What is the longest prescription a doctor can prescribe?

vicwatson

Understand that a script is valid for 6 months but what's the longest amount of months a gp can prescribe tablets for, say I'm on long term prescription tablets and I want a supply for the next 12 months, is there any reason why my gp cannot give me a script for a 12 months supply???

locum-motion

The answer is in your question: Prescriptions are valid for a maximum of 6 months. Therefore the most a doctor can prescribe is 6 months. 6 months and 1 day after the doctor signs that piece of paper, your legal entitlement to possess that drug has expired.

palmcut

vicwatson wrote: »

Understand that a script is valid for 6 months but what's the longest amount of months a gp can prescribe tablets for, say I'm on long term prescription tablets and I want a supply for the next 12 months, is there any reason why my gp cannot give me a script for a 12 months supply???

In addition a pharmacist should not supply more than one months supply at a time for safety reasons.

vicwatson

palmcut wrote: »

In addition a pharmacist should not supply more than one months supply at a time for safety reasons.

So how can healthwave for example legitimately give me 6 months supply?

vicwatson

locum-motion wrote: »

The answer is in your question: Prescriptions are valid for a maximum of 6 months. Therefore the most a doctor can prescribe is 6 months. 6 months and 1 day after the doctor signs that piece of paper, your legal entitlement to possess that drug has expired.

And is there a point to this given the same medication is taken for last 10+ years??

Stheno

vicwatson wrote: »

And is there a point to this given the same medication is taken for last 10+ years??

Yes to ensure you are being checked regularly

palmcut

vicwatson wrote: »

So how can healthwave for example legitimately give me 6 months supply?

The pharmacy regulator the PSI state that more than one months supply should only be given in exceptional circumstances. There are many sensible health reasons for this.The prescribed strength or drug may be changed.A large supply of medication in the home may not be safe.The medication may not be stored properly in the home. (all pharmacies have recorded temperature and humidity controls)

locum-motion

vicwatson wrote: »

So how can healthwave for example legitimately give me 6 months supply?

That's a VERY good question.

I would wonder whether they can, to use your word, "legitimately" do so.

As palmcut has said, "The pharmacy regulator the PSI state that more than one months supply should only be given in exceptional circumstances."

If an interested person had specific knowledge of specific instances of six months' supply being given out, then that person could (and, probably, should) report that knowledge to the PSI. However, they will not act based on hearsay or even on newspaper articles in which the proprietor of that business specifically states that he is willing to do it.

vicwatson

Stheno wrote: »

Yes to ensure you are being checked regularly

One doesn't need to see a gp every 6 months, rather pick up a script for 20 euro at reception.

locum-motion

vicwatson wrote: »

And is there a point to this given the same medication is taken for last 10+ years??

Everything changes in time. Including the dose of a drug that is required to achieve the desired response in a given patient. Or which drug will achieve the best response.

It would be irresponsible in the extreme for a doctor to prescribe a drug for any patient for any reason and tell the patient "Ah sure it'll be grand; you'll be on that for the rest of your life; no need to ever bother your ar5e coming back for a check-up"

Have you been taking the same med, at the same dose, for 10+ years?

If so, have you been going back every six months or so for a check-up?

If so, has the Dr. said "That's grand, nothing has changed" each and every time?

If the answer to all of these is 'Yes', then you're either extremely lucky, or possibly, just possibly, the Dr. is missing something. Or doesn't give a damn.

vicwatson

locum-motion wrote: »

That's a VERY good question.

I would wonder whether they can, to use your word, "legitimately" do so.

As palmcut has said, "The pharmacy regulator the PSI state that more than one months supply should only be given in exceptional circumstances."

If an interested person had specific knowledge of specific instances of six months' supply being given out, then that person could (and, probably, should) report that knowledge to the PSI. However, they will not act based on hearsay or even on newspaper articles in which the proprietor of that business specifically states that he is willing to do it.

Long term medication is surely exceptional circumstances where the individuals requirement for that drug hasn't changed.

