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Prescribers
and FP10 Prescriptions
(Last updated
30/06/2008)
Learning Objectives
On completion of this package you will
- Be able to write FP10 prescriptions
to comply with legal requirements
- Be able to identify which health
professionals are allowed to write prescriptions
- Know where to find out whether a
product can be prescribed on FP10
- Know the extra information to include
on a prescription for a controlled drug
The package is divided into the following
sections:
Before patients can receive a medicine
paid for by the NHS they usually have to receive a prescription.
Some medicines are normally only available on prescription
and not surprisingly these are referred to as POMs or
prescription only medicines. Other medicines can be
bought in pharmacies or from general retail outlets.
Most of these medicines can also be obtained through
the NHS on prescription. In addition patients receive
products on prescription that are not licensed medicinal
products for example appliances or dressings.
Who can write
an NHS prescription?
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Identify which of the
following groups of health professionals can write
prescriptions that the NHS will pay for if they
are dispensed in primary care: |
- General practitioners
- Dentists
- Podiatrists
- Pharmacists
- Health Visitors
- Physiotherapist
- Veterinary Surgeons
- Chiropodists
- Practice Nurses
- Optometrists
- Hospital doctors
- Radiographers
Follow
this link to check your answers.
To enable the NHS to pay for medicines
dispensed in primary care the correct prescription form
has to be used. Prescribers use different prescription
forms in Scotland and Wales to those in England. The
bottom section of the prescription is printed with details
of the prescriber such as his or her name and with information
that identifies the contract to which the cost of the
medicine will be charged. Each prescriber has his or
her own number so that ultimately the person responsible
for prescribing the medicine can be identified. Primary
care organisations such as general practices and Primary
Care Trusts are allocated budgets to cover the cost
of prescribing.
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The following can write
NHS prescriptions: |
- Most prescriptions are written by
General Practitioners. Sometimes doctors working in
NHS hospitals write prescriptions for patients to
take to community pharmacies (Chemists). This is usually
in situations where the hospital pharmacy department
cannot supply the medicine. Doctors working in hospital
out-patient drug addiction clinics can also issue
special NHS prescriptions.
- Dentists
can prescribe for their NHS patients
- Some
nurse practitioners have qualified as independent
prescribers. This means that they can draw up a management
plan and initiate therapy for the patients they treat
unlike supplementary prescribers. There are two groups
of independent nurse prescribers: (a) Community Practitioner
Nurse Prescribers who qualified under the original
arrangements for nurse prescribing and (b) Nurse Independent
Prescribers (formerly known as Extended Formulary
Nurse Prescribers). The first group have to hold either
a district nursing qualification or be registered
as a health visitor and they have to have completed
an approved training course (this training is now
part of the university-based specialist practitioner
programmes for new district nurses and health visitors).
The second group of nurses must be a 1st level Registered
Nurse or Registered Midwife or a Registered Specialist
Community Public Health Nurse who has completed the
specific programme of preparation for Nurse Independent
prescribing. For both groups of nurses, they have
to be registered in the register maintained by the
Nursing and Midwifery Council (NMC) with an appropriate
annotation next to their name indicating the type
of nurse prescriber.
- Pharmacist
Independent Prescribing was introduced from 1st May
2006.To qualify they must be a registered pharmacist
whose name is held on the membership register of the
Royal Pharmaceutical Society of Great Britain with
an annotation signifying that the pharmacist has successfully
completed an education and training programme accredited
by the RPSGB and is qualified as an independent prescriber.
- Optometrist
Independent Prescribing was introduced from 4th June
2008. Once training is completed practitioners will
need to register their independent prescribing specialty
with the General Optical Council before they can exercise
prescribing responsibilities.
- The
Department of Health has introduced supplementary
prescribing, which is “A voluntary prescribing
partnership between an independent prescriber and
a supplementary prescriber, to implement an agreed
patient-specific clinical management plan with the
patient’s agreement”. Supplementary prescribers
are able to prescribe from a range of medicines for
a broad range of medical conditions under the terms
of a clinical management plan. The plan will be drawn
up, with the patient’s agreement, in consultation
with an independent prescriber. The independent prescriber
is a doctor or a dentist. The supplementary prescriber
is either a Registered Nurse, Registered Midwife or
Registered Pharmacist. Nurses can hold more than one
qualification e.g. as a Nurse Independent Prescriber
and also as a supplementary prescriber. In May 2004,
the DH proposed that allied health professionals,
including physiotherapists, radiographers, chiropodists
and optometrists, should be able to prescribe medicines,
as supplementary prescribers in partnership with a
doctor. The introduction of supplementary prescribing
by these health professionals was implemented in April
2005 to allow AHP’s to train as supplementary
prescribers.
