AN NHS ACCOUNT

From the NHS
“Getting started with your NHS account” includes “Find out who can have an NHS account to use the NHS App or NHS website to access certain NHS services – and how to set up your account, log in and prove who you are to get full access.” Getting started with the NHS App – NHS App help and support – NHS

Log in or create your NHS account
View your GP health record not just your repeat medication View your GP health record – NHS

FURTHER INFORMATION ON THE ADVANTAGES OF AN NHS ACCOUNT

There is more information on your NHS account including many other functions beyond just online access to your test results under

• Your NHS Account

What is electronic repeat dispensing?

From NHS Business Service Authority
eRD information for patients eRD information for patients | NHSBSA

From the Pharmaceutical Services Negotiating Committee
Repeat Dispensing/electronic Repeat Dispensing (eRD) Repeat Dispensing/electronic Repeat Dispensing (eRD) : PSNC Main site

From NHS Digital
Intended for GP practices but covers the advantages of repeat dispensing for patients
Electronic repeat dispensing for prescribers Electronic repeat dispensing for prescribers – NHS Digital

From NHS Business Service Authority
Mainly intended for GP practices but some useful information
Electronic repeat dispensing (eRD) Electronic repeat dispensing (eRD) | NHSBSA

Who is suitable for electronic repeat dispensing?

As NHS England suggest
Any patient suitable for a repeat prescription could be suitable for electronic repeat dispensing. This includes but is not limited to:

• Patients on stable therapy
• Patients with long term conditions
• Patients on multiple therapy e.g., hypertension, diabetes, asthma etc.
• Patients that can appropriately self-manage seasonal conditions
  electronic-repeat-dispensing-guidance.pdf

A key word is “stable” therapy meaning if you have just been started on medication or if your medication is changing over time then you are likely not suitable until your medication is stable and is unlikely to change.

EMERGENCY SUPPLY OF MEDICATION (OUT OF HOURS)

From the NHS and Patient info

• Where can I get an emergency supply of medicine? – NHS
• Where to get an emergency supply of medication | Patient

Disposing of medical waste

As the NHS suggests you can dispose of any medical waste including sharps bin normally through your council.
How should I dispose of used needles or sharps? How should I dispose of used needles or sharps? – NHS

From Buckinghamshire Council
Request a healthcare waste collection Request a healthcare waste collection | Buckinghamshire Council

From Slough Council (for patients living in Berkshire)
“In order for a resident to receive a clinical waste collection, the healthcare professional must formally engage with Slough Borough Council. A letter of authorisation stating that they are formally requesting collection of clinical waste from the property of the resident must be provided”. This can be from a hospital service, community nurse, health visitor as well as a doctor. Clinical waste – Slough Borough Council

From Gov UK
For those patients registered to a Buckinghamshire GP but living outside the county
Request clinical waste collection  Request clinical waste collection – GOV.UK

GP Practices are not able to dispose of patient medical waste (including sharps bins).

Disposing of medicines through your local pharmacy

As the NHS suggests
If your medicine is out of date or unwanted, do not put it in the bin or flush it down the toilet. Take it to your pharmacy to be disposed of safely. How pharmacies can help – NHS

GP Practices are not able to dispose of patient medical waste (including old medication).

How to avoid over ordering medication

Wasted medication not only impacts the environment but it also costs the NHS huge amounts of money.

From NHS England
One estimate is around £300 million of medication is wasted every year NHS England » Pharmaceutical waste reduction in the NHS

Over a 10 year period this would pay for 300,000 hip replacements or many more cheaper operations, slashing waiting lists.

An awareness of the impact of wasting medication is a good start to make changes. Reordering medication too early or ordering medication which is not used, can lead to stock piling which often leads to wasted medication. However, there is a simple way to control your reordering of repeat medication, through using Electronic Repeat Dispensing (ERD). This is explained in detail in this section. ERD also makes the reordering process much easier, and can be used even if you do not order your medication online.

Medicines optimisation

A common question from many patients is “Do I need to be on this medication?”