I might have misunderstood healthwave, in that maybe they do infact dispense only on a monthly basis, that first 4 months are delivered free and the 2nd two are 5€ per delivery.

myshirt

I'm fully for taking 1 month supply only, but absolutely on the basis that the pharmacist does not claim 3 dispensing fees and that any 3 for 2 offers they got off the supplier are not recharged to the HSE etc. Grinds my gears, and I think that's people's frustration. In some cases quite legitimate health reasons can be the basis for issuing one month only, but it is overshadowed by scumbag pharmacies engaged in unethical practices for their gain. And that is wrong.

vicwatson

Dont know about peoples professions, or not, here but with all respects it all seems like a swizz to me. Rather that go into my personal circumstances one can be assured my condition does not need the attention of a gp twice per year and I certainly don't need my hand held by a pharmacist every month.

All sounds draconian to be honest. Dont mean to be insulting to anyone.

lukegriffen

if you're on good terms with your doctor, you could ask for a future-dated prescription (ie. 6 months from now). I've got that several times, but mostly through a hospital doctor, as i rarely attend a gp. I've also got a couple of months supply at a time from a pharmacy, but it was a low-risk drug.

locum-motion

vicwatson wrote: »

Long term medication is surely exceptional circumstances where the individuals requirement for that drug hasn't changed...

Not sure if you're being deliberately obtuse.

"Exceptional circumstance" means "not the norm".

If it has become the "norm" that a pharmacy sends a patient six month's supply, twice a year, then that - by definition - is not an "exceptional circumstance", and the pharmacy quite simply should not be doing it.

Especially not if there is no interaction between the patient and the pharmacist where the patient can bring up any concerns they might have regarding side effects etc, or even where the pharmacist can ask "How are you? Is everything OK? Have you any concerns or questions?"

locum-motion

vicwatson wrote: »

Dont know about peoples professions, or not, here but with all respects it all seems like a swizz to me. Rather that go into my personal circumstances one can be assured my condition does not need the attention of a gp twice per year and I certainly don't need my hand held by a pharmacist every month.

All sounds draconian to be honest. Dont mean to be insulting to anyone.

I'm not asking you to go into personal* specifics, but with respect, every condition might need the attention of a GP.

That's why a patient with an ongoing condition needs to go to the GP every six months.

Let's say Joe Bloggs has a condition that has been stable and unchanging for 10 years. (Unlikely, but for the sake of argument, let's say he has.)

How does Joe know that his condition won't change in 3 months' time? In 6 months'? In a year?

So what that he's had 20 consultations where nothing has changed? Does that mean that nothing will change in the next 10 years? If we assume it does, and the doc says "Right, off you go, this prescription is valid for 10 more years, we'll see you then."

10 years later, Joe comes back and the doc discovers that Joe's been afflicted with some dreadful lurgy for about 9.5 years and has 2 weeks to live. That's 19 opportunities to catch the problem that have been wasted.

The law and the guidelines have evolved over time (much as the professions of medicine and pharmacy) as a balance between the patient's personal freedoms to make their own choices and the need to protect patients from those choices (I think we can take it as a given that patients frequently make bad choices).

Therefore, the LAW says that a prescription is valid for no more than six months, because - generally speaking - it's a good idea for people to get a check up twice a year.

And, also therefore, guidelines state that pharmacists should give out a month's supply at a time. Reasons for this include (but are not limited to):
The opportunity for either pharmacist or patient to ask questions/ check everything's OK
Patient safety/reduction in overdose or abuse potential/child safety etc
Prevention of wastage if medication is changed

*: My earlier use of the word 'you' was meant in a more general way. Perhaps I should have said "Has one been taking the same med, at the same dose, for 10+ years?"

locum-motion

lukegriffen wrote: »

if you're on good terms with your doctor, you could ask for a future-dated prescription (ie. 6 months from now). I've got that several times, but mostly through a hospital doctor, as i rarely attend a gp. I've also got a couple of months supply at a time from a pharmacy, but it was a low-risk drug.

A prescription is a legal document.

By definition under the law, it includes a date, and a doctor's signature. If either of those things is missing, it's not a prescription. It's a piece of paper with some meaningless words written on it.

That signature is the doctor's confirmation that - on that date - they had taken all the steps required to satisfy themselves that the treatment outlined on the prescription is the best treatment they can offer to that patient, taking account of all the information available to them.

If the date on the document is not the date on which the document was written, then the doctor has signed his/her name to a false document.

I'm not saying it hasn't happened. I'm just saying it would open up a legal can of worms if anything went wrong.

