REPEAT DISPENSING MURsProgress so far

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REPEAT DISPENSING/ MURs-Progress so far

• David Birch, Key Prescribing Adviser
  Wolverhampton City PCT

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Progress so far (2nd wave pathfinder)
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SHA data(Q2)
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Who has got involved?

• 48 out of 61Pharmacies are dispensing RD scripts
• Pharmacies visited as part of contract monitoring
• 6 out of 61 pharmacies have not produced RD
  certificates for their current staff

• 30 GP practices out of 57 have been trained or
  briefed
• 23 GP practices are actively producing scripts
• Activity between practices is variable

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What works well

• Practice champion who understands the value of
  the scheme from patients and practice perspective
• Where practice manager takes an interest or has
  experience of repeat prescribing

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Barriers(PCT)

• Lack of dedicated support officer (inability to
  recruit in key acceleration phase (April 06-March
  07), focus of MMT on prescribing indicators)
• Priority given to Minor Ailment scheme roll out
• Technical issues with IT systems (disconnection
  from spine required, removal of smartcard,
  doesnt work for NMPs although legally allowed)
• Uncertainty about moving to new systems (GPSOC)
• Performance issues in individual practices
• Cross border issues

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Barriers(Practices)

• Worry about QoF point loss
• Inability to secure buy in from whole practice
  team
• Consent forms- feel awkward
• Waiting for Release 2 of EPS

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Barriers(pharmacies)

• Poor filing systems (reduced patient confidence)
• Pharmacies in other PCTs not expecting RD scripts
• Poor locum awareness
• Promotion of existing managed repeat prescription
  collection and delivery scheme (staff confusion)

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Methodology

• Identify practices able to produce RD scripts
• Seek interest from those GP practices(selling the
  benefits-Medicines Management Team)
• Assess readiness of the practice to participate
• Book training sessions
• Community pharmacists to raise awareness during
  MURs
• Recent approach from Lloyds to use external
  company to identify suitable patients

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Advice given to GP practices

• Read code patients on the scheme
• Record the nominated pharmacy
• Getting started is a big step
• Dont have a gap between training sessions and
  starting
• Understand the triggers for initiating repeat
  dispensing
• Allow time to explain the scheme

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MURs- current position (Jan 08)

• 41 pharmacies capable of providing a service out
  of 61
• 3987 completed (April 07 to Jan 08)
• 36 pharmacies have done MURs
• Range 1 - 501

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MURs SHA(Q2)
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PCT/LPC role

• Promoted asthma reviews
• Provided support materials- asthma educational
  leaflets
• Keele Depart of Medicines Management ran a
  training session
• Initial audit completed
• Joint PCT LPC Feedback meeting
• Personal feedback on random sample of MURs at
  monitoring visits(2007 visits only)
• Discussion papers to PBC groups by LPC
• Facilitated use of GP consulting room

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MUR audit in Wolverhampton 2006

• At the time there were 27 accredited pharmacists
  in Wolverhampton
• MMT collected data from MURs sent to GP practices
• There were 583 MURs completed between July 2005
  and February 2006, 140 of which were declared as
  annual reviews and 16 were declared as
  prescription based interventions

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Barriers

• Sustainability- only 19 pharmacies can provide
  the service throughout their contracted hours (no
  strength in depth)
• Frequent managerial changes
• Difficult to get focused campaigns e.g. asthma
  campaign( however Lloyds and Co-op have been more
  successful)

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Future plans

• Integrated Medicine Usage Review Service
  Collaboration between LMC LPC(GP practices to
  identify the most appropriate cohort of
  patients).
• MURs conducted in neighbouring pharmacy with
  consultation room (local policy)
• MURs conducted at home (local policy)