Safe repeat prescribing systems

It is estimated that £300 million is wasted on medicines in the UK each year. The causes of waste vary, from inefficient prescribing and stockpiling to patient recovery and non-adherence. Pharmaceutical waste can occur at any stage from the point of prescribing to the taking/not taking of medicines by the patient, and can occur through failures in existing processes or patient behaviours. The prescriber, dispenser and patient all play a part in the creation of waste. Repeat prescribing can contribute to medicine waste in a number of ways (NHS England, 2023):

• Items prescribed/dispensed, but not required by patients
• Items dispensed without being requested by the patient
• Patients over-ordering to create a stockpile of medication (often this applies to ‘when required’ medication)
• Patient concerns over medicine shortages (having ‘plenty of medicines as a stand-by’)
• Patient concerns over effects of non-adherence: ‘Always ask for everything on the slip … don't want to run out, easier to say everything, don't want doctor to think I'm not using them properly by not re-ordering’.

In primary care, a review of high-cost drug prescribing can reveal areas of waste, not to mention opportunities to address patient safety issues and improve patient care.

Case scenario

The following scenario shows the prescribing cost of three medicines in general practice over a 1-month period. Work out the monthly cost savings after reviewing each prescription.