Repeat prescribing - we can do better

Repeat prescribing is ubiquitous throughout general practice, but its one of the riskiest things GPs do according to Distinguished Fellow Dr Steven Lillis.

Understanding how to better manage and reduce this risk, was one of the motivators behind a repeat prescribing research project led by the College – the results of which were recently published in the College’s Journal of Primary Health Care

“Prescribing is an area where mistakes can happen, and repeat prescribing is particularly prone to errors,” says Steven.

“I got involved in this project because I was interested finding ways to improve patient safety and make life a little easier for GPs. I wanted to understand more about the processes and policies GPs use for repeat prescribing,” he says.

“The end goal is to produce a reference document and some guidance to help GPs check that what they’re doing is reasonable and appropriate.”

A number of College staff, including National Clinical Lead and Distinguished Fellow Dr Liza Lack and Head of Quality Lucia Bercinskas, were involved in the research – working alongside College Distinguished Fellow Dr Kristin Good, former College Medical Director Dr Richard Medlicott, Distinguished Fellow Dr Helen Rodenburg, Dr Vanessa Souter- and of course Steven himself.

“We tapped into the College membership to gather data, inviting members to share their experiences via a survey,” he says. “This gave us a baseline understanding of members’ attitudes, awareness, processes, concerns and benefits of repeat prescribing. 

“We discovered that, while practices all seem to have processes and policies in place, their GP registrars often have low awareness of those policies. This is concerning, because we all know, registrars move between practices fairly regularly, and they need a thorough orientation when starting somewhere new.

“We found huge variability between practices in terms of repeat prescribing processes, which is probably why registrars are sometimes unsure about what to do.”

In July, the research team met with College members to workshop ideas and suggestions to inform best practice guidelines. This data is currently being consolidated, and the ensuing report will be circulated for feedback within the next six months. 

Liza Lack says this is an important piece of work, which will become a useful tool for GPs.

“That’s why we’re taking the time to consult widely and get feedback on the proposed guidelines, ensuring they are fit-for-purpose,” she says.

Steven highlights that repeat prescribing provides many benefits to patients in terms of convenience and self-management.

“If a patient with hypertension is capable of monitoring their blood pressure at home, and they’re willing to take responsibility for managing this – with the help of their GP – then this is a positive outcome for both parties,” he says.

“I would encourage all practices to proactively review their current policies and see if they are meeting the needs of their patients, registrars, and their wider practice team. There is nothing more powerful than getting your team together to talk about what’s working and what’s not – this is a good way to get buy-in from everyone involved in repeat prescribing, to identify gaps in knowledge and to help identify areas of clinical risk.

“Designing good processes and policies takes time and commitment – but it’s terribly important.”