Private prescriptions

In 2002-3 there were 158.5 million community PBS prescriptions -132.7 million (83.7%) to concessional patients (pensioners, seniors, repatriation health beneficiaries) and 25.9 million to general patients. In addition, about 42.1 million prescriptions did not attract a subsidy - 26 million below the co-pa)unent threshold and about 16.1 million private prescriptions, that is, prescriptions for drugs not listed on the PBSorRPBS, for which the consumer pays the full cost of the medicine. Thus 79.0% of prescriptions were for items subsidised through the PBS. 

This chapter covers similar material to Chapters 2 and 3, focusing on non-NHS supply, including the supply of medication against private prescription forms and the supply of medication via oral and written requisitions. 

Prescription-only medicines (POMs) (see Section 1.3.3) are usually obtained on the authorisation of a valid prescription form (either an NHS or a private prescription form) written by a recognised prescriber registered in the UK and presented at a registered pharmacy (although exceptions to this do exist, for example, dispensing doctors (see Section 2.3.1), in-patient hospital supply (see Section 4.2.1) and emergency supply at the request of a patient (see Sections 7.2 and 7.3)). 

In addition to any clinical and patient-specific considerations that need to be taken into consideration when supplying an item against a prescription, there are a number of additional restrictions that are placed upon certain items being prescribed (and therefore dispensed) on an NHS prescription form. It should be remembered that these restrictions are based upon the nature of the item and are specific to NHS prescription forms (i.e. the item may be prescribed on a private prescription form - see Chapter 5). 

Doctors may prescribe any licensed (i.e. products with a UK marketing authorisation) or unlicensed medicinal product on an NHS prescription form (unless the item is specifically prohibited by the relevant Drug Tariff - see Section 2.6). In addition they may prescribe any licensed or unlicensed product on a private prescription form (see Section 5.1). NHS prescriptions written by doctors for dispensing in the community will usually either be written by general practitioners (GPs) or (less commonly) by hospital doctors. Prescriptions for patients written by hospital doctors that are to be dispensed within the hospital are written on hospital-specific forms (see Section 4.2). 

Dentists are regarded as practitioners and can legally prescribe any licensed or unlicensed medicinal product on a private prescription form (see Section 5.1), although they are ethically expected to limit their prescribing to within their individual area(s) of competence. 

This section contains examples of NHS prescription forms for dispensing within a community pharmacy. Although a number of different examples are used in this section, from a variety of different prescribers, all prescription forms can be addressed by using a standard systematic approach (see Section 3.3 for NHS prescription forms, and Section 5.4 for non-NHS (private) prescription forms). 

The dispensing procedure for non-NHS (private) prescriptions is similar to the dispensing procedure followed with NHS prescriptions (see Section 3.3). The main differences are that in most cases, an entry detailing the supply will always need to be made in the prescription-only medicines register (see Section 5.1.4) and that the pharmacist or pharmacy technician will not need to check that the item is allowed on the NHS. In summary, the procedure to be followed is as follows ... 

Check the legality of the non-NHS (private) prescription form (see Section 5.1.1). 

The requirements as to what needs to be present on a non-NHS (private) prescription form are similar to the requirements of an NHS prescription form (see Section 2.2.7). In summary, the necessary pieces of information are ... 

An indication as to the prescriber type. On an NHS prescription form, the prescriber type is clearly identifiable. However, non-NHS (private) prescriptions will not be on specific prescription forms (except the private prescribing of Schedule 2 and Schedule 3 controlled drugs - see Section 6.3.3). Therefore, the identification of the prescriber is not always obvious. There needs to be something on the prescription to identify the prescriber type and usually, this will be the prescriber s qualifications (e.g. MB ChB - see Appendix 1). 

Non-NHS (private) prescription forms will need the following pieces of information to be present before the prescription can be dispensed ... 

With repeat prescribing on a non-NHS (private) prescription form, the prescriber will annotate with the number of times that the prescription may be repeated (for example, repeat X 3 ). In this example, the prescription may be dispensed a total of four times (i.e. one initial dispensing and then three repeats). On the first, second and third dispensing, the prescription may be returned to the patient as they are not obliged to receive subsequent supplies from the same pharmacy (see Section 5.1.7). However, many patients will return to the same pharmacy and so may ask you to hold the prescription on their behalf. 

In addition, it is important not to confuse repeatable non-NHS (private) prescriptions with instalment dispensing for addicts (see Section 6.3.5), where the NHS prescription is only dispensed once although the dispensing takes place in instalments. 

If a non-NHS (private) prescription form stated that the medication may be repeated three times, the item may be supplied a total of four times (i.e. the one original dispensing, followed by three repeats). 

After the last dispensing, the prescription will be retained by the dispensing pharmacy. The exception to this would be if there were, for example, two items on the prescription form and only one of those was repeatable. If the repeatable item were on the non-NHS (private) prescription form on its own, the form would be returned to the patient. However, as there is a non-repeatable item on the form, the form must be retained by the dispensing pharmacy. Therefore in rare cases such as these, the patient will have to return to the same pharmacy to obtain any repeats of the repeatable medication. 

All supplies of medication will need to be entered in the prescription-only medicines register. However, if the supply is a repeat (and the pharmacy where the repeat is being dispensed has previously dispensed the medication), it is sufficient for the new entry in the prescription-only medicines register (which will have a new reference number) to refer to the details of the older entry (by referring to the older entry s reference number). Therefore, it is useful when stamping a non-NHS (private) prescription form... 

Non-NHS (private) prescription forms may be repeatable. The first dispensing must take place within six months from the date on the prescription. 

As discussed above (Section 5.1.1) it is necessary to identify the prescriber to ensure that he or she is an individual who is legally allowed to prescribe item(s) on a non-NHS (private) prescription form. Non-NHS (private) prescription forms may be written by ... 

Remember, that unlike prescribing on the NHS, prescribers are not limited to the items that they may prescribe on a non-NHS (private) prescription form. However, all prescribers are ethically obliged to only prescribe within their area of competence. 

Therefore, it would not be uncommon for a dentist to prescribe analgesic medication on a non-NHS (private) prescription form for a patient under his care, even if that item was not in the Dental Practitioners Formulary (see Section 3.2.2). However, it would be unusual for them to prescribe, for example, medication for the treatment of schizophrenia. If a pharmacist received a non-NHS (private) prescription form from a dentist for medication to treat schizophrenia, the pharmacist should query the supply with the prescribing dentist to confirm that the dentist is prescribing within their area of competence. 

The process of clinical checking for a non-NHS (private) prescription is the same as for NHS prescriptions. This has been covered in Section 3.3.4. Remember that the following points will need to be covered ... 

Once it has been established that the item(s) on the prescription form are safe and suitable for the patient, the label(s) can be generated and the item(s) dispensed. The same procedure can be followed when dispensing non-NHS (private) prescription items as for NHS prescription items (see Section 3.3.5). 

However, in both cases it is still considered good practice to make an entry (as it would be for non-NHS (private) prescriptions or wholesale dealing of non-prescription-only medicines (i.e. for GSL/P medicines)). 

Unlike NHS prescription supply (see Section 3.3.8), the patient or the patient s representative will pay you for the entire cost of the medication (plus a mark-up cost and dispensing fee charged by the pharmacy to cover their costs). Therefore, non-NHS (private) prescription forms do not need to be sent off to the NHS Business Services Prescription Pricing Division (or equivalent) for reimbursement at the end of each month (except with the private prescribing of Schedule 2 and Schedule 3 controlled drugs see Section 6.3.3). 

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