Our practice policy is that we prescribe 28-day prescriptions to all patients. In some exceptional circumstances we may consider prescribing 7-day prescriptions, as outlined by Coventry Warwickshire Integrated Care Board (CWICB):
Coventry & Warwickshire ICB recommends that most repeat prescriptions be written for 28-days’ supply. This is to avoid medication waste and ensure stability of the medication supply chain. However, there are situations where differing intervals are more suitable:
Fewer than 28 days:
On rare occasions, prescriptions for 7-days may be more suitable where risks are perceived, or medication is frequently changing. This should be an agreement with the patient/representative, pharmacy and the GP.
The following considerations will be taken into account if prescriber agrees to 7-day prescribing:
· Drugs liable to abuse.
· Vulnerable patients who are likely to get confused and/or over-dose.
· Terminally ill patients receiving palliative care support.
· Dressings for short-term use or where likely to change.
· When required / PRN medication.
· Medications that are recommended for short term use only, e.g., hypnotics, benzodiazepines.
· Newly prescribed medication when a shorter period is appropriate to assess response / titrating dosages etc.
· An assessment of suicide risk in patients with a past medical history of overdosing should be undertaken and medication prescribed in a suitable quantity and with appropriate support.
Greater than 28 days:
· Oral contraceptives and HRT (supplied in 3-month packs)
· Medication that is supplied in special containers.
Monitored Dosage Systems (MDS):
Where the pharmacy is supplying medication in monitored dosage systems (MDS), a 28-day prescription should be issued and 4 weeks of MDS will be supplied at a time.
The community pharmacist should carry out a Disability Discrimination Act (DDA) assessment with a patient who is requesting an MDS or dosette box. If the assessment identifies that it is appropriate for the patient to receive an MDS, the pharmacy is required to do this at no additional charge. If the patient does not meet the criteria for requiring an MDS but would still like one, the pharmacy is able to charge the patient for this service.
https://www.covwarkformulary.nhs.uk/docs/chapter18/CG017-Monitored%20Dose%20System%20guidance.pdf
Our Local Pharmaceutical Committee (Ardens LPC) has issued the following advice as well with regards to MDS/7-day prescriptions:
It is at the pharmacy’s discretion as to whether they supply MDS – this is ONLY where they meet Equality Act and useful for the patient – which is a very small number of cases and do not qualify if they have a carer either formal or informal.
7 days prescriptions are applicable (MDS or not) if patient cannot safely have more than 7 days at a time – otherwise the pharmacy should provide 28 days at a time, whether that is original pack or other format. Sometimes patients do get confused if given multiple packs and so if concern they may on occasion need 7-days prescription and collected weekly.
Note pharmacies are not funded to provide MDS nor deliveries. If the patient ‘needs’ MDS but do not meet Equality Act then the pharmacy can charge the patient.
When going on holiday:
The maximum prescription duration allowed by the NHS for supplies for an extended holiday is THREE months.
Patients should check UK government advice on travelling with medicines and specific rules for the country that they are travelling to. There is a useful factsheet available here: https://travelhealthpro.org.uk/factsheet/43/medicines-and-travel.