8) Pharmacy Procedures and Exemption to Retail Rules

Question 1

Jan 2005?

Answer 1

Every pharmacy must have in place and be operating in accordance with written standard operating procedure
- Applies to both hospital and community pharmacy and covers all activities from receipt of a prescription through to the transfer of the completed prescription and the medication of the patient

Question 2

Operation procedures do not apply to pharmacies that don’t employ staff

Answer 2

exactly

Question 3

What did the RPS require to put in place to minimise harms?

Answer 3

SOPs = an SOP is a document which you and the staff will work to
- will specify in writing what should be done, when, where and by whom it should be done, so it’s very specific and it outlines everything within a process.

Question 4

Benefits of a SOP?

Answer 4

• anyone coming into a pharmacy, if they’re able to read the SOP and it adhere to those steps of a process that every process would be the same. no matter who is carrying it out
  also those steps that have been articulated in such a way and put in such a way to ensure reduction of risk and also to achieve harm minimisation
• sticking to the concept of clinical governance, all NHS organisations either centrally eg hospital pharmacies or via contract like community pharmacies, are under statutory requirement to haver clinical governance procedures in place.
• so it has a duty to put and keep in place arrangements for the purpose of monitoring and improving the quality of healthcare it provides to individuals
• quality
• consistency
• safe practice
• fully utilise skill mix
• free up pharmacist
• avoid confusion
• advice and guidance for locums
• training new staff
• contribute to audit

Question 5

What mistakes can go wrong in the dispensing process?

Answer 5

• illegal or unsafe prescriptions
• wrong prods or wrong strengths
• wrong info being transcribed into the label of the product
• ## insufficient warning info

Question 6

What mistakes can go wrong in the dispensing process?

Answer 6

• illegal or unsafe prescriptions
• wrong prods or wrong strengths
• wrong info being transcribed into the label of the product
• insufficient warning info

Question 7

How many dispensing errors can occur?

Answer 7

So, on average, for every 10,000 items

dispensed, there are 22 near misses and four dispensing errors.

Question 8

What is a near miss?

Answer 8

When an error is identified and corrected before it actually reaches the patient.

Question 9

Dispensing error?

Answer 9

Dispensing error is when
the error actually reaches the patient. So, a dispensing error could occur at least once or twice a month in every pharmacy in the U.K

Question 10

What can the pharmacist be punished with?

Answer 10

hey could be subject to criminal prosecution. They could be
subject to “fitness to practice” action. They could also be subject to disciplinary action by the NHS
and they can be sued by the patient.

Question 11

How can these errors come about?

Answer 11

• We could have misreading of the prescription.
• We can have incorrect medicine selection.
• Dispensing from the label and not from the prescription. Now, that’s just sometimes bad
  habit. You should always use the prescription as the reference.
• Transposing the label or labelling the medicine incorrectly.
• Giving the wrong prescription to the wrong patient or supplying contaminated or outof-
  date stock.

Question 12

You’re a pharmacist manager of a local
pharmacy. Now, the superintendent is concerned about the level of dispensing errors that’s
increasing in your pharmacy and they ask you to identify actions to reduce this. So what can you do in answer to his query?

Answer 12

• So, you could ensure that standard operating procedures for the supply of medicine are in
  place. They’re regularly used, evaluated, and reviewed. So you really want to make sure the
  paperwork is up to date.- - You want to ensure that there isn’t just one person as a sole dispenser and checker of the
  medicine. You want to make sure that someone else’s eyes are looking at this process.
• You want to ensure that medicines of similar sounding names or with similar packaging are
  not placed next to each other on the self. So you might have strategies of highlighting where
  those medicines that sound the same, look the same, might be put in different places or
  they may be highlighted differently on shelves or drawers or wherever they are stored.
• Another way to reduce risk of errors – by maintaining a medication error log. And what
  you would do is you monitor near misses. So if you can see that there are frequent near
  misses with a particular drug or drugs, then that would allow you to identify any specific
  issues and you can start to look at addressing those issues.
• You might look at the work environment. So you might want to look at dispensary layout
  to see if you can reduce risk.
• It may be an issue around ability to concentrate. So that might be something that needs to
  be addressed. A workflow pattern. So, in some pharmacies, they may actually stipulate
  where certain aspects of the dispensing can take place within the pharmacy. So on one
  bench, that’s where the actual check is done. On another bench, that’s where the labelling is
  done, et cetera.
• Dynamics of the team. So taking on board all the skills within the team that may need to be
  considered in understanding where risk of error can lie. And if there are any personalities
  that are also contributing to errors –so, maybe a conflict within the team may be
  contributing to a stressful environment, therefore increasing the possibility of error.

