Quantities and Costs
The cost of issuing prescriptions, to the Practice, as well as the risk of error, are underestimated. While unusually expensive drugs should clearly be parcelled out in small aliquots, cheap ones intended for prolonged use are better provided in reasonable quantity.
Systems introduced to reduce costs from wasteage frequently have the unintended consequence of increasing overall costs.
Classes of Repeat Medication
Intended and permitted. Tablets for BP are intended to be repeated, continuously, according in general to a schedule which is highly predictable. Loperamide for variable diarrhoea is intended, but the schedule is not predictable with certitude. Antihistamine tablets for hay fever are permitted repeats but the time when a fresh supply is needed is quite unpredictable, as a supply may last two quiet years, or be needed twice in a highly pollenated one.
Current GP prescribing systems lack an ontology to adequately describe the actual classes of repeat, and the flexible people operating them work around this.
There are several arguably conflicting aims, desires and needs involved in repeat prescribing, ranging from the psychological to the financial and with overtones of a power relationship and customer service. It looks simple, but is not, like many things we take for granted - but also like many things we take for granted, for many people it really is simple and straightforward. A consciousness of the underlying semiotics and politics should inform the design, modification and operation of systems, but the actual operation of them arises over generations and follows rules disseminated by diffusion through the Practice population. It follows that it would be surprising if Practices within an area were wholly alike, or areas within a wider area. This may also apply beyond the UK.
Issue on request
The patient asks for a repeat, and unless there is a reason, the Practice arranges to release one.
Issue in Anticipation
The Practice predicts when the next supply should be required, calls the patient anything that should be done prior to it (eg measurement of BP before issue of another 6 months treatment to maintain it below the upper limit), prepares and issues the prescription ready for collection on schedule. At the end of each week, uncollected prescriptions are examined, enquiries made where indicated, and if they are not going to be used the record is amended so it does not appear that this medication has been given to the patient.
An advantage of this for patients is that the effort of arranging and obtaining the prescripotion is minimised. For the Practice it is one way of providing a work-token to follow up missed treatment and establish the reason. Disadvantages include the necessity for such action, and the need to record the unissuing of unused prescriptions. Conceivably application of this may increase dispensing, which may be one reason dispensing areas are more likely to see it done, without necessarily increasing the taking of the treatment.
Systems not Used
Among the possible systems of providing medication, combining the safety to the patient of not running out, with the frugal use of the resources of the State, would be operating an imprest system. This has not been implemented because of the design of legislation and payment systems.
No statement is currently required of patients that they have completed their previous supplies, or indeed taken any of them.