This is an important question for you to ask at your annual medication review, for both 

• Your practice clinician (e.g. doctor) and 
• Your hospital clinician – if you are under a specialist

Medicine optimisation is a process you can complete with your clinician (e.g. doctor) at a medication review. The goal of medicines optimisation is to help patients to:

• improve their outcomes;
• take their medicines correctly;
• avoid taking unnecessary medicines;
• reduce wastage of medicines;
• and improve medicines safety.
  NHS England » Medicines optimisation

There is more information on medicines optimisation under

• Senior Health

Four key questions – understanding your medication

Understanding your medication and the 4 key questions to ask are well covered by the Patient Association. “There are four main questions to think about when starting a new medication. Remember the initials BRAN (Benefits, Risks, Alternatives and Nothing).

1. What are the benefits?
2. What are the risks?
3. What are the alternatives?
4. What if I do nothing?”
   Understanding your medicines Understanding your medicines | The Patients Association

Better Information on medication – understanding your medication

There is significant complexity with medication but the better understanding and involvement you have with your medication, the better the outcomes for your condition and the better the safety of your medication. This involves giving you access to the best information available. This is done here at 3 levels, simple information from NHS choices, more detailed information from patient info and clinical level information from NICE (British National Formulary). It does not matter which level you focus on but greater involvement is of huge value to you.

When your clinician prescribes medication, they will ask you to review the information in the leaflet that comes with your medication (produced by the manufacture) but you can also review the information available here both from a point of view of shared decision making but also safety.

Enter the name of your medication into the relevant medication data base from the NHS, Patient info or NICE to get information on the medication.

From the NHS, Patient info and NICE             

• Medicines A-Z – NHS
• Medicine and Drug Directory | Information and Side Effects | Patient
• BNF British National Formulary – NICE – Adults
• BNF for Children British National Formulary – NICE – Children

From Drugs.com

• Drugs.com | Prescription Drug Information, Interactions & Side Effects is an excellent drugs data base which is regularly updated.
• UK Drug Database | Drugs.com The Drugs.com UK Database contains drug information on over 1,500 medications distributed within the United Kingdom.

Medication for mental health conditions in adults

From Oxford Health NHS foundation Trust
Find out more about mental health conditions, treatments and medications, just search for common mental health conditions. Provides answers to common questions and also leaflets for commonly used drugs Oxford Health NHS Foundation Trust Home

PATIENT MEDICATION LEAFLETS

If you have lost the patient leaflet that came with your medication you can look the information up:

From the EMC
The electronic medicines compendium (EMC) contains up to date, easily accessible information about medicines licensed for use in the UK: EMC database of medicine patient information leaflets Home – electronic medicines compendium

PATIENT DECISION AIDS (PDAs)

Patient decision aids (PDAs) are aids to help you discuss health decisions including medication with your clinician. The number of PDAs which are available is limited but is likely to increase over time. Further information on PDAs, including some examples, can be found under

• Shared Decision Making

Further information

There are other general GP related articles on medication from patient info
Treatment and Medication Treatment and Medication | Patient

High risk drugs MONITORING

High risk drugs such as Disease-modifying anti-rheumatic drugs (DMARDs) and lithium require monitoring. This section covers the principles of responsibility which lies with the patient, the hospital and the GP. The document which is on occasions used to support this relationship is called a shared care protocol.

General information – DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS

Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat inflammatory arthritis but also other conditions (including bowel conditions such as Crohn’s disease). They need to be monitored with bloods tests done on a regular basis.

From Versus arthritis
Disease-modifying anti-rheumatic drugs (DMARDs) Disease-modifying anti-rheumatic drugs (DMARDs) | Side-effects

From the National Rheumatoid Arthritis Society (NRAS)
Understanding your RA blood tests Understanding your RA blood tests | NRAS

From NICE
Disease modifying drug monitoring requirements DMARDs | Health topics A to Z | CKS | NICE

Shared Care Protocols – DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS

As NHS England suggest
“Shared Care Protocols are clinically focused and provide the information required to support safe and effective shared care for the specified medicines.” They include some common shared care protocols.
Shared Care Protocols (SCPs) NHS England » Shared Care Protocols (SCPs)

Shared care protocols from the Buckinghamshire Formulary
The shared care protocols Buckinghamshire Formulary outline prescribing and monitoring responsibilities of the specialist, GP and patient in Buckinghamshire for high-risk drugs which require monitoring. This needs to be followed by all 3 parties and requires good patient involvement to ensure safe prescribing which is at the centre of these shared protocols. There is a separate shared care protocol for each drug been monitored and your drug will be explained by your hospital consultant. You can find the details of your drug shared care protocol on the Buckinghamshire Formulary Link which also explains what abnormalities are looked for on your regular blood tests. How often your blood tests are repeated is set by your hospital consultant, and this will change over time. You can always ask your consultant if you can safely move to having your bloods done less often. Your consultant will then need to write to your GP to confirm any change (word of mouth is not deemed safe in this situation).