Question 13

What is the Professional Duty of Candour?

Answer 13

Now, if a dispensing error does actually happen, there is something called the Professional Duty of
Candour. Now, this is where health professionals must be open and honest with patients when
things go wrong. This means that you need to tell the patient when something has gone wrong. You
should apologise to the patient and offer an appropriate remedy or support to put matters right.
And you really need to explain to the patient the short and the long term effects of what has
happened. So you need to be really open with the patient.

Question 14

If a mistake was made, patients may like to take the matter further. Okay? Why might they like to do so?

Answer 14

Well, the fact that the error has been made at a
pharmacy, which many members of the public believe should work 100% accurately, may be a
reason why they think they need to take the matter further. Because it proves that there isn’t 100% accurate. Also, a patient may have been harmed by that error and therefore may want a further investigation. Or a patient is dissatisfied with the way in which the error was dealt with in the
pharmacy. So, maybe there wasn’t a clear, transparent owning up of the error and explanation of how it happened or any kind of effort to resolve anything, really, that happened.

Question 15

Now, if the patient

takes a complaint further, does it mean that the pharmacist will be struck off?

Answer 15

Not necessarily. The
GPhC will determine if the error is of sufficiently serious nature to require a referral to fitness to
practice hearing.

Question 16

What occurs within the GPhC process?

Answer 16

They’ll have an initial investigation and that’s
carried out by the GPhC inspector. They will deem if a threshold criteria are met. And if it is, the
cases are referred to an investigating committee. Now, the investigating committee can then refer
to Fitness to practice committee, and the fitness to practice committee can remove the pharmacist
from the register. So it’s quite a lot of investigations that need to be undertaken before a pharmacist
will be struck off. Now, the criteria for referral of dispensing errors.

Question 17

Cases are not referred to the investigating committee unless they meet certain thresholds, and those are stipulated by the GPhC
and are available on the GPhC website. Now, they really include that:

Answer 17

• there is either moderate to severe harm, which was avoidable;
• there was a deliberate attempt to cause harm;
• there was failure to act when necessary to protect the safety of the patient;
• there are unsafe working practices;
• and also, the pharmacist is unfit to practice safely.

Question 18

So if those aspects are met, then there is a referral of the error to the investigating committee. It’s
important to remember that, until now, pharmacists are committing a criminal offence each time
they make a dispensing error. And that’s because there have been breaches of law – so Section 64 of
the Medicine’s Act 1968 – and then, specifically, Regulations 268, 269, and 270 of the Human
Medicine’s Regulations 2012. Currently, all dispensing errors are considered as strict liable offences
and a criminal offence is committed even if the error itself is unintentional and regardless of the
level of patient impact. Now, the majority of cases are brought under Section 64, and that stipulates
that a person commits an offence under Section 64 if he or she, prejudice to the purchaser, sells any
medicinal products and that product is not of the nature or quality demanded by the purchaser or
specified in the prescription. So, basically, anything outside of what was written on a prescription is
breaking the law. Prosecutions are rare. Cases will be referred to the criminal justice system if there
have been – there has been a death following an error and gross negligence or manslaughter
charges are being considered. I THINK THERES UPDATES TO THIS

Answer 18

just read thatalso watch/ read this
Since this video cast legislation has been passed on inadvertent dispensing errors: UPDATED INFO ON GPHC PROCEDURES IN LINK
https://www.pharmacymagazine.co.uk/dispensing-error-protection-comes-into-force

Question 19

The Registrar should not refer a case to the Investigating Committee unless the evidence as a whole suggests that:

Answer 19

Conduct, performance
- It presents an actual or potential risk to patient safety or public safety;
- It undermines, or is likely to undermine, confidence in pharmacy professions;
- There has been a serios or persistent failure to meet any of the standards for pharmacy
professionals; or
- The honesty or integrity of the pharmacy professional can no longer be relied on;
Health
- There is adverse physical or mental health which presents a risk to the pharmacy
professional’s ability to practice safely or effectively
Public Interest
- And it is in the public interest to refer

