| PRESCRIBING
FOR EX-OFFENDERS
Following
a change to the National Health Service (Charges for
Drugs and Appliances) Amendment (No.3) Regulations 2007
(for England only), prisoners released from prison unexpectedly
can take a FP10 or FP10[MDA] to a community pharmacy
to obtain their medicines free of charge until they
can arrange to see their GP, or register with a new
GP.
This
will be limited initially to six prisons and rolled
out over a period of time. For detailed information,
please see here.
Using FP10 or FP10 [MDA] for Prescriptions for
Substance Misuse Treatment
- On
the day of their release, it is recommended that,
before release, prisoners receive any supervised medication.
This will minimise the risk of delayed access to subsequent
doses.
- At
the time of prisoner release, prescribers can either
issue one or more FP10s or a single FP10[MDA] for
opiate maintenance prescriptions.
- If
the prisoner is likely to access the same pharmacy
for at least seven days, an FP10[MDA] prescription
should be provided for the required time (up to 14
days).
- If
the prisoner is more likely to move around for the
first seven days after release, then several single
FP10 prescriptions may be issued, allowing for up
to seven individual supplies. It is recommended that
the prescriber specifies the start date for dispensing
of each in the main body of each prescription.
- Prescribers
should issue no more than one day’s supply on
each FP10, except for weekend/bank holiday supplies.
Accessing large amounts poses a higher risk for vulnerable
prisoners immediately post-release.
- For
all other medicines that are needed for prisoners
as a result of release, an FP10 should be used if
a prescription is needed.
- Information
about how to prescribe on both FP10 and FP10[MDA]
prescriptions (including the revised Misuse of Drugs
Act 1971 and Medicines Act 1968 requirements) can
be found here.
Obtaining
and Handling Prescription Forms
- Prisons
can obtain FP10 and FP10[MDA] prescription forms from
their PCT. The prison will need to contact their PCT
and ask them to add each new prescriber to the PPD
database before ordering prescription forms.
- If
a prescriber already works in primary care (e.g. in
a GP practice) as well as providing medical services
to a prison in the same PCT, the prescriber will need
to notify the PCT separately for their prison-based
service provision. This requirement includes prisons
where PCTs either provide or commission prison healthcare
services.
- Where
prisons have locum prescribers, PCTs will have to
establish internal mechanisms for accessing FP10/FP10[MDA]
agreed with the Accountable Officer.
- PCTs
should provide the details of each prison prescriber
to the PPD using the standard form available here.
Existing prescribers will also require new prescriber
codes and prescription forms to ensure that the costs
are charged back to the correct PCT budget.
- Prescriptions
must be stored safely and securely (ideally in a locked
drawer or cabinet). Access to the prescriptions should
be by named personnel only. Records should be kept
of the serial numbers of prescriptions received and
supplied to prescribers.
- Standard
Operating Procedures for the handling of prescriptions
should be adapted by prisons to include FP10 and FP10[MDA]
prescriptions. A useful resource for this is the recent
publication Safer Management of Controlled Drugs:
Guidance on the Standard Operating Procedures for
CDs, DH January 2007 available to download here.
- Prisons
and PCTs should also ensure that the security arrangements
meet the requirements of the NHS Counter Fraud and
Security Management Service Guidance.
Issuing
FP10 and FP10[MDA] Prescriptions
- If
prescribing controlled drugs on FP10 and FP10[MDA]
forms, prescriptions must be written in accordance
with the controlled drugs regulations and requirements,
which can be found here.
This includes the revised electronically printed versus
handwritten requirements for both general medicines
and controlled drugs.
- FP10[MDA]
prescriptions should be written as daily quantities
with provision for doses for Saturday, Sunday and
Bank Holidays to be dispensed in advance, on the preceding
pick-up day before pharmacy closure.
- Supervised
consumption should be used for prescriptions of opiate
maintenance medication wherever possible. Where possible
PCTs should provide information to their Drug Action
Teams, Drug Intervention Programme (DIP) Managers
and their local prison(s) on where the supervised
consumption service is available within the PCT.