Going back to our old friend Joe Bloggs. Let's say he suffers from asthma and recurring chest infections. He gets a script for 6 months' worth of his inhalers, and the Dr also writes Clarithromycin on it to take just in case he gets an infection.
Then let's say the Dr gives him an identical script dated six months later.

In the meantime, Joe sees a mobile unit on the street advertising cholesterol testing. In he goes, and the friendly Dr gives him a prescription for a Statin to reduce his raging high cholesterol. Off he goes and gets the script filled, and repeats it each month.

11 months later, he feels a chest infection coming on, so he digs out that old 'pre-dated' prescription for the Clarithromycin, which he takes to the nearest (not his regular) pharmacy - "Sure it's only an antibiotic; no need to trouble Locum-Motion with it""

Joe then presents in the hospital some time later with vomiting, confusion and muscle pains, eventually being diagnosed with kidney failure due to rhabdomyolysis brought on by the interaction between his antibiotic and his cholesterol medication.

Who's responsible? I would argue that some responsibility lies with the non-regular pharmacist, who should ask about other meds Joe's taking, but even if he asks, he has been presented with what looks like a valid prescription that was written by the patient's regular doctor, so surely it includes all the meds Joe's on, doesn't it?

Once it emerges (perhaps in court, or perhaps even at an inquest) that the doctor had falsified the prescription, I suspect that it would be the doctor's insurers, not the pharmacist's, who would be paying out, And it would be the doctor who would face a Fitness To Practice inquiry, not the pharmacist.

By the way, this little story also illustrates why prescribing and dispensing are carried out by two separate professions, and also why it's a good idea to stick to the same pharmacy so that the records of what you've had are all in the one place.

locum-motion

vicwatson wrote: »

One doesn't need to see a gp every 6 months, rather pick up a script for 20 euro at reception.

That raises questions about whether the doctor is being diligent in the provision of care to the patient.
Suggests to me that the doctor cares more about what's coming in over the reception counter than about what's going out over it, to be honest.

sam34

This isn't something I've ever given great thought to. As a doc, I never issue prescriptions for more than 6 months and tbh most scripts I write are for far less than that as the patient will be coming back soon for a review.

As a patient however, when I was on regular meds, i always got a 6 month script from my GP then went to the pharmacy and collected the full 6 months in one go. Nobody ever questioned that or suggested I do otherwise. (And this wasn't just one pharmacy, due to the nature of my job and training back then I was moving around every 6-12 months so going to different GPs and pharmacies).

palmcut

sam34 wrote: »

This isn't something I've ever given great thought to. As a doc, I never issue prescriptions for more than 6 months and tbh most scripts I write are for far less than that as the patient will be coming back soon for a review.

As a patient however, when I was on regular meds, i always got a 6 month script from my GP then went to the pharmacy and collected the full 6 months in one go. Nobody ever questioned that or suggested I do otherwise. (And this wasn't just one pharmacy, due to the nature of my job and training back then I was moving around every 6-12 months so going to different GPs and pharmacies).

I would be very reluctant to dispense 6 months supply at a time particularly meds in the psychiatric area or any meds that would effect the brain.

vicwatson

locum-motion wrote: »

Not sure if you're being deliberately obtuse.

Not sure if you are being deliberately insulting by your use of the word obtuse

locum-motion wrote: »

I'm not asking you to go into personal* specifics, but with respect, every condition might need the attention of a GP.

That's why a patient with an ongoing condition needs to go to the GP every six months.

Let's say Joe Bloggs has a condition that has been stable and unchanging for 10 years. (Unlikely, but for the sake of argument, let's say he has.)

How does Joe know that his condition won't change in 3 months' time? In 6 months'? In a year?

So what that he's had 20 consultations where nothing has changed? Does that mean that nothing will change in the next 10 years? If we assume it does, and the doc says "Right, off you go, this prescription is valid for 10 more years, we'll see you then."

10 years later, Joe comes back and the doc discovers that Joe's been afflicted with some dreadful lurgy for about 9.5 years and has 2 weeks to live. That's 19 opportunities to catch the problem that have been wasted.

The law and the guidelines have evolved over time (much as the professions of medicine and pharmacy) as a balance between the patient's personal freedoms to make their own choices and the need to protect patients from those choices (I think we can take it as a given that patients frequently make bad choices).