These changes in who can prescribe result from the
implementation of the Crown Report. Follow this link
for more information about nurse prescribing, pharmacist
prescribing and supplementary prescribing click here.
What are the Different Types
of NHS Prescription Forms in England?
Different types of prescribers use different
versions of the standard NHS FP10 prescription form.
Each version is a different colour, which helps the
dispenser and the Prescription Pricing Division to identify
the prescriber. The different versions of the FP10 also
have different codes.
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For the following codes, name the
prescriber who uses the form: - |
FP10P
FP10MDA-SS
FP10NC
FP10D
FP10SS
FP10HNC
FP10MDA-S
FP10HMDA-S
FP10MDA-SP
FP10PCD
Follow
this link to check your answers.
The FP10 form has been redesigned in
the last few years to make counterfeiting of the form
more difficult, for example special dyes are used. Other
measures introduced to reduce patient charge evasion
have resulted in the back of the form being changed
as well. The back of the form specifies exemption categories
for patients who don't pay the prescription charge and
these have been updated following the introduction of
new types of social benefits. An example of an FP10
form is shown below.
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The following groups of prescribers
use these various forms: |
GPs – FP10NC,
FP10SS, FP10MDA-SS, FP10MDA-S
Hospital-based prescribers - FP10SS, FP10MDA-SS, FP10HNC,
FP10HMDA-S
Dentists - FP10D
Nurses - FP10P, FP10SS, FP10 MDA-SS
Supplementary prescribers – FP10P, FP10SS, FP10
MDA-SS, FP10MDA-SP
" OOH - FP10P-REC
Private prescribers - FP10PCD
Form FP10MDA-S is used for prescribing
controlled drugs (mainly methadone) to addicts. It is
twice the size of the standard FP10 because it contains
space for the pharmacist to record each time an instalment
is supplied.
FP10SS forms are designed for use with
the prescriber’s computer system. Many prescriptions
are produced in this way and they are usually easier
to read than hand-written prescriptions. FP10NC are
for hand-written prescriptions.
The
FP10P is printed with information to indicate the type
of prescriber:
COMMUNITY PRACTITIONER NURSE PRESCRIBER - the original
group of nurse prescribers
NURSE INDEPENDENT PRESCRIBER - nurses formerly known
as Extended Formulary Nurse Prescribers
SUPPLEMENTARY PRESCRIBERS
OUT OF HOURS CENTRES
The FP10PCD was introduced to support
the DH project for safer management of CDs and is used
for any private prescriptions for schedule 2 & 3 controlled
drugs dispensed by community pharmacists. It is printed
with information to indicate the type of private prescriber:
PRIVATE DOCTOR
PRIVATE NURSE PRESCRIBER
PRIVATE PHARMACIST PRESCRIBER
PRIVATE OPTOMETRIST PRESCRIBER
PRIVATE PHYSIOTHERAPIST PRESCRIBER
PRIVATE RADIOGRAPHER PRESCRIBER
PRIVATE PODIATRIST PRESCRIBER
What can a prescriber
order on an NHS prescription?
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What do you think prescribers should
be allowed to order on prescriptions - anything
they think the patient needs? How about a regular
session of exercise or a daily helping of fruit
for a patient who requires vitamins? These suggestions
are not as daft as you might suppose. There have
to be limitations on what can be prescribed at NHS
expense and it is important that prescribers only
prescribe within their own competencies. How do
you think this might affect prescribing by dentists
or nurses? Why not discuss these issues with your
colleagues or tutor. |
Follow the links to find out more.
General Medical Services (GMS) Contract
The Standard General Medical Services
Contract states that
"A prescriber shall order any drugs,
medicines or appliances which are needed for the treatment
of any patient who is receiving treatment under the
contract by issuing to that patient a prescription form
or a repeatable prescription and such a prescription
form or repeatable prescription shall not be used in
any other circumstances." This means that the prescriber
can't use the FP10 form to prescribe exercise sessions.