It is important you know who is following up any blood tests that have been organised, any blood tests ordered by the hospital should be followed by the hospital specialist, any tests ordered by your GP practice should be followed up by your GP.

From the BMA
From the BMA “ Duty of care when test results and drugs are ordered by secondary care” Duty of care when test results and drugs are ordered by secondary care

Blood tests – DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS

From Lab tests online
Cover the blood tests required to monitor a lot of the DMARDs.

• Full Blood Count (FBC) Full Blood Count – Understand the Test
• Haemoglobin Haemoglobin Test- Understand the Test
• Red Cell Indices Red Cell Indices
• White Blood Cell Count White Blood Cell Count | Lab Tests Online-UK
• White Blood Cell Differential Count WBC Differential Count
• Platelet Count Platelet Count
• U&E U&E
• Creatinine Creatinine
• Liver Blood Tests Liver Function Tests – Understand the Test
• Alanine aminotransferase (ALT) Test Alanine aminotransferase (ALT) Test
• Rheumatoid Arthritis Rheumatoid Arthritis

lithium and digoxin monitoring

From Lab tests online UK

• Lithium Lithium
• Digoxin Digoxin

long term conditions

If you look under specific long term conditions on this website there is information on what the targets are, allowing you to judge how well your medication is helping you and then discussing with your clinician whether you want your medication to be increased or reduced if appropriate. Some common long term conditions can be found under

• long-term conditions – Adults

reporting side effects

Reporting side effects of medication to the Medicines and Healthcare products Regulatory Agency (MHRA)

• Information on reporting and why should you report suspected side effects to medicines or vaccines or incidents involving medical devices? Information | Making medicines and medical devices safer 
• How to report online? Yellow Card | Making medicines and medical devices safer 

From the Medicines & Healthcare products Regulatory Agency

• Find product information about medicines Find product information about medicines – GOV.UK
• Alerts, recalls and safety information: drugs and medical devices Alerts, recalls and safety information: drugs and medical devices – GOV.UK

reducing the cost

From the NHS
Who can get free prescriptions? Who can get free prescriptions – NHS

This NHS article includes telephone helplines (at the bottom of the page) you can contact if you need support with understanding the help available on NHS prescription costs. However, it is first worth reading this whole article because hopefully your question will be answered without you needing to contact anyone.

• When you need to pay towards NHS care When you need to pay towards NHS care – NHS

If you receive Universal Credit, you may also qualify for help with health costs.

• Help with health costs for people getting Universal Credit Help with health costs for people getting Universal Credit – NHS

From the NHS Business Services Authority

• Help with NHS prescription costs Help with NHS prescription costs | NHSBSA
• Free NHS prescriptions Free NHS prescriptions | NHSBSA

prescription prepayment certificate (PPC)

If you are on a number of prescriptions and not entitled to free prescriptions then a prepayment certificate may save you money.

From the NHS
Save money with a prescription prepayment certificate (PPC) Save money with a prescription prepayment certificate (PPC) – NHS

From Coeliac UK
Prescriptions policies across the UK with postcode checker Prescriptions – Coeliac UK

what medication is needed

All drugs come with a cost either personal (prescription charge) and/or to the NHS in the real cost of the drug, often significantly higher than the prescription charge.

From the NHS
What is the cost of prescriptions (NHS prescription charges)? NHS prescription charges – NHS

Understanding the downsides of all medication
Medication can come with side effects, interactions and other issues, so it is always important they are only taken when the benefits outweigh the downsides.

For example, with antibiotics:

From the NHS

• Antibiotics side effects Antibiotics – Side effects – NHS
• Antibiotic interactions Antibiotics – Interactions – NHS

Also see link in “How to help avoid antibiotic resistance” on this page for other downsides of antibiotics.