Question 20

Decriminalisation of dispensing error
The Pharmacy (Preparation and Dispensing Errors – Registered Pharmacies Order (2018))

Answer 20

• Recent legal change introducing a new legal defence for pharmacy staff who make
  inadvertent dispensing errors I registered pharmacies to prevent the automatic
  criminalisation of inadvertent dispensing errors,
• The Pharmacy (Preparation and Dispensing Errors – Registered Pharmacies) Order 2018 makes
  provision for a defence to prosecution under section 63 and section 64 of the Medicines Act 1968 in cases where medicines are prepared or dispensed by a registered pharmacist, or registered
  pharmacy technician, or someone acting under the supervision of a registered pharmacy
  professional.

Question 21

The conditions of the defence for the sale or supply of a medicine are that:

More information and references: https://www.rpharms.com/making-things-right#what

Answer 21

• The medicine must have been dispensed at a registered pharmacy; and
• The person who dispensed the medicine was a registered pharmacist or registered
  pharmacy technician acting in the course of their profession or other person acting under
  their supervision; and
• The medicine was sold or supplied to fulfil a prescription or direction by a relevant
  prescriber or a PGD or a POM sold or supplied where there was an immediate need for it
  (i.e. a prescription could not have been obtained without undue delay); and
• That one of the following is met:
  o The person who dispensed the medicine did not know that the medicine was not of the
  required nature or quality (i.e. had no knowledge that the medicine was inappropriate); or
  o Before the person who dispensed the medicine was charged, “an appropriate person” on
  becoming aware that the medicine was not of the required nature or quality promptly
  ensured that all reasonable steps were taken to notify the person to whom the medicine was
  intended or reasonably formed the view that it was not necessary or appropriate to do so
  and the person who dispensed the medicine did not know at the time of sale or supply of the
  medicine that it was not of the required nature or quality.
  The change aimed to increase patient safety by reducing the fear of criminal prosecution and
  encourage a more open culture or reporting and learning

Question 22

So do hospitals and health centres have to be registered pharmacies?

Answer 22

No, although many hospitals do, but clearly they could not function if they can’t supply or
administer medications to patients. So, these centres and hospitals can supply medicines to patients
provided it’s in the course of business of a hospital. In other words, supplies are made to patients in
response to a direction [prescription or drug chart] from an appropriate practitioner. Usually that’s a
doctor or dentist, but it could be a nurse, pharmacist, or supplementary prescriber. In those
circumstances, the hospital may supply any medicinal products for the purpose of being
administered, whether it’s in the hospital or elsewhere. It’s important to know that for POM, the
directions have to be written, but they don’t have to fulfil the normal prescription requirements,
therefore entries in the patient’s bed, card, or notes can be considered written directions for
administration or supply. But for P and GSL medicines, the directions don’t have to be written.

Question 23

What is a patient- specific direction?

Answer 23

something that’s termed as a written instruction from a doctor,
dentist, or other independent prescriber for a medicine to be supplied or administered to a named
patient after the prescriber has assessed the patient on an individual basis. So, a key example there
would be an inpatient chart on a hospital ward. They’ve made an assessment and they’d write down
what they think that patient should be supplied or administered.

Question 24

Who can give medicines direct to the patient?

Answer 24

Now, doctors and dentists often give medicines direct to the patient, so that can happen on a house call with a doctor and they can
give you supply of medicine. This doesn’t apply to nurse prescribers who should not be responsible for both the prescription and supply. In the case of independent pharmacy prescribers, it’s
recommended that prescribing and supplying activities should be carried out by the same individual
in exceptional circumstances only. So, again, there should be two different people carrying out those two different things.

Question 25

Midwives?

Answer 25

They have exemptions both on the sale and supply of
certain medicinal products, but only in the course of their professional duty. These are all GSL and P
medicines and some POMs. Clearly, it would be unlawful if, for instance, a midwife supplied
diclofenac to a male for pain. Obviously, that doesn’t sound like it’s going to be in the course of their
professional duty. In addition, midwives, they’re allowed to administer certain injections, again, in
the course of their professional practice. Only those medications for which exemptions exist can be
sold, supplied, or administered. If that exemption doesn’t exist for that medication, then such action
would be illegal.

Question 26

Podiatrists or chiropodists?