The General Medical Services (GMS)
contract was introduced in April 2004. The contract
is between the primary care organisation (PCO) and the
primary care practice as opposed to a contract with
each GP. The contract includes proposals to help
GPs to manage their workload by enabling practices to
transfer responsibility for providing some services,
including out-of-hours care, to their PCO. Under the
terms of the contract a practice can decide which
additional and enhanced services they wish to provide,
for example, contraceptive services, childhood vaccinations
and minor surgery. If the practice opts out the PCO
becomes responsible for the service provision.
Drugs
and other substances not to be prescribed under the
NHS Pharmaceutical Services
In practice there are some restrictions
on what a GP can prescribe on FP10. Schedule 1 to the
NHS (General Medical Services Contract) (Prescription
of Drugs etc) Regulations 2004 lists drugs and other
substances not to be prescribed under the NHS pharmaceutical
services. This list can be found in Part XVIIIA of the
Drug Tariff. If an FP10 prescription is dispensed for
an item on this list, no reimbursement is made to the
contractor for that item.
Drugs
and other substances to be prescribed in certain circumstances
under the NHS Pharmaceutical Services
Schedule 2 to the NHS (General Medical
Services Contract) (Prescription of Drugs etc) Regulations
2004 lists drugs to be prescribed in certain circumstances
under the NHS pharmaceutical services. It specifies
groups of patients who may receive specific drugs for
specific purposes. These drugs can not be prescribed
to other types of patient or for different purposes.
The list of drugs covered by Schedule 2 is usually referred
to as the Selected List and it can be found in Part
XVIIIB of the Drug Tariff. If one of these drugs is
prescribed, the GP must endorse the face of the FP10
with the reference “SLS”.
Appliances
Unlike drugs where a GP can prescribe
any drug that is not in Schedule 1, only the appliances
listed in Part IX of the Drug Tariff can be supplied
on FP10. If an appliance not listed in the Drug Tariff
is dispensed or an appliance that does not conform to
the Drug Tariff specification, no reimbursement will
be made to the dispensing contractor for that appliance.
Borderline substances
The products that GPs prescribe on FP10
do not have to have marketing authorisations (product
licences) to be considered as drugs. Some patients will
require unlicensed medicines. There are also patients
who need products where it is borderline whether the
product is a drug or something else such as a food or
cosmetic. Whether a product is allowed as a drug on
an FP10 may depend on the particular circumstances in
which the product is used e.g. it may be considered
a drug when used for treating a specific condition.
The Advisory Committee on Borderline Substances advises
as to the circumstances in which some foods and toilet
preparations may be regarded as drugs. The ACBS recommendations
can be found in Part XV of the Drug Tariff. If a GP
prescribes one of these substances, he or she should
endorse the FP10 with "ACBS".
Dental Practitioners
Formulary
Unlike GPs, dentists are restricted
to a specific list of products that they can prescribe
on FP10D. The Prescription Pricing Division will only
reimburse the dispensing contractor if the products
are in the formulary. You can find the list of preparations
which may be prescribed on form FP10D as Part XVIIA
of the Drug Tariff.
Nurse
Prescribers Formularies
There are two groups of independent nurse prescribers.
Community Practitioner Nurse prescribers who have completed
the necessary training can only prescribe the preparations
listed in Part XVIIB(i) of the Drug Tariff. The list
includes almost all appliances (including wound management
products) and reagents listed in Part IX. The second
group, Nurse Independent Prescribers, can prescribe
any licensed medicine for any medical condition, including
some Controlled Drugs listed in Part XVIIB(ii) and must
work within their own level of professional competence
and expertise.
Supplementary
Prescribing
Supplementary
prescribers can prescribe the following, provided they
are included within the patient-specific clinical management
plan
a) All General Sales List medicines, Pharmacy medicines,
appliances and devices, foods and other borderline substances
approved by the Advisory Committee on Borderline Substances.
b) All POMs.
c) Controlled Drugs (except those listed in Schedule
1 of 'The Misuse of Drugs Regulations 2001' - that are
not intended for medicinal use). (The current exception
is when an AHP is the supplementary prescriber)
d ) Medicines for use outside their licence indications.
e ) Unlicensed drugs (a product not licensed in the
UK).