- It
is strongly recommended that the availability of supervised
consumption services at the chosen pharmacy is established
before release and that the pharmacy is contacted
to inform them of the expected FP10 or FP10[MDA].
This will facilitate the transfer of the prisoner
into primary care especially where access to supervised
consumption services is required.
Supply
of the FP10 or FP10[MDA] to the prisoner
- Prisons
need to consider when to hand over the signed prescription(s)
to the prisoner. A factor to consider is the security
of the written prescription whilst in the prisoner’s
possession before actual release from the prison grounds.
- It
is possible that if the prisoner is attending court,
this will not result in the prisoner being released
but returned to the previous prison or another prison.
Prisons should make local arrangements regarding the
secure handling and destruction of the signed FP10
or FP10[MDA].
Dispensing
prison-issued FP10 or FP10[MDA] prescriptions
- Usual
regulatory requirements apply for the dispensing of
the prison-issued FP10 and FP10[MDA] prescriptions.
- Pharmacists
should continue to use their discretion and professional
judgment about actions to take due to missed doses
and other clinical professional issues.
- Released
Prisoners will not be expected to pay prescription
charges for the prison-issued prescriptions.
- HMP
and the prison name, address and prison telephone
switchboard number must be printed in the box provided
for the practice address on the front of the form,
with the prescribing code and responsible PCT code
as required by the NHSBSA PPD.
- No
signature is required on the reverse of prescriptions
issued by HM Prisons for released prisoners. The patient
should print their name (and address) if different
from the front of the form) in part 3 of the prescription
form. Should the patient be homeless then the use
of including “No Fixed Abode” is acceptable)
in part 3 of the prescription form.
- If
the prescription is for a schedule 2 or 3 controlled
drug and is being collected by a prisoner’s
representative, the prisoner must supply an authorising
letter and the representative must sign for the prescription.
For instalment prescriptions this is required the
first time the patient presents. Further information
about this is available in Annex A3 of the revised
Drug misuse and dependence: UK Guidelines on clinical
management”, DH Nov 2007.
- Dispensers
can confirm the legitimacy of the prescription (including
the identity of the prisoner) and the prescriber by
contacting the Healthcare Manager (or acting Healthcare
Manager) at the prison stated on the prescription
via the HM Prison switchboard. The telephone number
can be accessed independently (if dispensers have
concerns about the printed number) via directory enquiries
or alternatively via the HM
Prison website.
Submission
of Prison-issued FP10 and FP10[MDA] prescriptions to
the NHSBSA PPD
- After
supply, the prescriptions should be should be sorted
as described on the FP34C submission document (i.e.
by form type, prescriber type). Forms received from
prisons do not need to be separately bundled but should
be placed with no charge prescriptions when submitted
to the PPD for reimbursement. Failure to do so could
result in prescription charges being deducted from
the items dispensed. Reimbursement will be as for
other FP10 and FP10[MDA] prescriptions.
- Prison
issued prescriptions will be allocated to the relevant
prison and will be reported on all PPD information
reports and extracts as normal GP practices.
NHSBSA
PPD Charging and Monitoring Arrangements
- The
PCT in which the HM prison is located will be charged
both reimbursement costs and remuneration costs. These
will both need recharging to prison budgets or prison
healthcare providers.
- Where
the issuing prison is a private prison, the PCT will
need to arrange for the prison to be charged for these
items.
- Prison
issued prescriptions will be allocated to the relevant
prison by the PPD and will be reported on all PPD
information reports and extracts as for standard GP
practices. The PPD will report dispensing fees and
allowances for prison prescriptions dispensed in the
community on the Itemised Prescribing Payment Report
(IPP report). A new national level report will be
available to allow the monitoring of all prison prescribing.
- Prison
prescribing information can be made available to the
prison via the ePFIP Electronic Prescribing and Financial
Information management to Practice system (. Prisons
will need to register with the PPD help desk who will
supply them with the relevant log-ons.
- PCTs
and prisons will need to incorporate the prescribing
of Controlled Drugs via prison-issued FP10 and FP10[MDA]
prescriptions into the required Controlled Drug monitoring
and reporting arrangements to the Healthcare Commission.
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