Answer 26

As with midwives, only certain medicines can be
sold, supplied, or administered. Basically, any chiropodist can, in the course of their professional
practice, sell or supply readymade products for external use which are GSL or, in limited cases, P.
Now, these things can include miconazole, so daktarin for treating athletes foot. Glutarol, so that’s glutaraldehyde for treating warts on the feet. So, very specific for foot problems. Chiropodists also have exemptions on both sale and supply of certain medicinal products in the course of their
professional duty and also the right to administer certain injections, provided they hold the necessary certificates of competence. If they don’t hold the certificates, then they cannot sell or supply certain medicines, such as co-dydramol, ibuprofen, antifungal treatments, and topical hydrocortisone, but they can still, however, sell and supply some medicinal products. In addition to
exemptions for sale and supply, if a chiropodist holds the certificate of competence in the use of
analgesics, they may administer certain injections– and these are really generally the local
anaesthetics. Now, optometrists, again, similarly, they’re allowed to sell or supply certain medicinal products in the course of their professional practice. These obviously tend to be eyedrops and
ointments for such conditions as infections and treatments for glaucoma. However, if the premises can be closed to the public, then GSL medicines can be sold by retail in any circumstances and that can be useful for eye lotions, et cetera. Now, optometrists can supply some eye drops and eye
ointments which are POMs. Now, in order to do this, in order to obtain the supply of these POMs
from a pharmacist, they need to present a signed order.

Question 27

What is a signed order?

Answer 27

It isn’t a prescription; it’s a type of document that allows the authority [in most
cases the healthcare practitioner] to supply a POM issued by an appropriate practitioner, and an
optometrist in this case is an appropriate practitioner, or organisations. The pharmacist has to be
satisfied that the product is labelled accordingly and the PIL is provided and an entry is made in the
POM register. In other words, a pharmacist would treat it like a prescription even though it isn’t a
prescription. Further details on the capabilities for sale and supply of POMs is available in the MEP.

Question 28

Signed order in the case of ambulance paramedics

Answer 28

They would generally have a certificate of proficiency in ambulance paramedic skills and they can administer certain parenteral POMs for the immediate and
necessary treatment of sick or injured persons. Other categories of people who can be exempt for
the sale and supply of medicines, we have things such as drug treatment services, shipping
personnel, offshore installations, public analysists, aircraft commanders, first aid organisations,
schools and the exhaustive list is contained within the MEP and some of them are also found on the
MHRA website.

Question 29

What is wholesale dealing?

Answer 29

This is the process by
which many of the exempt groups and individuals obtain supplies and medicines from pharmacies.
So, in order to sell, supply, administer medicines from these people or organisations, they have to
obtain them. And the way we obtain them is through a wholesale transaction. Now, the sale is being
done for a person who buys the substance in order to sell it, supply it, or cause it to be administered
in the course of their business.

Question 30

Does wholesale dealing require a license?

Answer 30

Wholesales dealing also requires a licence. So, the person actually
carrying out the wholesale dealing will actually require a licence.

Question 31

Wholesaling by pharmacists:

Answer 31

The MHRA does allow a limited amount of noncommercial wholesaling by pharmacies. So,
pharmacies can trade small amounts of medicines to UK healthcare providers for patient supply or
treatment. They can also supply to other pharmacies, but the quantities must be small and they
must be only on an occasional basis. And it can’t be done for profit and the supply is not for onward
wholesale distribution

Question 32

When can P and POM medicines by wholesale dealing take place?

Answer 32

only if the purchaser is authorised to sell or supply the goods or administer them in the course of their
business. So, really it’s about those practitioners or those people who are exempt from the sale and
supply.

Question 33

Who can be supplied by wholesale dealing?

Answer 33

We’ve got the practitioners that I’ve said, doctors, dentists,
vets, any person lawfully conducting a retail pharmacy business, authorities or persons carrying on
the business of a hospital or health centre, any person who may sell or supply by retail by virtue of
an exemption, for example, midwives and the other healthcare professionals we considered, but
only in respect of medicinal products covered in their exemption.

Question 34

SIGNED ORDERS: So, how would you deal with a wholesale transaction?

