All Polices

Entitlement to NHS Treatment

The NHS is the UK’s state health service which provides treatment for UK residents. Some services are free, other have to be paid for. The regulations that govern who can and can’t receive treatment are complex and may change.

A person who is regarded as ordinarily resident in the UK is eligible for free treatment by a GP. A person is ‘ordinarily resident’ for this purpose if lawfully living in the UK for a settled purpose as part of the regular order of his or her life for the time being. Anyone coming to live in this country would qualify as ordinarily resident. Overseas visitors to the UK are not regarded as ordinarily resident if they do not meet this description.

The following NHS treatment is available to anyone:

  • Treatment in an emergency (but not follow up treatment).
  • Treatment of certain communicable diseases.
  • Compulsory psychiatric treatment.

To qualify for other NHS treatments you must meet certain conditions which are outlined below:

EU Nationals
  • Foreign nations from EU member states have reciprocal arrangements for both dental and medical healthcare so can access the full range of NHS services.
Non EU nationals
  • Foreign nationals from non-EU countries have no automatic right to NHS healthcare (other than those outlined above). Students and visitors who are going to stay in the UK for less than 6 months would have to be seen as private patients and would have to pay for their treatment. It is therefore essential that you have medical insurance to pay for any private treatment.
  • If you are not a student registered at a UK university and you are not going to stay in the UK for between six months and a year, it may be unlikely that you will be able to receive free NHS Treatment.
  • If you are unsure of entitlement to NHS treatment, or require further information please ask the reception staff when you register, and they will advise you accordingly.
  • Be aware that a valid 6 month visa does not automatically confer the right to free NHS treatment.
  • Please note that registering with a GP does not give you automatic entitlement to access free NHS hospital treatment. It is therefore essential that you take out medical insurance for the duration of your visit prior to arrival in the UK
  • If you are a student registered at a UK University (and you have documentary proof of this) and are going to stay in the UK for more than six months you will qualify for NHS treatment from the beginning of your stay and you (and your dependants) will be entitled to NHS treatment and you may register with a GP.
Medical emergencies
  • If you need immediate medical assistance (e.g. because of an accident) telephone 999 – the call is free. An operator will ask you which emergency service you require (fire, police or ambulance). You will need to tell the emergency services what has happened and where you are. If someone is injured and needs to go to hospital an ambulance will arrive and take them to the nearest hospital with an emergency department
  • If you need urgent treatment but are well enough to travel please make your own way to the nearest Accident and Emergency Department.

Carbon Reduction Plan

Carbon Reduction Plans are to be completed by the bidding supplier entity and must meet the reporting requirements set out in supporting guidance, and include the supplier’s current carbon footprint and its commitment to reducing emissions to achieve Net Zero emissions by 2050.

  • The Carbon Reduction Plan should be:-
  • updated regularly (at least annually)
  • published and clearly signposted on the supplier’s UK website.
  • approved by a director (or equivalent senior leadership) within the supplier’s organisation to demonstrate a clear commitment to emissions reduction at the highest level.

Suppliers may wish to adopt the key objectives of the Carbon Reduction Plan within their strategic plans.

Procurement Policy Note 06/21: Taking account of Carbon Reduction Plans in the procurement of major government contracts – GOV.UK (www.gov.uk)
Publication date: 7th March 2025

Commitment to achieving Net Zero

Premium Wipes and Textiles Limited is committed to achieving Net Zero emissions by 2050.

Baseline Emissions Footprint

Baseline emissions are a record of the greenhouse gases that have been produced in the past and were produced prior to the introduction of any strategies to reduce emissions. Baseline emissions are the reference point against which emissions reduction can be measured.

Baseline Year: 2024 – we have not previously reported on our emissions. We have estimated our emissions from 2024 and will use this as our baseline to measure progress against reducing our carbon emissions.
Additional Details relating to the Baseline Emissions calculations.
As this is the first operational year for Spirit Primary Care Limited, no prior emissions reporting has been conducted. Therefore, the 2023-24 baseline has been established to align with the requirements under this measure.

