CMS Serial Prescriptions - Still alive and kicking!!!

Elaine Paton

Tuesday, May 2, 2017

The answer as to whether serial prescribing is still happening is a resounding yes!!! There are community pharmacy teams working closely with their GP practices to identify suitable patients for serial prescriptions and demonstrating that it can work, and work well to improve care for patients.

Specific work looking at different models has been underway for the last year in pharmacies located in NHS Board areas in GG&C, Tayside and Dumfries and Galloway. Colleagues in NHS Highland and Grampian are also continuing to make progress with this as well.

It is acknowledged that some PMR and GP systems have had various IT issues relating to serial prescriptions, and we all appreciate the hard work that community pharmacists across Scotland have put in to find ways around the problems and to seek resolutions. Your patience and persistence is much appreciated.

The issues that were reported with GP clinical systems have thankfully been resolved with recent upgrades and have been stable for a while (fingers crossed).

CMS is here to stay, but it is likely that it will need a renewed vigour and enthusiasm to take it forward. Given the looming GP crisis and the workload within practices that prescribing support or practice based pharmacists are currently supporting, it is time for community pharmacy to revisit serial prescribing with our colleagues and really sell the operational benefits that could be realised.

Serial prescriptions offer a way where community pharmacists can manage the dispensing and supply of medications to patients for up to 12 months. This is a huge contribution and time saver to the daily work within GP practices. This doesn’t mean that this workload all shifts to the pharmacy team to manage – no, it allows the pharmacy team to be more proactive and manage their workload too as the scripts are already in the pharmacy and teams can plan when to dispense.

So, how do you get started? To see any benefit at all from managing serial scripts there are several key things that you ideally should have considered:

  • Local agreement with your practice that this is the way forward. There are wins from both sides to doing this. Discuss potential patients to start with; discuss how the practice wants to manage PRN meds. Also, discuss if there are any medicines that the practice do not wish to be included e.g. antidepressants, strong opioid analgesia.
  • Consider which patients may be suitable for a serial script and seek their consent to register for CMS. These are often those who get the same items repeated each time with little variation. Start with patients on 3 items or less..
  • Liaise with your local prescribing support or practice pharmacist who may be able to help develop a suggested list of potential candidates for serial prescriptions.
  • Have an agreed process within the pharmacy to manage the scripts. Use a diary, or A-Z filing, or Day 1-31. Chose a method that will work and is the right process for your pharmacy.

Start with a few patients and test the process but don’t stop with 4 or 5. Keep adding several a week once the process is established as it is only when you reach a significant number will it all make sense. Doing the odd one now and again doesn’t really help – you need to really go for it to make it work but keep the increase reasonable.