Answer 34

So, generally the purchaser will issue a signed order. So, this is something that is dealt with like a prescription but isn’t a prescription. So, the law doesn’t actually set out what information should be contained within a
signed order, but the RPS has recommended the minimum information that is on there and that
includes the
- name, quantity, and when necessary the form and strength of the medication,
- the name and address, trade, business, or profession of the person requesting the
medicine, and
- the person for which it is acquired, signed and dated by the person requesting the POM.
Now, when those medicines are issued to the purchaser, records must be made in the POM register
or you need to retain copies of an invoice or the signed order itself. And within any records, you
need to have
- date of supply,
- details of what was supplied, so name, quantity, strength, and form,
- the name and address of the person who was supplied, trade, business, or profession of
the person supplied, and
- the purpose for which the product was supplied. Now, orders or invoices need to be kept
for two years if an entry isn’t made in the register.
Although written record doesn’t need to be made if orders or invoices are retained, it is considered
good practice to make an entry in the POM register as well as retaining the orders and invoices.
Because it’s been quite a packed videocast, I’m going to leave the topic of emergency supplies and
join that up with another topic around dispensing prescriptions written outside of the UK in another
videocast.
Details about specific signed order requests can be found in the MEP e.g., page 78 MEP 2021 for
information about school signed order requests for salbutamol or adrenaline

Question 35

So emergency supplies (for POMS) can be made at the request of who?

Answer 35

 the doctor, 
 dentist, 
 supplementary prescriber, 
 community nurse prescriber, 
 independent nurse prescriber, 
 independent pharmacist prescriber, 
 optometrist independent prescriber, 
? Physiotherapist independent prescriber
?Podiatrist independent prescriber
?Therapeutic radiographer independent prescriber
? A paramedic independent prescriber 
 a doctor from the European Economic Area or a Swiss doctor, dentist, nurse or a 
pharmacist prescriber. 
- The emergency supply can be made at the request of the patient or of a suitable prescriber.

Question 36

What happens if it’s made at the request of a suitable prescriber?

Answer 36

• Then the pharmacist must be satisfied that
  the request has been made by reason of an emergency and that prescriber is unable to supply a prescription immediately.
• Also that prescriber has to agree to supply the prescription within 72
  hours.
• You as the pharmacist, need to be satisfied that the medicine in question is sold or supplied in
  accordance with the directions of the prescriber requesting it.
• The POM that is requested cannot be
  a schedule 1, 2 or 3 controlled drug except for phenobarbital, and that’s only to be used for treating
  epilepsy. EEA or Swiss health professionals cannot request phenobarbital even in an emergency.

Question 37

Records
An entry is made in the POM register on the day of supply or, if impractical, within 24 hours. Now,
the entry needs to include the:

Answer 37

 date of supply,
 the details of the medicine,
 the name and address of the practitioner,
 the name and address of the patient,
 the date on the prescription; and
 when received the entry should be amended to show the date on which the prescription was
received also.
So, as you can see, there are three dates that should be recorded. But make note that the nature of
the emergency doesn’t have to be recorded in the register, but in most cases it is for good practice
you’ll see that the reason is actually recorded.

Question 38

Supply at the request of a patient

Answer 38

a pharmacist, again, they need to
interview the patient (in some exceptional circumstances this may not be possible e.g., for a child or
being cared for and professional judgement will be needed). And they need to ensure that they are
satisfied that the need is immediate for a POM and it’s impractical to obtain a prescription.
For that medicine to be supplied, the pharmacist needs to be satisfied that that medicine has been
previously prescribed by one of the practitioners previously mentioned. Of course, there won’t be a
prescription detailing the dose or necessarily the particular details of the medicine, so again it’s
down to the pharmacist to find out what the medicine is so the details around that medicine. So you
may use such evidence such as an empty box, an empty medication box; or you may have access to
the patient medication record where they’ve had medication dispensed in your pharmacy before. Or
you may have to try and contact their surgeries or other pharmacies that they go to, to get the
details. So you need to ensure that what you give them is safe so the dose is appropriate.

Question 39

Length of treatment?

Answer 39

You cannot supply more than 30 days’ supply unless there’s certain circumstances to allow this.

Question 40

Length of treatment if the medicine is a controlled drug in schedules 4 or 5?

Answer 40

a maximum of five days of supply can

be given.

Question 41

Length of treatment if the medicine is schedule 1, 2 or 3 controlled drug?

Answer 41

No supply can be given except if it is

phenobarbital for the treatment of epilepsy.

Question 42

Now, such things like insulin, ointments, creams,

aerosols for asthma, for example?