– Scope 1 and Scope 2 Emissions: Calculations for direct emissions (Scope 1) and energy-related emissions (Scope 2) have been conducted using data from energy usage, fleet operations (which is not applicable), and other relevant sources.

– Scope 3 Emissions: This baseline year also includes a newly created reporting structure for Scope 3 emissions, which incorporates supply chain activities, waste generation, and employee commuting. Historical data for Scope 3 emissions are unavailable due to the absence of prior reporting requirements.

The creation of this baseline reflects organisational change, including the establishment of BWPCA as a distinct operational entity. Moving forward, this baseline will be used to track and manage emissions reductions in line with net zero targets.
Baseline year emissions:
EMISSIONS TOTAL (tCO2e)
Scope 1 N/A (no direct emissions due to lack of fleet or fuel use/not relevant for the organisation)
Scope 2 25 tCO2e
Scope 3
(Included Sources)		 40 tCO2e (e.g., waste generation, staff commuting, and procurement of medical supplies)
Total Emissions 65 tCO2e

Current Emissions Reporting

Reporting Year: 2025 – we currently do not report on our emissions. Our baseline year is 2024 with data for our 2025 emissions to be reported at the end of this year.
EMISSIONS TOTAL (tCO2e)
Scope 1 N/A (no direct emissions due to lack of fleet or fuel use/not relevant for the organisation)
Scope 2 22 tCO2e (reflecting energy efficiency upgrades)
Scope 3
(Included Sources)		 38 tCO2e (reflecting minor operational changes).
Total Emissions 60 tCO2e

Emissions reduction targets

To achieve Net Zero by 2050, we have adopted the following interim reduction targets:

  • By 2030: Reduce emissions by 30% to 45 tCO2e.
  • By 2040: Reduce emissions by 70% to 20 tCO2e.

These targets will be reviewed annually, and progress will be reported publicly on the organisation’s website.

Carbon Reduction Projects

Completed Initiatives:

Since the baseline year (2024), we have implemented the following measures to reduce its carbon footprint:

  • Staff Education: We have introduced “carbon reduction plans” at induction and have engaged staff feedback to identify additional opportunities.
  • Sustainable Travel: We encourage public transport, walking, cycling, and car sharing; as well as register with the Bike2Work Scheme and track participation via travel expense claims.
  • Remote Working: We support remote working and hold meetings via MS Teams to reduce travel emissions.
  • Paper Reduction: We have increased reliance on digital records and electronic communications, monitored through reductions in postage, ink, and paper costs.
  • We maximise EPS usage.
  • Water Conservation: We are working with stakeholders to implement water-saving measures, tracked via reduced water bills.
  • Local and Green Suppliers: We actively prioritise local suppliers with green credentials to reduce transportation emissions.
  • We are educating staff to reduce single-use plastics and waste.
  • We are monitoring reductions in black-bin refuse and increasing recycling rates.
  • Across the constituent member practices, we have transitioned 60% of patient communication to digital platforms (e.g., text messaging, patient portals), reducing reliance on paper-based methods.

Future Projects:

To further progress towards Net Zero, we plan to:

  • Work with stakeholders to achieve a 60% transition to renewable energy sources for electricity consumption in practice buildings
  • Work with stakeholders to improve water-saving measures, such as low-flow taps, in facilities.
  • Increase digital transformation efforts, including further adoption of paperless record-keeping.
  • Continue to engage staff and patients in sustainability initiatives through awareness campaigns.

Declaration and Sign Off

This Carbon Reduction Plan has been completed in accordance with PPN 06/21 and associated guidance and reporting standard for Carbon Reduction Plans.

Emissions have been reported and recorded in accordance with the published reporting standard for Carbon Reduction Plans and the GHG Reporting Protocol corporate standard1 and uses the appropriate Government emission conversion factors for greenhouse gas company reporting2

Scope 1 and Scope 2 emissions have been reported in accordance with SECR requirements, and the required subset of Scope 3 emissions have been reported in accordance with the published reporting standard for Carbon Reduction Plans and the Corporate Value Chain (Scope 3) Standard3

This Carbon Reduction Plan has been reviewed and signed off by the board of directors (or equivalent management body).