· Pharmacist Independent
Prescribing
Pharmacist Independent
prescribers, as stated in Part XVIIB(ii) of the Drug Tariff, are able to
prescribe any licensed medicine for any medical condition but cannot prescribe
Controlled Drugs.
· Optometrist Independent
Prescribing
Optometrist Independent
prescribers can prescribe any ophthalmic medication for any eye condition and
must work within their own level of professional competence.
How should a
prescriber complete the prescription form?
FP10 forms have to be completed in accordance
with legal requirements such as the Medicines Act (if
the drug is a POM) and the Misuse of Drugs Act (if the
product contains a controlled drug). The NHS (General
Medical Services Contract) Regulation 2004 also contains
some requirements for writing prescriptions: these apply
to all prescriptions regardless of whether the item
prescribed is a drug or an appliance.
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Which of the following pieces of
information does a prescriber have to include on
an FP10 prescription to meet legal requirements? |
- Patient's date of birth
- Patient's name
- Patient's title e.g. Mr
- Quantity of the product to be supplied
- Prescriber's qualifications
- The date the prescription was signed
- Instructions to the patient on how
to use the product
- Prescriber's signature
Follow
this link to check your answers.
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Which of the following statements
about prescriptions are true? |
- Carbon paper can be used to write
FP10 prescriptions provided the prescriber signs each
copy of the prescription in indelible ink
- FP10 prescriptions can contain an
instruction to allow repeat dispensing of the same
prescription
- A doctor can write a single prescription
for a POM to treat more than one patient
- An FP10 prescription is normally
valid for 6 months from the date on the prescription
Follow
this link to check your answers.
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A prescriber should include the
following on an FP10 prescription: |
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Prescribers and dispensers also
need to know the following about FP10 prescriptions:
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- FP10 prescriptions can be written
using carbon paper or similar material providing they
are not for a Schedule 2 or Schedule 3 controlled
drug. Carbon copies of the prescription can be useful
if the prescriber wants only a small quantity of a
drug to be dispensed and the identical prescription
is being given two or three times. The prescriber
must sign and date each carbon copy.
- Repeat dispensing of an FP10 prescription
allows patients to obtain a prescription from their
GP which they can have dispensed in several episodes,
rather than having to go back to the surgery each
time for a new prescription. For repeat dispensing
the prescriber’s software system produces a
repeatable prescription on an FP10 and a further series
of ‘batch issues’ (also printed on FP10s)
of up to a year’s duration. The repeatable prescription
contains all the usual details i.e. name and address
of patient, age, date of birth, prescriber details,
signature and date. The prescriber is required to
specify the number of issues he/she wishes to permit
from this prescription. The prescriber signs the repeatable
prescription because this is the legal prescription,
as defined by the Medicines Act, needed by the dispenser
at each dispensing episode. The ‘batch issues’
are not signed by the prescriber since they are not
prescriptions but are used for reimbursement purposes.
The computer system annotates the FP10 form so that
the dispenser can distinguish when an FP10 is being
used for repeat dispensing rather than for a normal
single-event FP10. Systems also link the number of
batch issues by overwriting the prescriber signature
box on each batch issue form with text "Repeat
dispensing: [example] 6 of 12". The date on which
the repeats were authorised is printed on all the
batch issues. The pharmacy will retain the repeatable
prescription and the patient can keep the remaining
batch issues or ask the pharmacist to retain them
on his/her behalf until the next issue of medication.
The patient signs each batch issue form at the time
it is dispensed. The dispenser processes batch issues
and forwards the forms to the Prescription Pricing
Division at the end of the month dispensed. The repeatable
prescription is sent to the Prescription Pricing Division
once all batch issues have been dispensed or, if the
patient does not collect all instalments, on expiry.
When the patient collects their medicine the pharmacist
has an opportunity to confirm that the prescription
still meets their needs and to answer any questions
they may have.
- Follow this link for more information:
Repeat
dispensing
- A separate prescription form has
to be used for each patient, except where a doctor
is prescribing in bulk for a school or institution.
POMs can not be prescribed on "bulk prescriptions".
