"Repeat Prescription Process Variances by Practice."

My mother is a 92 year old patient in the Gourock Practice Clinic. She suffers from significant Macular Degeneration, dense cataracts, breathing difficulties and Chronic Arthritis. As such, she has significant problems getting to the practice unless she is accompanied and even then it is with great difficulty. More importantly,however, she has difficulty using the telephone, as she can no longer see the key buttons and she requires to make contact regularly to place repeat prescriptions.

Having checked that Clinic's website, it would appear that the only other option open to her to undertake this task is to have a form filled in by nominated relative each time a repeat prescription is required, for each item required from the prescription, which, as you can imagine, a) requires to be set up on the system, with both password and pin code, b) still requires her to contact that relative each time it needs to be refilled c) puts much of the onus on to that relative to complete and submit the form.for her.

I, on the other hand, attend the Ardgowan Practice in Greenock, where I also have a need for repeat prescriptions, where the process is much simpler and much of my repeat prescription is handled automatically without my involvement or need to contact the surgery / practice.

Within their process when medication is settled and required on a regular basis, there is no need to contact the practice at all for repeat prescriptions, unless a) new medication has been introduced, b) the previous medication has run out, c) there needs to be a prescription review, d) the medication is to be taken as required and is less stringently controlled (for example antacid preparations). 

All clinical monitoring of medication, including regular blood tests, is handled as  a separate process. In the case of medication running out, this may happen initially, but again, once the medication has settled down, the dosage and the length of time that medication will last, is known and can be forecast.

These difference beg these questions in my mind:

 a) why do different practices / clinics, within the same Board, have radically different processes for repeat prescriptions?

b) surely having the same process throughout would provide simplicity, ease of control and Economy of Scale?

c) it is well known that Scot.Gov, through consultation try to provide flexibility, simplicity, economy and best practices from the input of 'customers' throughout all of the services that are Devolved to them, and this includes NHS Scotland.

d) it would appear then that the Gourock clinic have provided three processes of a nature that are not flexible, but rather are very limited for the aging population within their practice. ie attend the practice, phone in or fill in an electronic form... all of which assume the patient is capable of these things.

e) further limitation or restrictions also seem to apply to their operation of 'repeat prescriptions, versus the commonly held definition..... What is a repeat prescription? When your doctor prescribes you the same medication on an ongoing basis, this is often done with a repeat prescription. ... The repeat prescription is an instruction from your doctor that says you can be issued this prescription in the future without having to have an appointment to get further authorisation.

f) given the authorisation above, the knowledge of the dosage and the consumption, the next prescription date can be deduced, so why then is it necessary for the 'customer' to order it at all?  This is the approach taken within the Ardgowan Practice!

g) surely it can be recognised that within the more aged clientele, or those that are more handicapped, the reliance on repeat medication is particularly high, as would be the anxiety to them to have to get involved in a far from simple process each week, or month to get exactly the same medication over a long term period?

h) similarly if the medication is known to be long term and stable, why do some clinics or practices require the patient to 'order' repeat prescriptions on a weekly basis, where a monthly delivery is far easier and much more economical?

Many of the points above are posed as questions rather than complaints, and as such, answers to them would be greatly appreciated, however they should also be considered as review items and suggestions to be implemented throughout the board.

Thanks for taking the time to read this input and I would appreciate your feedback at a time suitable to you. 

I will, by copy, pass this communication directly to the Practice Manager, through the practice suggestions & Complaints process, for discussion with the rest of the team!

Yours Respectfully

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