Therefore, the LAW says that a prescription is valid for no more than six months, because - generally speaking - it's a good idea for people to get a check up twice a year.

And, also therefore, guidelines state that pharmacists should give out a month's supply at a time. Reasons for this include (but are not limited to):
The opportunity for either pharmacist or patient to ask questions/ check everything's OK
Patient safety/reduction in overdose or abuse potential/child safety etc
Prevention of wastage if medication is changed

*: My earlier use of the word 'you' was meant in a more general way. Perhaps I should have said "Has one been taking the same med, at the same dose, for 10+ years?"

You are completely forgetting that a patient will take a spin up to a GP only if they think their circumstances have changed, that's the nature of humanity. Most aren't proactive.

Anyway, thanks for all contributions, MODS please lock thread as I've learned enough.

vicwatson

locum-motion wrote: »

That raises questions about whether the doctor is being diligent in the provision of care to the patient.
Suggests to me that the doctor cares more about what's coming in over the reception counter than about what's going out over it, to be honest.

And this has been the way with 2 different gps over the last 10 years

vicwatson

sam34 wrote: »

As a patient however, when I was on regular meds, i always got a 6 month script from my GP then went to the pharmacy and collected the full 6 months in one go. Nobody ever questioned that or suggested I do otherwise. (And this wasn't just one pharmacy, due to the nature of my job and training back then I was moving around every 6-12 months so going to different GPs and pharmacies).

I think it's very much more common practice than not. IME anyway.

locum-motion

vicwatson wrote: »

Not sure if you are being deliberately insulting by your use of the word obtuse...

Not intending to be insulting, it just struck me as the appropriate word to describe a poster who appeared to be twisting what I said to match up with what they would like it to mean.

vicwatson

Well that wasn't the case.

locum-motion

fair enough. Apols for any offence.

Stheno

vicwatson wrote: »

I think it's very much more common practice than not. IME anyway.

My pharmacist will dispense six months in one go to save on dispensing fees dunno about antidepressants though

vicwatson

Not antidepressants

jumpguy

Renewal of scripts is a fantastic idea and getting no more than one months supply from the pharmacy is good common sense, except unfortunately this makes life more difficult for poorer patients who might not qualify for a medical card. 50 euro a pop to go to the GP (assuming you'll only ever go twice just to renew these scripts - I would guess this is not so common if you've a long-term issue requiring a long-term script), then dispensing fees and the cost of the drug itself. This is another example of the cost of primary healthcare standing in the way of safe and certainly best practise.

I'd personally be pretty grateful if my GP and pharmacy gave me and dispensed a script in a way that would minimise my costs, even if it might poor practise. As long as primary care remains as prohibitively expensive as it is for the average Joe there's an element of social injustice to it all.

Mrs OBumble

Anyone have up-to-date information about how the service described here a couple of years ago is going? http://www.thejournal.ie/online-pill-prescription-ireland-985429-Jul2013/

It strikes me that the type of monitoring that is needed for some long term medications (I'm specifically thinking about oral contraceptives) could be done equally well - and a lot more cheaply - by a practise nurse.

Frankly I've never seen a pharmacist in this country give advice about anything, except to sympathise that it's crazy that some things which are over-the-counter in the UK are prescription-only here. I recently took a hospital-issued script for a three-month supply into a local pharmacy, who were only too happy to issue the whole lot at once -I declined 'cos I'm not sure if I want to take it or not.

angeldelight

The Lloyds online doctor service is still running. Anecdotally I would only see the occasional prescription from them though. not sure whether that's due to a lack of awareness that the service is available or because many women prefer to be monitored albeit they'd prefer it didn't cost as much?

palmcut

"in the case of a repeatable prescription, if a patient were to seek multiples of the quantity specified by the prescriber, the pharmacist should only agree to such supply with caution and then only in exceptional circumstances.
In this context the pharmacist should also be mindful of their obligations to have regard to the rate of dosage specified on the prescription(4) and the fact that such supplies may not be appropriate for certain patients or medicines.
Furthermore the necessity that the medicines concerned be appropriately stored in the patient's home and the need to avoid wastage must also be taken into account."

(4) Regulation 7(2) of the Medical products(Prescription and Control of supply) Regulations 2003, as amended.

The above quote is taken from the Pharmacy practice Guidance issued by the PSI which is the pharmacy regulator. This guidance was issued in May 2015.