1 https://ghgprotocol.org/corporate-standard
2 https://www.gov.uk/government/collections/government-conversion-factors-for-company-reporting
3 https://ghgprotocol.org/standards/scope-3-standard

GDPR and Data Protection

We comply with the General Data Protection Regulation 2016 and the Data Protection Act 2018.

We use your information to provide you with Health Care services, and share your information with other organisations involved in your care.

We do this under Article 6(1) and Article 9(2)(h) of the GDPR.

You are entitled to see what information we hold about you on request.

Satis House Medical Practice Privacy Notice
Privacy notice – Candidates applying for work
Privacy notice – Employee

This website collects some personal data from users, as stated in our website provider’s Privacy Policy.

Modern Slavery Policy and Human Trafficking Policy

Introduction

This policy applies to all persons working for us or on our behalf in any capacity, including employees at all levels, Directors, Senior Managers, Agency Workers, Locums and Suppliers. We strictly prohibit the use of modern slavery and human trafficking in our services and supply chain. We have and will continue to be committed to implementing systems and controls aimed at ensuring that modern slavery is not taking place anywhere within our organisation or in any of our supply chains. We expect suppliers to the same high standards.

Definitions

• Modern slavery

The Modern Slavery Act 2015 encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

• Human Trafficking

Trafficking is the movement of people by means such as force, fraud, coercion or deception with the aim of exploiting them. It is a form of Modern Slavery. People can be trafficked for many different forms of exploitation such as forced prostitution, forced labour, forced begging, and forced criminality, forced marriage, domestic servitude and forced organ removal. Trafficking can occur within the UK as well as countries outside the UK.

Key signs of Modern Slavery and Human Trafficking

Physical

• Injuries apparently as a result of assault or controlling measures
• Neurological symptoms, headaches, memory loss, dizzy spells
• Gastrointestinal symptoms
• Cardiovascular symptoms
• Musculoskeletal symptoms
• Tattoos or other marks indicating ownership by exploiters
• Work related injuries, often through inadequate personal protective equipment or poor health and safety measures.

Sexual

• Sexually transmitted infections
• Injuries of a sexual nature
• Gynaecological symptoms such as urinary or virginal infections, pelvic inflammation
• Pregnancy as a result of their modern slavery situation, or they may have recently been forced to terminate a pregnancy.

Psychological

• Expression of fear or anxiety
• Depression or isolation
• Suffering from post-traumatic stress and or a range of other trauma induced mental or physical illnesses
• An attitude of self-blame, shame and an extensive loss of control
• Withdrawn and submissive
• Drug or alcohol use
• Self-harm
• Suicidal ideations.

• Reluctance to seek help
• Poor or no antenatal care
• Few personal effects.

Situational and environmental indicators

• Frequently moves locations, boroughs, counties, or countries
• Fearful or emotional about their family or dependants
• Lack of knowledge about the area they live in the UK
• Passport or travel document has been confiscated
• Fear of saying what their immigration status is
• Limited English, e.g., having vocabulary relating only to their exploitative situation
• Acting as if instructed by another
• Someone is taking advantage of their illegal status in the UK
• Distrust of authorities.

General Signs

• No passports
• No information about rights as a UK worker
• No information about their rights as a visitor in the UK
• Vague and inconsistent history
• Always accompanied by someone who may appear controlling
• Person with them does all the talking
• Never left alone
• Unsure of own medical history
• Not registered with a GP, nursery or school
• Appearance suggest neglect, note, someone working in prostitution may look well kept.

