Policy for Repeat Prescribing/Medication Ordering
Introduction
ADHD Direct patients can receive their ADHD medication in three ways. The policy for repeat prescribing/ordering describes the three processes where patients can obtain their medication:
• Through a shared care arrangement between ADHD Direct and the patient’s GP.
• Directly from a local pharmacy, in which ADHD Direct would post a private prescription to the patient to have filled.
• Directly from ITH Health, whereby an order is issued by ADHD Direct to ITH Health’s services and the private medication delivered to the patient.
Repeat prescribing/medication ordering is an agreement between the patient or patient’s parent/carer and the clinical team. It allows for issuing prescriptions/medication orders at agreed intervals whereby the patient does not need to contact the clinical team before each issue of the prescription/medication order until the date of the agreed medication review appointment.
Purpose of the Policy
The purpose of this policy is to define and describe the management and processes of the practice’s policy for prescribing/ordering medication on a repeat basis. The aim of the policy is to standardise the repeat prescribing/medication ordering processes and to enable staff to understand their roles and responsibilities around repeat prescribing/medication ordering, but also to allow ADHD Direct patients to become familiar with the processes of repeat prescribing/ordering. The policy describes the duties of both clinical and non-clinical staff involved in the process of repeat prescribing/medication ordering.
Summary of Repeat Private Prescribing/Medication Ordering Process
Patients can be prescribed their medication or have their medication ordered via ITH Health by one of the ADHD Direct clinical staff. When that is agreed between the clinician and the patient, clinical and non-clinical staff will follow the process below:
1. A reminder is set to renew the treatment plan 10 days before the patient is due to run out of medication. Our prescription/ITH Health ordering processing timeframes are 7-10 days.
2. On the due date, the Prescription Team will administer all necessary checks on the patient’s record, including an up-to-date review and up-to-date measurements. (If any of these are outstanding, patients will be contacted and the information requested before the prescription is issued or the ITH Health order is completed).
3. If all the required information is on record, the Prescription Team will send the request form to be completed by the patient.
4. The patient will submit the request form with the correct and required information and complete payment for the prescription/order upon submission of the form. The patient will choose to have a prescription issued physically via post, or to have their medication ordered through ITH Health.
5. The request form is passed to our clinical team and processed.
6. i. If the patient has selected our ‘postal’ prescription method, the physical prescription is scanned onto the patient’s electronic file and the patient is notified of postage. The
Prescription Team will purchase the appropriate first-class delivery postage and the
Prescriber will affix the postage label, seal the envelope and the prescription is posted to the patient’s delivery address of their choice. The patient will then take the physical prescription to a local pharmacy of their choice.
ii. If the patient has selected to use ITH Health’s service, the medication order is processed and ITH Health invoice the patient. Once the medication is paid, it will be delivered using DPD’s services.
Summary of Repeat Prescribing Process Where Shared Care Arrangement is in Place
Where a patient’s GP prescribes medication based on a shared care arrangement with ADHD Direct, patients will order and collect their prescriptions from their GP Practice or the GP Practice Pharmacy. It will be the patient’s GP who will issue an NHS prescription.
In the letter that the patient’s GP will receive from ADHD Direct’s clinician, the GP will be asked to continuously prescribe medication for the patient; both type and dose of the medication will be detailed in the letter. Also, an approximate date when the patient will be required to meet with an ADHD Direct clinician for a medication review appointment will be shared with the patient’s GP in the letter.
Repeat Prescribing/Medication Ordering and Regular Medication Reviews
Patients who receive private prescriptions from ADHD Direct or private medication through ITH Health, and those who collect NHS prescriptions from GP Practices must attend for regular Medication Review appointments. Intervals at which medication reviews should be arranged will be discussed with patients during appointments. It is required that patients who receive repeat prescriptions have regular Medication Review appointments with an ADHD specialist every 4-8 weeks until stable. Once stable and optimised on their treatment, the reviews will decrease to every 6-12 months.
Patient Prescriptions/Medication Orders – Record Keeping
Accurate record keeping is essential for high-quality patient care. All physical private prescriptions are scanned, named, and dated, and uploaded into the electronic patient record. All ITH Health orders are electronically logged on the patient’s records.
All clinical and non-clinical staff of ADHD Direct can access patients’ files at any time and if requested by the patient, share the files with the patient themselves.
Security
Blank prescriptions must never be signed by a prescriber for later completion by practice staff. Unused space should be scored out after the last drug by the prescriber, deleting the space manually. All prescription pads with blank prescriptions are stored in lockable storage. Only the prescriber or the manager can access prescription pads.
Responsibilities and Accountability
It is the responsibility of the Business Manager and CEO to ensure that prescription pads are ordered and delivered to ADHD Direct when required and to guarantee continuity of providing private prescriptions to patients.
Addressing Queries and Errors
1. Prescription Queries Raised by the Pharmacy
If a pharmacist has questions or queries related to the private prescriptions issued by ADHD Direct, the pharmacist should contact ADHD Direct or advise the patient to contact ADHD Direct with the pharmacy details and the query. The Prescription Team will arrange to contact the pharmacist at the earliest convenience.
2. Addressing Problems/Potential Errors with a Prescription/Medication Order
Although every effort is made to ensure prescriptions and medication orders are issued accurately, prescribing/ordering errors can occasionally occur in any healthcare setting. In the unlikely event that a private prescription or medication order contains an error, patients are asked to contact ADHD Direct as soon as possible by emailing enquiries@adhddirect.co.uk. The matter will be investigated promptly and, where an error is identified, a replacement prescription will be processed and sent to the patient at no additional cost, or if there is an error with a medication order for ITH Health, the order will be cancelled and reissued at no additional cost.
