Hello,
This probably isn't relevant to some users of this forum, but...

How have folk interpreted this guidance - acute prescriptions and a consultation every time a controlled drug needs to be issued to a patient? Or does this wording relate to a single repeatable prescription (e.g a private script). This is causing much debate in our little corner of the world.
Also would any kind sole like to share any exemplary work they may have done around SOPs for GP practices in relation to the management of CDs,
Thank you
Alastair

I don't put them on repeats mainly bcause Emis would then overprint on the instalment side. I would usually leave out one script if a client fails to attend with a strongly worded post it on it saying they won't get one next time if they DNA. Unsurprisingly they turn up again the following appointment.

I don't think it's legal to prescribe cd's on repeats.

Simon,
Interesting comment - can you recall where that has come from?
Alastair

Alastair
check out page 33 but this isn't where I remember it from, I don't remember where I remember it from I get more feeble-minded as each day passes
http://www.npc.co.uk/controlled_drugs/CDGuide_2ndedition_February_2007.pdf

That is a rather wonderful link, thanks Simon. I'd never knowingly seen this document. I particulary like this bit:

""Technical errors on a prescription
pharmacists are able to supply Schedule 2 and 3 CDs except temazepam (which is exempt from CD
prescription requirements), against some prescriptions that have a minor technical error but where the
prescribers intention is clear.
The only errors that pharmacists may amend are:
• Minor typographical errors or spelling mistakes
• Where the total quantity of the preparation of the CD or the number of dosage units as the case may
be is specified in either words or figures but not both (i.e. they may add the words or the figures to
the CD prescription if they have been omitted).""

The section you refer to on page 33 is about repeat "Dispensing", a pharmacy service, not repeat prescribing.

Like Beverly, I never put methadone or buprenorphine on repeat perscription, because on EMIS the list of prescribable medication would then be printed over the right hand side of the script, getting in the way for installment scripts. However as far as I know there is no actual rule preventing the use of the normal practice repeat prescribing protocols for CDs, as we have various people who have various CDs on repeat script..eg for chronic pain relief, or for terminal care.

[QUOTE]Originally posted by Alastair Monk:


"How have folk interpreted this guidance" -

Alastair, I am not sure to which guidance you are referring.

I give patients (or post to the chemist)post dated scripts to last until the next appointment. I do not see the person for each prescription, but might give them 4 or 6 weeks worth of scripts which are post dated, to take to the pharmacy. The CDT i work in posts scripts in an automatic and continuous way to the patient's pharmacists and they are signed by us prescribers in bulk each 6 weeks. A horrible task. I check before signing that the person has seen a presciber for review within the presceding 12 weeks. If not I set varoius wheels in motion to find out where and how they are. If the person has missed appointments the key worker rings the pharmacist and leaves messages of increasing ferocity, which eventually drag the person in to be seen.

Judith I took page 33 to be referring to both prescribing and dispensing. It says this:

"Current legislation does not allow Schedule 2 and 3 CDs to be prescribed as repeat prescriptions (i.e. to
be part of the repeat prescribing system within a practice, or part of a repeat dispensing system)."

goodness me, thanks jim, i was obviously reading very selectively. if that is really the case, there must be many GP surgeries who bend the rule. I'll read it again when i have time.

It's an extraordinary comment, and although the document is a guide, the reference actually says 'current legislation etc' suggesting it's illegal.
My queries would be;
1.What's the basis for the statement ie which bit of legislation is referred to?
2.What's the definition of 'repeat prescribing'as covered by that legislation?

BNF it's in there under controlled drugs and drug dependence.
''...prescriptions ordering repeats on the same form are not permitted for controlled drugs in schedule 2 or 3...'

That's not really a problem as EMIS prints CDs out on a separate form anyway. The BNF guidance is about keeping the paperwork for CDs separate probably to facilitate monitoring. Doesn't prevent the actual surgery admin and processing as a repeat tho'.

Actually looking at this more closely the guidance above is incorrect. The 2001 Regulations specifically allow for repeat dispensing - , (s15 and 16), and the 2005 Regulations allow printing of scripts. The regulations are silent about repeat prescribing.

But Dr Wasson, as Jim says, what about this sentance on page 33 of the "good guide to practice" on the link Simon put up. :
"" Repeat prescribing
Current legislation does not allow Schedule 2 and 3 CDs to be prescribed as repeat prescriptions (i.e. to
be part of the repeat prescribing system within a practice, or part of a repeat dispensing system).""

It does seem to say "repeat prscribing" is banned. maybe it was a slip of the tongue. It would certainly alter the habits of our local CDTs if it were banned. Probably it is a transcription error maybe.
Do you have a link the 2001 and 2005 guidelines you refer to?

I think that you may be mixing this up with 'repeatable prescriptions' where the Pharmacy recieves a repeatable prescription along with batch prescriptions. It is used for people who are stable on a medication eg allopurinol 300mg od x 28.. the Pharmacist would recieve one repeatable script with 12 batch prescription, which they issue every 28 days for 1 year. Schedule 2 and 3 are not allowed on these forms(and temazepam and phenobarbitones). This is the fore runner of electronic prescribing. At the moment legislation does not permit CD prescribing electronically, but reading between the lines, I believe that this may change..but a long time into the future.
So Judith, this doesnt relate in anyway to what you are doing

jolly good. thanks.

Could we get definitive clarification from an authoritative source of the legality of 'repeat prescribing' of CDs?
This is surely the core issue, not how we as prescribers choose to interpret or ignore legislation.

The stuff on pg.33 seems really clear to me that it's not allowed. It's not something that it's easy to find links about.

Simon, as you see from the above postings there are a variety of views about this, including that the guidance may be incorrect/a slip of the tongue/pen.(Or it may be illegal, which is a big problem for high capacity prescribers.)
my own viewis that it depends on how 'repeat prescribing' is defined.
However, as I've said, this isnt about prescribers interpreting guidance or finding links, it's about legislation, and that needs authoritative medico-legal advice.
I think I've just volunteered myself to get that advice - I'll approach the MPS

Graham
thanks kindly