Answer 42

you have to give the smallest pack size; but obviously you can’t
break those down to give a 30-day supply. Or contraceptives, again, give a full supply. You don’t
break those up. And liquid antibiotics, you just give the smallest quantity to ensure the patient’s
going to have a full course of treatment. So give 30 days where appropriate. But if the actual
formulation doesn’t allow it, you give the smallest pack size.

Question 43

Records for emergency supplies at the request of a prescriber

Answer 43

An entry needs to be made in the
POM register on the day of the supply, or if impractical the following day; and these need to be
clearly recorded. You do not require a prescription to cover supplies. That’s not something you need
to request afterwards. But that entry needs to have:
 the date on which the supply was made;
 the details of the medication supplied,
 the name and address of the patient; and,
 in this case, you need to have the nature of the emergency i.e., why the patient needs the
POM and why a prescription cannot be obtained.
Labelling
Now, on the label of the dispensed medication, you need to have:
 the date of supply;
 details of the medication;
 name of the patient,
 name and address of the pharmacy;
 ‘keep out of the reach in sight of children’
 the words ‘emergency supply’

Question 44

So all of those are labels that we’ve discussed previously for any medication, but it also needs to
have written on there?

Answer 44

‘emergency supply’

Question 45

There are some issues to consider when deciding whether to give an emergency supply at the
request of a patient. So although the Medicines Act sets out the rules about what you can and
cannot do, you’re making a decision as to whether to supply or not the medication. And in making a decision, you should consider a number of issues. So what would happen if you didn’t give that supply?
- For example, blood pressure tablets for mild hypertension, insulin for diabetes.

Answer 45

So you need to make a clinical
decision there. It may be relevant also to consider for how long that patient needs that prescription
for. So if they’re away for, you know, for a month, maybe that blood pressure tablet for mild
hypertension goes up on the priority list and you do think that it is appropriate to supply. Also you
might want to consider that the person who’s presenting themselves are who they say they are. Do
you really have enough information to make a decision, and would it be better to contact the
prescriber? So you need to do the investigative work to ensure that, when you do make a supply,
you are completely satisfied that all of the requirements are met. If during your checks you find that
the treatment has been stopped, it may not be appropriate to start again without referring the
patient to the doctor. So it might not be appropriate to actually give an emergency supply. Also, if
the patient hasn’t had a prescription recently, you may want to think again whether it’s appropriate
to give a supply. Or if there has been repeated requests for emergency supplies by a patient. And
you just must use your professional judgement in making decisions to carry out the checks. Think
about whether you need to give 30 days. This could be unnecessary, and it could also be expensive
for the patient. So, again, use your professional judgement and common sense. Where a
prescription can be provided later, some people will class that as a loan. You should still treat this as
an emergency supply. Make all of the records as if it was an emergency supply. Payment isn’t a legal
requirement, but if there is no prescription to be issued then the pharmacy needs to be reimbursed
for those medications. So the patient may be asked for a fee. If an NHS prescription is provided, then
a refundable charge could be made. If as a pharmacist you feel that you cannot make an emergency
supply of medicine, then you should do everything possible to advise the patient how to obtain
essential medical care. So it may be going to an NHS walk-in centre or a temporary registration at a
GP practice.

Question 46

Now, if you look at prescriptions outside of the UK so unless the prescriber is registered in the UK or
in an EEA country or Switzerland, then

Answer 46

The prescription for a POM is not legally valid in the UK.
Patients presenting with such prescriptions signed by a practitioner from outside these areas will
need to be referred to an appropriate UK prescriber. Now, since 2008, valid prescriptions issued by doctors or dentists in an EEA country or Switzerland have been legally recognised in the UK. Now,
from March 31, 2014, the law has been amended to extend the range of prescribers and to
introduce new prescription requirements. So now nurses, podiatrists and pharmacist prescribers
(among others- see MEP) can be accepted, prescriptions from these practitioners can be accepted in
the UK. They are now valid.

Question 47

And the new prescription requirements include:

Answer 47

 the patient’s full first name, surname and date of birth;
 the prescriber’s full name, surname, professional qualifications, direct contact details
including email address, telephone number or fax number and work address (inc. country);
 the name of the medicine, form, quantity and strength and also the dosage details.
 And there also needs to be the signature
 and date of issue. (prescriptions are valid for up to 6 months from the appropriate date.
Prescriptions for SCh 4 CDs for 28 days. The appropriate date on these prescriptions is the
date on which the prescription was signed.