What to do if you spot the signs

If you suspect that a person is a victim of slavery or trafficking, this is a safeguarding issue. You should trust and act on your professional instinct that something is not quite right. It is usually a combination of triggers, an inconsistent story and a pattern of symptoms that may cause you to suspect trafficking. If you have any concerns about a child, young person or adult take immediate action to ask further questions and get additional information and support. It is important to remember that:

  • trafficked people may not self-identify as victims of modern slavery
  • trafficking victims can be prevented from revealing their experience to health care staff from fear, shame, language barriers and a lack of opportunity to do so. It can take time for a person to feel safe enough to open up
  • err on the side of caution regarding age. If a person tells you they are under 18 or if a person says they are an adult, but you suspect they are not, then take action as though they were under 18 years old
  • support for victims of human trafficking is available

Action to take

  • Take immediate action for those considered to be in immediate danger
  • Follow local safeguarding referral processes
  • Raise concerns with safeguarding lead
  • Ensure a clear and accurate record of the concern is made and actions taken.

Policy

Commitments

We are a company that expects everyone working with us or on our behalf to support and uphold the following measures to safeguard against modern slavery and human trafficking:

  • We have a zero-tolerance approach to modern slavery and human trafficking in our organisation and our supply chains.
  • The prevention, detection and reporting of modern slavery and human trafficking in any part of our organisation or supply chain is the responsibility of all those working for us or on our behalf. Colleagues must not engage in, facilitate or fail to report any activity that might lead to, or suggest, a breach of this policy.
  • We are committed to engaging with our stakeholders and suppliers to address the risk of modern slavery and human trafficking in our operations and supply chain.
  • We take a risk-based approach to our contracting processes and keep them under review. We assess whether the circumstances warrant the inclusion of specific prohibitions against the use of modern slavery and trafficked labour in our contracts with third parties. Using our risked based approach, we will also assess the merits of writing to suppliers requiring them to comply with our Code of Conduct, which sets out the minimum standards required to combat modern slavery and human trafficking.

Consistent with our risk-based approach we may require:

  1. Employment and recruitment agencies and other third parties supplying workers to our organisation to confirm their compliance with our Code of Conduct.
  2. Suppliers engaging workers through a third party to obtain that third parties’ agreement to adhere to the Code.

As part of our ongoing risk assessment and due diligence processes, we will consider whether circumstances warrant us carrying out audits of suppliers for their compliance with our Code of Conduct.

If we find that other individuals or organisations working on our behalf have breached this policy, we will ensure that we take appropriate action. This may range from considering the possibility of breaches being remediated and whether that might represent the best outcome for those individuals impacted by the breach to terminating such relationship.

Section Details
Author David Englefield
Document Approver Dr. Adeolu Arikawe
Staff Group Safeguarding Leads
Consultation [Insert Consultation Details]
Version V1.0
Date Issued May 2025
Review Date April 2026
Review Frequency Annual
Reason for Review New policy

 

Organisational Structure and Supply Chains

SPCL is a provider of Healthcare, whose registered office is in Leicester

We deliver healthcare services in Leicestershire and Warwickshire. We employ staff ranging from General Practitioners, NMC registered Nurses and administrative support staff. We procure goods and services from a range of providers. Contracts vary from small one-off purchases to service contracts.

Our current Procurement processes are as below:

  • All spend, aside from a few exceptions such as rates, is paid via PO. The Applicable Contract Terms Policy applies to any NHS organisation and states that where an NHS body issues a PO the standard Terms & Conditions apply.
  • Our procurement process has been reviewed to ensure that human trafficking and modern slavery issues are considered at an early stage, requiring self-certification from potential suppliers that their supply chains comply with the law.
  • We procure many goods and services through frameworks endorsed by the NHS, under which suppliers such as Crown Commercial Services and NHS Supply Chain adhere to a code of conduct on forced labour.
  • We operate professional practices relating to procurement and supply and ensure procurement staff attend regular training on changes to procurement legislation.
  • Due Diligence Processes for Slavery and Human Trafficking With regard to national or international supply chains, our point of contact is always preferably with UK entities, and we expect these to comply with legislation and have suitable anti-slavery and human trafficking policies and processes in place.
  • The majority of our purchases utilise existing supply contracts or frameworks which have been negotiated under the NHS Standard Terms and Conditions of Contract, these all have the requirement for suppliers to have suitable anti-slavery and human trafficking policies and processes in place.
  • Organisational policies in relation to slavery and human trafficking – We update relevant policies on a regular basis to highlight obligations where any issues of modern slavery or human trafficking might arise, particularly in our procedures for safeguarding adults and children and young people, tendering for goods and services, and recruitment and retention.
  • Assessing and managing risk and due diligence processes in relation to slavery and human trafficking – We are committed to ensuring that there is no modern slavery or human trafficking in our supply chains or in any part of our business.