The Drug Tariff specifies the requirements that have
to be met before a "bulk prescription" can
be issued. This information can be found in Part VIII,
Notes, Paragraph 9 of the Drug Tariff, and can be
viewed online at www.ppa.org.uk/ppa/edt_intro.htm
- An FP10 prescription can be dispensed
up to 6 months from the date on the prescription except
(a) if the FP10 is for a Schedule 2 or Schedule 3
controlled drug or
(b) if the FP10 is a repeatable prescription.
FP10s for Controlled
Drugs
When a doctor or dentist writes a prescription
for a controlled drug, he or she also has to comply
with the requirements of the Misuse of Drugs Act. In
practice there are only extra requirements for Schedule
2 and Schedule 3 controlled drugs. Prescriptions for
Schedule 4 and Schedule 5 controlled drugs just have
to meet the requirements for writing prescriptions for
POMs. The prescriber must ensure the FP10 contains the
following additional information:
- The prescriber's usual signature
and the date
- If issued by a dentist, "for
dental treatment only"
- The name and address of the patient
- The dose of the drug to be taken
- In the case of preparations, the
form and, where appropriate, the strength of the preparation
- Either the total quantity of the
preparation or the number of dose units in both words
and figures, with a strong recommendation that the
maximum quantity is limited to 30 days for schedule
2, 3 & 4 controlled drugs.
- FP10s for temazepam do not have to
comply with the above requirements.
- Validity of prescriptions for schedule
2, 3 & 4 controlled drugs is now restricted to 28
days.
FP10MDA-S
The FP10MDA-S prescription form is used
to order Schedule 2 controlled drugs and buprenorphine
for supply by instalments for treatment of addiction.
When a GP writes an FP10MDA-S, he or she must specify
the number of instalments to be dispensed and the interval
between each instalment. The GP can only order a sufficient
quantity of the drugs as will provide treatment for
not more than 14 days. A starting date for dispensing
the instalments does not have to be specified but if
such a date is given, it must be complied with and the
instalment directions run from that date. Other drugs
the patient might require (besides those for treating
addiction) can not be ordered on an FP10MDA-S.
Out
of Hours (OOH) service provision
Non FP10 Supply Forms (which are sometimes
referred to as FP10P-REC forms) were introduced in 2005
for use specifically within Out of Hours Centres. However,
other FP10 prescriptions also remain available for use
in the more traditional OOH prescribing scenario, where
the patient is visited by a prescriber outside of normal
working hours. This overview is intended to clarify
the circumstances in which each type of form should
be used.
PCTs (or their Prescription Form Purchasing
& Distribution Unit / Agency) will need to supply the
different types of form to OOH service providers (all
form types are obtainable from the usual suppliers).
These are:
Non FP10 Supply Forms - FP10P-REC
The Non-FP10 Supply Form was designed
for a specific purpose - to support the introduction
of Out of Hours Centres in February 2005. These OOH
Centres provide patients with an opportunity to receive
any urgently required medication at the same
time and place as the out of hours consultation.
The FP10P-REC forms should only be used
by the OOH provider to record items supplied directly
to a patient on-site (i.e. an item not dispensed through
a community pharmacy). These forms should be submitted
by the OOH provider to the Prescription Pricing Division
of the NHS Business Services Authority on a monthly
basis (by the 5th working day). This will enable the
PPD to provide monitoring and reporting information.
FP10P-REC forms should not
be dispensed through traditional community pharmacies,
as they are not intended for patients to take away from
the OOH Centre and exchange for medication.
Standard FP10 Prescriptions
These are the standard FP10 prescription
forms that will be dispensed by a community pharmacy.
They can either be computer-generated type (FP10SS)
or hand-written prescriptions (FP10NC). Or alternatively,
FP10P forms for any qualified nurse or pharmacist prescribers.
In an OOH setting these forms should continue to be
used where prescribing takes place outside of normal
working hours, but where there is no immediate treatment
required (i.e. where it is not detrimental to the patient
to wait until the prescription can be dispensed at a
later point by a community pharmacy).
Click here
for a copy of the original letter communicating the
creation of the Out of Hours Centre initiative. This
describes the initiative in more detail and also explains
the steps that PCTs need to take in order to set up
these sites.
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Further reading |
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