If an incorrect prescription or order has resulted in the wrong medication being dispensed, patients should again contact ADHD Direct as soon as possible. The issue will be reviewed promptly and, where appropriate, a corrected prescription will be issued or ITH Health order processed free of charge.
In these circumstances, patients will usually be asked to return the incorrect medication to the clinic, provided it is unopened and unused. This is particularly important where the medication is a controlled drug, as controlled drugs must be handled, stored and destroyed in accordance with strict legal and clinical governance requirements. Requesting the return of incorrectly dispensed medication helps ensure safe destruction, prevents inappropriate use, and maintains a clear audit trail and accountability in relation to controlled medicines.
Once the incorrect medication has been returned, ADHD Direct will arrange reimbursement for the cost of the medication as well as reasonable postage costs incurred by the patient.
3. Postage Delivery Issues for the Prescription
If a prescription has been posted using Royal Mail first-class signed-for delivery and does not arrive after 7 days, patients are asked to contact us to inform us. A replacement prescription will be posted to the patient as soon as possible. If the second replacement prescription does not arrive, a medication order will be issued to ITH Health instead or a posted prescription will be sent directly to a local pharmacy.
4. Prescription Expiry Timeframes
Once a prescription has been posted or medication order issued, patients or parents/carers of patients must present the prescription to a pharmacist or pay ITH Health for their medication within 28 days. After this time, the prescription/medication order will expire, and a new prescription/medication order will have to be requested. The cost of the new prescription must be paid by the patient or parent/carer of the patient.
5. Medication Renewal and Medication Review Timeframes
It is unlikely that a patient’s medication renewal date and their medication review
date will align perfectly. It is the patient’s responsibility to inform ADHD Direct if they wish to hold off on renewing their treatment if they have an upcoming medication review appointment booked. To avoid any breaks in taking their medication, the patient can request a smaller supply of medication, e.g. 2 weeks, to tide them over before their appointment. If a prescription is ordered or ITH Health order processed prior to a medication review appointment and the patient’s treatment is then altered, no returns or refunds will be provided for the previous prescription/order or medication issued.
Whether we are going down the ‘shared care’ route to prescribing, prescribing on a private basis, or ordering private medication via ITH Health we always follow what’s in the national guidelines for ADHD and in the UK, we follow the NICE Guidelines, which states that, ‘All medication for ADHD should only be initiated by a healthcare professional with training and expertise in diagnosing and managing ADHD’, which would NOT be your GP. Our Clinical Specialists with Prescribing Qualifications will always write your prescriptions/order your medication until your treatment is stable.
Let’s break the costs down for you. There are 2 options for a private ADHD medication.
Option 1:
You receive your private prescription from ADHD Direct in the form of a paper prescription posted either to you, address of choice or directly to your chosen pharmacy. This option costs £20 for the prescription. This covers the prescription fee and Royal Mail recorded delivery. You will then purchase the medication at your pharmacy, which will include the medication cost plus the pharmacy’s private dispensing charge.
Option 2:
ADHD Direct can order your medication through ITH Health. ITH Health will then invoice you for the medication, dispensing fee and delivery fee. You will pay ITH Health directly and once paid they will dispense your medication and deliver it directly to your home or chosen address via DPD. This option removes the need to go to a pharmacy, reducing the number of steps for you. The cost to have the medication ordered for ITH Health is £20.
The national guidance and local shared care agreements stipulate that the private service (that’s us) must regularly review your medication to ensure it’s effective, safe and make any adjustments as required.
Good news: we’ll only see you when it’s necessary. If your treatment is stable, you’ll usually be reviewed every 6 months for a child, and every 6 or 12 months for an adult. Even better, some of these appointments may be free. If you’re stable at your medication review and neither you nor your clinician expect any changes over the next 6 to 12 months, you may be advised to book your next review with one of our Clinical Assistants, and these appointments are free of charge.
If you experience side effects or any complications at any point, you’ll need a review with one of our Specialists instead.
At ADHD Direct, we’re committed to your wellbeing. We understand that once your medication is stable, the cost of ongoing review appointments can become difficult. That’s why we offer eligible reviews free of charge. We also recognise that the NHS may not always be able to take over your care right away, and our goal is to make this part of your healthcare as accessible as possible.
However, if you develop any side-effects or any other complications, then you will need to have a review appointment with one of our Specialists.
At ADHD Direct, we are committed to your well-being. We understand that once you have achieved stability with your medication, the ongoing costs of medication review appointments can be challenging. That’s why we offer these appointments to you free of charge. We recognise that the NHS may not always have the capacity to fully take over your care, and our aim is to make this aspect of your healthcare as accessible as possible for you.
The guidelines state that an ECG is not routinely required before starting ADHD medication unless there is a significant family or personal history that may indicate an underlying cardiac condition. This includes:
• Congenital heart disease or previous cardiac surgery
• Sudden death in a first-degree relative under 40 years that may suggest a cardiac condition
• Shortness of breath on exertion compared with peers
• Fainting during exercise or in response to sudden fright or loud noise
• Rapid, regular palpitations that begin and end abruptly
• Chest pain that may be cardiac in origin
• Signs of heart failure
• A heart murmur identified during examination
We will always carry out a structured review of your cardiac history and record baseline measurements, including blood pressure, pulse, and weight (plus height for children). These measurements will be monitored at agreed intervals for as long as you remain on ADHD medication.
If at any stage we believe you require further cardiac assessment, we will advise you to see your GP in the first instance.