To identify and mitigate the risks of modern slavery and human trafficking in our own business and our supply chain we:

  • adhere to the National NHS Employment Checks / Standards (this includes employees UK address, right to work in the UK and suitable references
  • have systems to encourage the reporting of concerns and the protection of whistleblowers
  • purchase a significant number of products through NHS Supply Chains, who’s ‘Supplier Code of Conduct’ includes a provision around forced labour. Other contracts are governed by standard NHS Terms & Conditions. High value contracts are effectively managed, and relationships built with suppliers

Effective action taken to address modern slavery – Performance Indicators

We are committed to social and environmental responsibility and have zero tolerance for Modern Slavery and Human Trafficking. Any identified concerns regarding Modern Slavery and Human Trafficking are escalated as part of the organisational safeguarding process. This statement is made pursuant to section 54(1) of the Modern Slavery Act 2015 and constitutes BWPCAs slavery and human trafficking statement for the current financial year.

Training for staff

All staff receive a comprehensive induction programme which includes information on, and guidance regarding, slavery and human trafficking. All staff are required, as part of mandatory training, to complete safeguarding courses, which cover obligations under the Act.

We also require external agencies supplying temporary staff to demonstrate compliance with the legislation. All clinical and non-clinical staff have a responsibility to consider issues regarding modern slavery and incorporate their understanding of these into their day-to-day practices.

All colleagues have a personal responsibility for the successful prevention of slavery and human trafficking with the procurement department taking responsibility for overall compliance.

A quarterly Integrated Learning Report is submitted to the Board of Directors which includes an overview of the number of concerns raised by staff and the category that they fall into.

Signed

Managing Director – David Englefield
Clinical Lead – Dr Adeolu Arikawe

Summary Care Record

There is a new Central NHS Computer System called the Summary Care Record (SCR). It is an electronic record which contains information about the medicines you take, allergies you suffer from and any bad reactions to medicines you have had.

Why do I need a Summary Care Record?

Storing information in one place makes it easier for healthcare staff to treat you in an emergency, or when your GP practice is closed.

This information could make a difference to how a doctor decides to care for you, for example which medicines they choose to prescribe for you.

Who can see it?

Only healthcare staff involved in your care can see your Summary Care Record.

How do I know if I have one?

Over half of the population of England now have a Summary Care Record. You can find out whether Summary Care Records have come to your area by asking your GP.

Do I have to have one?

No, it is not compulsory. If you choose to opt out of the scheme, then you will need to complete a form and bring it along to the surgery. Please ask reception for this form, or use the one located on the NHS Digital website.

More Information

For further information visit the NHS Digital website.

Your Personal Health Information

We ask you for information and keep it together with details of your care.

We may use some of this information to help us to protect the health of the Nation, to help plan the future of the NHS, to train tomorrow’s clinical staff and to carry out research for the benefit of everyone.

You have a right of access to your health records. Please ask at the reception for further details.

Everyone working for the NHS has a legal duty to keep information about you confidential.

Telephone Recording

All telephone calls to and from the surgery are recorded to protect our patients and healthcare professionals. Patients are protected by the practice having a record of our conversations with patients, staff and other health workers to protect from potential abuse. We also occasionally use recordings for staff training and quality control.

For new patients, when you register with us, we will make it clear that all inbound and outbound calls from the surgery are recorded.

Calls, or transcripts of calls, audio or audio-visual recordings or elements of the discussion you have with the clinicians that contain clinical information may be added to your medical records, but this will be clarified with you at the time.

The recordings are stored securely on a system provided by X-on and are protected through the company’s Data Protection Policy, which is complaint with GDPR legislation. These recordings will not usually be shared outside the practice. If we hold recordings that have not been deleted, you can ask for a copy. In order to do this, you must put the request in writing to the Practice Manager via a Subject Access Request.

