Repeat prescribing in secondary care: are there any standards?

Repeat prescribing in secondary care mental health service has implications regarding cost, workload, service user safety and convenience. The standards available for repeat prescribing (National Prescribing Centre, 2004) apply to primary care, but there is no guidance for secondary care.

We undertook a survey of repeat prescribing practices at a community mental health team (CMHT). All psychotropic medications prescribed at the same dose on three or more consecutive appointments were considered repeat prescriptions unless otherwise specified.

Prescribing over the previous year was examined in a sample of 42 case notes. A total of 35 (83%) had a clear record of which psychotropic agents were being prescribed by the CMHT and which ones by primary care: in 23 (66%) of these, this was recorded in the text of the letter from a general practitioner (GP) and in 21 (60%) it was in the list of medications at the beginning of the letter. In 20 (57%) out of 35 case notes, this record was highlighted (bold/coloured ink). Forty individuals had received the same dose of psychotropic over at least three consecutive appointments; of these, 30 (75%) received their repeat prescriptions from primary care, 4 (10%) from the CMHT and in 6 (15%) it was not clear who was supplying medication. Of the four individuals receiving repeats from the CMHT, three had clear documentation of the reason for this. The total number of individual prescriptions generated as repeats by the CMHT for this sample was only four. There was a handwritten record in the notes in all of them and in two also a photocopy of the prescription(s).

We therefore recommend the following.

1. 1. There should be a clear record, in medical notes as well as in the GP letter, stating which psychotropic agents are being prescribed by secondary care and which ones by primary care.

2. 2. All the repeat prescriptions generated at the secondary care service should be recorded.

3. 3. Where service funding is such that repeat prescribing budgets are directed through primary care trusts, individuals who are on a stable dose of a psychotropic agent should normally obtain repeat prescriptions from their GP.

4. 4. Should it be appropriate to deviate from this general framework for an individual service user, the reason for this and the estimated duration of repeat prescribing of the agent by secondary care should be clearly documented and communicated to the GP.