LYPFT guidelines. LHP provides a valuable link between primary and secondary care by signposting how to manage patients, to find available services and how to prescribe and refer.

Web address for LHP is http://www.lhp.leedsth.nhs.uk/.

 

Pharmaceutical Stationery Orders

EPS tokens and other NHS stationery can be ordered via the Primary Care Support England (PCSE) portal.  Click here for further details of how to register for the portal.

 

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.

School Inhaler Request Form

 

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

Information on any aspect of drug therapy can be obtained from the Regional Medicines Information Centre in Newcastle 0191 2824631.

 

Children’s Medicines Advice

Information on how to use meds, oral syringes etc are available at the following websites:

 

 

Last Updated: 2nd February 2022