Suggestions and Complaints

Your comments and suggestions are welcome to improve the quality of our service.

Friends and Family Test

The Friends and Family Test (FFT) is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. Listening to the views of patients and staff helps identify what is working well, what can be improved and how.

The FFT asks people if they would recommend the services they have used and offers a range of responses. When combined with follow-up questions, the FFT provides a tool to highlight both good and poor patient experience. This kind of feedback is vital in transforming our service and supporting patient choice.

So far, the FFT has produced more than 48 million pieces of feedback across England – and the total rises by around 1.2 million more every month – making it the biggest source of patient opinion in the world. Scores so far have told us that at least nine out of ten patients would recommend the NHS services they used to their loved ones. Patient comments also identify areas where improvements can be made so that providers can make care and treatment better for everyone.

The feedback gathered through the FFT is being used in NHS organisations across the country to stimulate local improvement and empower staff to carry out the sorts of changes that make a real difference to patients and their care.

Your Feedback

You can leave feedback based on your visits and appointments with us.

If you are unhappy with the service we provide to you, please speak to a member of our team as soon as possible.

For more information on how you can share your feedback, visit our ‘Your Feedback’ page.

Repeat Prescriptions

Introduction

The purpose of this policy document is to set out the methods by which a repeat prescription will be issued and the roles and responsibilities within the practice.

There are Four Stages:

  • Management control
  • Initiation/ Request
  • Production/ Authorisation
  • Clinical control/ Review

The GP should retain an active involvement throughout the repeat prescribing process and should not delegate any entire part of the process to ancillary staff. Those stages in bold above are entirely the responsibility of the GP.

Initiation / Request

  • The decision to transfer a drug from an acute prescription to a repeat prescription must always be made by the doctor after careful consideration of whether the drug has been effective, well-tolerated and is required long-term. (The patient should be seen, or at least spoken to, at this stage to ascertain this and check compliance). It is the duty of the doctor at this stage to ensure the patient understands the repeat prescribing process and what is required of them.
  • Consideration should be given to alternative drugs and / or generic prescribing where appropriate.
  • Care should be taken to ensure the repeat record is accurate, quantities for each drug are synchronised where possible and review dates are entered.
  • Computerisation of repeat prescribing is to be encouraged and is the ultimate aim for all practices.
  • Drugs should be linked by read code to medical conditions within the clinical system as appropriate.

Request

  • This will largely be the responsibility of the patient.
  • The patient should be given a list of drugs they are currently taking on repeat prescription, preferably as a computer-generated list (usually forming the right hand side of the prescription slip).
  • The patient or his /her representative must have an active role in requesting a repeat prescription.
  • The patient should be encouraged to indicate on the repeat request slip which drugs they require when a request is made. If they have left the form blank and it is not obvious from their computer record which medication is needed, then the patient should be contacted if possible, rather than all the medication given.
  • Only urgent telephone requests or telephone requests from elderly and housebound patients can be taken. Patients should allow 48 hours for requests to be dealt with. This allows adequate time for a good quality repeat prescribing system to operate. For postal requests, to be returned via an SAE, patients should allow one week.
  • Patients should be encouraged to tell their GP’s if they are no longer taking a repeat medication. The appropriateness of this can then be assessed and the computer updated to reflect the change.
  • It is becoming more common for chemists to request repeat medication on behalf of patients. Whilst this has advantages it is worth bearing in mind that not all chemists check with the patient their monthly needs which can result in everything being ordered when it is not necessarily required. Spot checks with patients and chemists are advisable to ensure the correct dosage and issue of medication is being made to those patients.

Electronic Prescribing Service (EPS)

This is a new service that is intended to make it easier for GPs to issue prescriptions and more convenient for patients to collect their medicines.

Using EPS means that prescriptions by GPs and other prescribers will be transferred electronically to the pharmacist nominated by the patient. The prescriptions will also be sent automatically to the Prescriptions Pricing Authority (PPA).