Having a better understanding of the downsides and the alternative solutions, including safety netting can help. Safety netting, includes what to do if a condition deteriorates or does not improve within a certain timeframe with or without treatment and can change how we all view the need for immediate medication. More information is available under

• Safety Netting

DRUG WASTE REDUCTION IN THE NHS

From NHS England
One estimate is around £300 million of medication is wasted every year NHS England » Pharmaceutical waste reduction in the NHS

As Medicine Waste suggest
“Wasted medicine is everyone’s responsibility and there are small changes you can make to help reduce the amount of medicine being wasted.” Medicine Waste UK

Medicine Waste suggest some simple steps that can make a real difference
How can you help Medicine Waste UK

Also see the answer in the local self referral section above for ” How medication wastage can be avoided”.

OUTPATIENTS –  a simple answer

A simple answer

• If the medication is required immediately (urgently) the hospital doctor will complete a prescription to enable you to get the medication immediately (Word of mouth or a piece of paper requesting your GP to do a prescription will not suffice).
• If the medication is not urgent then the hospital doctor will send a letter to both you and your GP detailing the medication (including the rationale for the medication). Note the letter can take up to 3-4 weeks for you and your GP to receive.
• The hospital doctor in either case will fully explain the medication to you.

Outpatients – a more in-depth answer

This is explained in much more detail below with reference to NHS England advice.

Outpatient (Contract details from NHS England)
“Where a patient has an immediate clinical need for medication to be supplied following outpatient clinic attendance, the Provider (e.g., Hospital specialist) must itself supply to the patient an adequate quantity of that medication to last for the period required by local practice, in accordance with any requirements set out in the Transfer of and Discharge from Care Protocols (but at least sufficient to meet the patient’s immediate clinical needs until the patient’s GP receives the relevant Clinic Letter and can prescribe accordingly)”. NHS England (see e.g., NHS Standard Contract 2020/21 Service Conditions (Full Length) S11.10) NHS England » GP Contract

When is an outpatient letter received?
Whatever is said by the NHS specialist there is always a significant delay between the clinic appointment and the practice GP receiving your letter. This delay can be at different levels. The specialist must dictate a letter, the secretary must process the letter in their system and when the practice receives the letter it must be scanned into your notes (remembering that practices are receiving 100s of letters and other messages every day for different patients.) So, the process of your GP receiving a letter can take 3-4 weeks.

What is very helpful now is the vast majority of NHS consultants now send a copy of their clinic letter to you, so when you have received your letter, the practice should have processed their copy of this letter a few days later (as normally these letters come at a similar time). If you need medication following an outpatient appointment and you have not received your letter then it is worth you contacting the secretary of the department you attended and ask them to send you (and the practice) a copy of the letter so that you are able to have further medication prescribed. There is more information how to contact the specialist departments for local hospitals, under

• Hospital

It is not the responsibility of GP practices to chase NHS specialists for their letter and more importantly they just do not have the capacity (clinical or administratively) to do so. Clinically there is a risk of errors prescribing medication without guidance following an outpatient appointment so GPs will not normally do that.

Inpatient, day case or A&E attendance –  a simple answer

A simple answer
The hospital will prescribe 14 days medication (if required) after an inpatient stay and up to 7 days medication (if required) if you have attended A&E.

Inpatient, day case or A&E attendance – a more in-depth answer

This is explained in much more detail below with reference to NHS England and BMA advice.

Inpatient, Day case or A&E (Contract details from NHS England)
“Where a patient has a clinical need for medication to be supplied on discharge from inpatient or day case care, the Provider (e.g., Hospital specialist) must ensure that the patient have on discharge an adequate quantity of that medication to for the period of a least 7 days and (if shorter) for a period which is clinically appropriate”. NHS England (see e.g., NHS Standard Contract 2020/21 Service Conditions (Full Length) S11.9) NHS England » GP Contract

For discharge after an inpatient stay locally medication is prescribed for 14 days.
If you have not received your expected medication for 14 days then if you contact the ward you stayed on, it is their responsibility to ensure that this is corrected. Most wards will give you a number you can call after an inpatient stay.

When is a discharge summary received and how can I get medication after the 14 days supplied by the hospital?
Discharge summaries (following an inpatient stay) are now processed quicker than previously but unfortunately there can be delays. If you are going to run out of medication after 14 days you can either drop in a copy of the discharge summary to your practice (if you have received one and your GP has not) or if you contact the hospital ward after an inpatient stay, they can urgently arrange a discharge summary to be sent to you and your GP.

It is helpful to tell the practice if there remains a problem with the discharge summary and they can then chase the hospital for the discharge summary if it still has not been received. If a GP has not received a discharge summary, they will struggle to prescribe medication after 14 days.

