Sale and Supply 2

Question 1

POM medicines

Answer 1

A medicine that requires a prescription written by an appropriate practitioner before it can be sold or supplied

Question 2

Appropriate prescribers

Answer 2

Doctor, dentist, supplementary prescriber, nurse independent prescriber, pharmacist independent prescriber, EEA and Swiss doctors/dentists (not CDs), EES and Swiss prescribing pharmacists and nurses, community practitioner nurses, optometrist independent prescribers, podiatrist and physiotherapist independent prescribers

Question 3

Doctors prescribing

Answer 3

General practitioners or doctors working in NHS hospitals can write prescriptions for patients to take to community pharmacies, should prescribe within clinical expertise, very few limits on what they can prescribe

Question 4

Dentists prescribing

Answer 4

Dentists are restricted to a specific list of products that they can prescribe on WP/FP10D
NHS prescription services will only reimburse the dispensing contractor if the products are in the formulary
Part XVIIA of the drug tariff

Question 5

Supplementary prescribers- what are they?

Answer 5

A partnership between a medical practitioner who establishes diagnosis and initiates treatment, a pharmacist who monitors the patient and prescribes further supplies of medication and the patient who agrees to the arrangement
Aims to provide patients with quicker and more efficient access to medicines and to make he best use of the skills of pharmacists and nurses

Question 6

Supplementary prescribing

Answer 6

Supplementary prescribers can make decisions after diagnosis
Decisions around dose, frequency, formulation and choice of drug from a class within the scope of a Clinical Management Plan (CMP)
The medical practitioner/independent prescriber must review the patient at pre-determined intervals

Question 7

Independent prescribers

Answer 7

Can prescribe for any clinical condition but they must only prescribe within their professional and clinical competence
Responsible for the clinical assessment of a patient’s condition, formulating or reviewing diagnosis and devising an appropriate treatment plan

Question 8

Pharmacist independent prescribers

Answer 8

Successfully completed an education and training programme accredited by the GPhC for independent prescribing
Name is held on the membership register of the GPhC with an annotation signifying further accreditation
Can then prescribe similar range to doctors both on NHS and private

Question 9

Nurse independent prescribers

Answer 9

Qualified under the original arrangements for nurse prescribing
Can then prescribe similar range to doctors both on NHS and private

Question 10

Optometrist independent prescribers

Answer 10

Once training complete optometrists will need to register their independent prescribing specifically with the General Optical Council before prescribing
Cannot prescribe CDs or unlicensed medicines
Can prescribe any ophthalmic reparation for any eye condition but must work within their professional competence

Question 11

Community practitioner nurses prescribing

Answer 11

May only prescribe the dressings, appliances and licensed medicines listed in the Nurse Prescribers’ Formulary for Community Practitioners

Question 12

Prescription requirements

Answer 12

The sale, supply and admin of POMs are restricted by the Humans Medicines Regulations 2012
Main route of supply is under the authority of a prescription from an appropriate prescriber
Several pieces of information must be present on the prescription to be legal

Question 13

Legal prescription requirements

Answer 13

Indelible- need to be written in indelible ink, may be computer generated or typed
Carbon copies- permissible to issue carbon copies of NHS prescriptions as long as they are signed in ink

Question 14

Signature of prescriber

Answer 14

Needs to be signed in ink by an appropriate practitioner in his or her own name
Printed signatures or stamps are not currently allowed on paper prescriptions

Question 15

Prescriber’s address

Answer 15

Prescriptions must include the address of the appropriate practitioner
This is usually the practice address for a GP or dentist and it is already printed on the FP10
For a nurse employed by a primary care trust, the trusts’s address is printed on the form and the nurse has to add a code that identifies the patient’s GP practice

Question 16

Date

Answer 16

Prescriptions need to include the date they were signed
Valid for six months from the appropriate date
For NHS scripts this is either the date on which the prescription was signed or a date indicated by the appropriate practitioner as the date before which it should not be dispensed, whichever is later
For private prescriptions, this will always be the date on which it was signed

Question 17

Particulars of the prescriber

Answer 17

Prescriptions require particulars that indicate the type of appropriate practitioner i.e. whether the prescriber is a doctor, dentist, nurse or pharmacist
This does not have to be the prescriber’s qualifications
FP10s contain a number to identify the prescriber

Question 18

Name and address of the patient

Answer 18

Self explanatory
Name and address must be given but the format for this information is not specified
Not essential to give the patient’s title but it can be helpful

Question 19

Age of patient

Answer 19

Only a legal requirement if under 12
Having the age of the patient is always helpful
GP computer systems should print the age or date of birth on the script for all patients and this information is very useful for the pharmacist

Question 20

Repeatable prescriptions (private scripts only)

Answer 20

Prescriptions against which medicines can be dispensed more than once
Repeatable means the instance where the prescriber adds an instruction to the main prescription for the prescribed item to be repeated
Does not refer to the prescription counterpart which is sometimes used as a patient repeat request to the prescriber
Schedule 4 and 5 CDs are repeatable

Question 21

Repeating repeatable prescriptions

Answer 21

Repeated as indicated by the prescriber:
Repeat 5 times would allow first dispensing and five repeats = 6 in total
Repeat x 2 would allow first dispensing and two repeats = 3 in total
If number of repeats is not stated then can only be repeated once
Only exception is prescription for an oral contraceptive, can be dispensed six times within six months of the appropriate date

Question 22

Repeatable prescriptions

Answer 22

The patient can either leave the repeatable script with the pharmacy until next needed or take it away with them after dispensing
The patient can choose to have subsequent supplies made from different pharmacies on their repeat prescription
To maintain an audit trail the pharmacist at the time of supply is advised to mark on the prescription the date, name and address of the pharmacy from where supply has been made

Question 23

Record keeping

Answer 23

Must be kept in respect of every sale or supply of a POM
NHS Rx: patient medication record, Rx is sent to HSW/PPA at end of month
Private Rx: PMR and POM register- Rx kept for two years, if repeat keep for two years after last dispensing, POM book kept for 2 years after last entry

Question 24

POM book entries private scripts

Answer 24

Must include supply date, prescription date, medicine details, prescriber details, patient details
Make a record of the price paid, no VAT added
Stamp script with branch stamp
Add a reference number to correlate the entry to the prescription
Prescriptions for oral contraceptives are exempt from record keeping
Prescriptions for schedule 2 CDs are also exempt where a separate CD register record has been made