A protocol for managing EPS within a practice could be as follows on the next page:

Production/ Authorisation

  • This will usually be the responsibility of the receptionist/prescription clerk.
  • Computer generated repeat prescriptions are good practice in that handwritten forms are prone to error.
  • A compliance check is preferable at this stage and the computer should normally alert the user if medication appears to be over or under used. Particular attention should be paid to ‘as required’ drugs and if problems are suspected the doctor should be alerted, preferably before the prescription is produced.
  • Practices should not supply further repeat prescriptions at shorter time intervals than have been authorised without agreeing the reason for the early request, e.g. holiday and documenting this reason in the patient’s medical record.
  • Provided there appears to be no problem, a prescription can be generated and left for the doctor to authorise and sign, with the notes to hand (computerised or manual) as far as practically possible, to cross check the validity and appropriateness of the request. Situations where notes should always be available include:
    • Where the request slip indicates that a review is necessary
    • Where any drug requested by the patient is not on their repeat record
    • Where any of the following drugs are requested:
      • Temazepam
      • Diazepam (Valium )
      • DihyGPocodeine
      • Paracetamol and codeine 500/30 preparations, e.g. Solpadol, Tylex
      • PPI
      • All controlled drugs
    • Where the item requested has been issued less than one month previously.
    • Any request about which the practice staff are concerned or uncertain.
  • Where additions or corrections are made the doctor signing the prescription should initial or countersign against them. A record should be made of any subsequent handwritten alterations to computer-generated prescriptions.
  • Blank prescriptions should never be signed by a doctor for later completion by
    him/herself or a delegate. To do so is in breach of terms of service.
  • Unused space should be cancelled out under the last drug by a computerised mechanism or by the doctor deleting the space manually.
  • All repeat prescriptions issued should be recorded on the computer.
  • Practices should store prescriptions awaiting collection in a secure way and have a standard time limit for collection of repeat medication (e.g. four weeks) after which those not collected should be investigated, e.g. no longer required or medication underused etc., and then destroyed and noted in the patient’s medical record.
  • It may be that patients need their medication to be placed in blister packs of 7 days. This is usually appropriate for elderly patients and those that have serious difficulties managing their medication. A request should be put in to the surgery by either the chemist, district nurse or support worker and this should be passes to a GP for approval. It is then usual to produce these prescriptions in 7 day dosages and 4 can be issued at any one time. Care must be given if a medication is switched part way through a prescription that the dossette boxes are also changed.

Clinical Control/ Review

  • This is solely the responsibility of the doctor, although the nurse can review certain patients on behalf of the doctor, e.g.: contraception and asthma although patients may not necessarily have to be seen by the doctor. The review date is set on the computer for every 6 months. For those patients who need annual review, e.g. chronic stable conditions, reviewing them in their birthday month may serve to remind patients of their obligation to attend for review.
  • A maximum of 28 days will be given for a prescription. A few patients could be given three month’s supply at GPs discretion e.g. when going on holiday or for certain types of medication – Oral contraceptives, HRT.
  • When patients are on several regular long-term medications, quantities should be prescribed to synchronise repeat intervals. In the UK patient packs are moving towards multiples of 28 days (rather than 30)
  • When patients are discharged from hospital, their regular medication may have changed. This is a particularly vulnerable time for errors to occur and ideally the doctor should amend the repeat record personally. A check of prescriptions not yet collected should also be made to ensure that it contains the correct medication.

The following considerations should be kept in mind by the doctor when carrying out medication review consultations:

  1. Control of the condition – is this optimal?
  1. Unnecessary medication – can anything be stopped?
  2. Compliance
    • Is the patient taking the medication properly?
    • Could the regimen be simplified?
    • Is there a problem with unwanted adverse effects?
    • Check understanding of medication?
  3. Monitoring – is this required, e.g. phenytoin levels, INR, TFTs, LFTs, U&Es
  4. Cost considerations – change to generics if appropriate, or consider change to a more cost-effective treatment (consider local formulary)

Management control

This would largely be the responsibility of the practice manager. Practice staff that write, or are involved in the preparation of, repeat prescriptions should be appropriately trained in the practice protocols for repeat prescribing, what their responsibilities are, and the need for accuracy. This should be on going, but is particularly important for new staff.