PATIENT ADVICE AND LIASON SERVICE (PALS)

Only In the very unlikely event that you are unable to resolve your issues around medication by contacting the relevant outpatient or inpatient department/ ward should you escalate your issue to the patient advisory liaison service of the relevant hospital. This service is in heavy demand so please use it only if necessary.

More details on PALS and how to contact each PALS in each hospital can be found under

• Patient Advice and Liaison Service (PALS)

From NHS England
Full-length NHS Standard Contract Service Conditions. 2020/21 (SC 11.9 and 11.10) NHS England » Full-length NHS Standard Contract 2020/21 and for the latest contract NHS England » GP Contract

From the BMA

• From the BMA “ Duty of care when test results and drugs are ordered by secondary care” Duty of care when test results and drugs are ordered by secondary care
• Pushing back on inappropriate workload (Letter templates for practices: Appendix 2 – Template response to inappropriate prescribing) Pushing back on inappropriate workload

MEDICATION AND PRIVATE CARE

The guidance for medication prescribed in private care is covered under

• Principles of private Care

See under the two questions

• “Can you have some of your private care covered on the NHS in the short term? (Covers short term medication e.g., antibiotics) and
• “Can you have some of your private care covered on the NHS in the long term? (Covers issues around long-term medication for a long-term condition)”

The simple answer is NO. Why is explained further below.

Medicines Optimisation

From the Integrated Care Board Buckinghamshire Oxfordshire, and Berkshire West
“The Medicines Optimisation Team supports healthcare professionals across Buckinghamshire, Oxfordshire & Berkshire West (BOB) to optimise medicines use and ensure the right treatment choices are made.” Medicines Optimisation | BOB ICB

THE BUCKINGHAMSHIRE FORMULARY

There are some drugs which are tightly controlled or not allowed in Buckinghamshire. The formulary produced by Buckinghamshire Healthcare NHS Trust (in collaboration with NHS Buckinghamshire Medicines Management Team) list, using a traffic list system, what medication can be prescribed in Buckinghamshire Buckinghamshire Formulary and who is allowed to prescribe the medication (Hospital only, hospital initially or GP following recommendation).

From Buckinghamshire Healthcare NHS Trust

• Buckinghamshire Formulary Buckinghamshire Formulary
• Key to traffic light system Formulary

To ensure ongoing prescriptions as explained in the previous question, it is important hospital doctors adhere to the Buckinghamshire formulary, in particular avoiding prescribing any “Black listed” drugs. Most consultants locally are aware of this formulary but it is worth you checking with hospital doctors below consultant level as they may be new to the trust. A hospital doctor adhering to this policy will save you a significant amount of time and trouble, as GPs are not able to prescribe drugs outside this guidance. This issue particularly applies to consultants outside the local area who are less likely to be aware of such guidelines (though most of the recommendations are national).

Medication for holiday and travel

A number of considerations (including repeat medication) for travel abroad are covered under

• holiday and travel health

MULTI COMPARTMENT AIDS

From the BMA (British Medical Association)
“What should we do about seven-day prescribing for MCA dispensing?” in
Prescribing in general practice bma-prescribing-in-general-practice-april-2018.pdf

As suggested by BMA

• “The request for seven-day repeat prescriptions has become an increasing pressure for GPs. Our advice is to resist such demands unless there is a clinical reason for restricting supply to seven days. Length of prescriptions should be specific to the status and condition of the patient and their particular clinical needs.”
• “There are also alternative ways to support patients taking medication, such as medicine advice charts, which allow the drugs to then be retained in their original packaging with advice sheets.”
• “The GPC supports the Pharmaceutical Services Negotiating Committee (PSNC) in that pharmacist issuing MCAs should be properly reimbursed for the services they provide to patients.”

SCHOOL, NURSERY AND CHILDMINDERS

The simple answer is NO.
Why does non-prescription or over the counter medication not need a GP signature or authorisation in order for a school, nursery or childminder to give? Prescribing over-the-counter medicines in nurseries and schools

CARE HOMES AND COMMUNITY DRUG CHARTS

The simple answer is NO.

As the BMA suggests
“There is no need for a GP to complete a community drug chart (MAR Chart) as a prescription is all that is legally required for a nurse or other community worker to administer medication.”
Prescribing in general practice bma-prescribing-in-general-practice-april-2018.pdf