Liaison with local community pharmacists is essential if procedures are changed that may ultimately impact on them.

An adequate system for the secure storage and use of FP10s should be in place. A log sheet will be kept (& maintained by prescription clerk TB) for prescription pads coming into the practice (from PCSE) and distribution within the practice. This will be audited twice every year.

The practice computer system holding the prescribing records must be backed-up regularly.

Periodic audit of repeat prescribing will be carried out annually. This audit should also include prescription re-prints.

Setting up a repeat prescription:

The medication to be included on a repeat prescription should be agreed between GP and patient. Certain items should not be on repeat (& should be on acute only).

These include but are not limited to:

  • Contraceptive pills
  • HRT
  • Salbutamol
  • Controlled drugs

The importance of the need for regular review of repeat medication should be stressed to the patient.

It is the responsibility of the patient’s GP to ensure that an accurate up-to-date record of a patient’s repeat medication is held in their computer records and that all prescriptions are indicated / linked to a condition by read code.

Repeat medication prescriptions should last for an agreed length of time, usually 6-12 months, before medication should be reviewed (although this period can be extended if felt appropriate at the discretion of the prescribing GP).

Provide patients with details of the system operation at an appropriate time (on registration with the practice, on commencing a repeat prescription). Posters detailing the operation of the system should be displayed around the practice.

Operation of the system

The practice staff are responsible for the day to day running of the system.

This should include:

  • An appointed member of staff being given responsibility for the daily collection and processing of all repeat prescription requests.
  • When preparing a repeat prescription, practice staff can make brand to generic name switches as appropriate (see attached list of those medications which should only be prescribed by brand name).
  • Routine reauthorisation of repeat prescriptions is the responsibility of the Doctor. If items requested have expired and need reauthorisation the patient is required to attend a medication review, unless housebound. If housebound, the GP is then responsible for deciding whether to automatically re-authorise the repeat prescription or to provide a home visit.

When to refer the prescription back to the doctor

  • If anything is unclear with a repeat prescription request refer back to the prescribing GP.
  • If a patient requests an item which is not included or differs from the details recorded in their records, they should be referred to the GP.
  • If a patient under or over orders items on their repeat prescription indicating poor compliance, this should be highlighted with the GP.

Monitoring of repeat prescribing

Ideally a GP should carry out a medication review when:

  • A block of repeat medication comes to an end.
  • Patients attend for monitoring of the condition requiring repeat
    treatment.
  • Opportunistically should a patient attend with another complaint.

The review should consist of an assessment of the patient’s condition and compliance with prescribed medication. If any repeat medications are no longer being requested, an attempt should be made to ascertain the reason why and appropriate action taken.

Controlled Drugs

All controlled drugs not sent electronically (EPS) should be signed for by the person collecting the prescription e.g. patient / chemist.

Non-collection of prescriptions

Monthly checks will be carried out of prescriptions not collected (by the prescribing clerk). Prescriptions will be cancelled on the patient’s prescribing record & a note added. The prescribing clerk will task the GP to advise them that a prescription has not been collected & what details of the medication. The GP will then decide if any action needs to be taken i.e. follow up call / consultation if concerns (mental health patient etc.)

Repeat Prescribing Flowchart

Following agreement between patient and doctor to commence medication on a repeat prescription:

Missed Appointments

A DNA is someone who Did Not Attend an appointment at the surgery and did not tell us beforehand. The Doctor or Nurse were waiting, but the patient did not attend. DNAs are a serious problem for the NHS. Research shows that around 13 million GP appointments and 6 million practice nurse appointments are missed each year.

Due to an increase in the number of wasted appointments through patients failing to attend without informing the practice, it has become necessary to implement the following policy:

  • If you fail to attend three appointments without informing us, we will write to you asking if there are any specific problems preventing us from letting us know.
  • If you repeatedly fail to attend for appointments, you may be removed from the practice list and have to find an alternative GP practice.