Pharmacy First myth busting series (#7)

This is the seventh of a series of articles to tackle some of the misconceptions around Pharmacy First. The articles will cover a variety of aspects of Pharmacy First and aims to myth bust, to increase understanding of the service.

Under the urgent supply of repeat medicines strand of Pharmacy First, I can supply a reasonable quantity that is clinically appropriate and that lasts until the patient is able to see a prescriber to obtain a further supply of codeine tablets.
Wrong! Codeine containing products (including co-codamol 30mg/500mg) are Schedule 5 Controlled Drugs. Therefore legislation limits the supply to five days for Controlled Drugs. This restriction also applies to other Schedule 4 and 5 Controlled Drugs such as dihydrocodeine and testosterone.

Codeine and related products are medicines that can be subject to abuse; pharmacists should always access the patient’s national care record or their GP record via GP Connect Access Record functionality and check for previous supplies. If the patient refuses to provide consent to view their clinical record, consideration should be given as to whether it is clinically appropriate to make a supply.

If I receive an Urgent medicines referral for a medicine liable to misuse, it is always ok to make a supply under Pharmacy First because I have received an electronic referral for this medicine.
Wrong! It is for the pharmacist to determine if a supply is appropriate, not the person who issued the referral. Pharmacists should check if the Integrated Care Board has issued guidelines to local GP OOH services on the supply of medicines liable to misuse. This information should ideally be included in the pharmacy’s SOP for the service.

The supplying pharmacist needs to balance the potential for misuse versus the need and the impact on the patient of not supplying a medicine or appliance. A limited supply of one or two days could be considered if appropriate, to allow the patient time to access their GP practice.

If I receive an Urgent medicines referral for a Controlled Drug which cannot be supplied under emergency supply regulations (e.g. Schedule 1, 2 or 3 Controlled Drug), I cannot claim payment for a Pharmacy First consultation.
Wrong! If it is not possible to make an emergency supply but the pharmacist believes that there is a genuine patient need to obtain a supply of their medicine, the pharmacist must ensure the patient is able to speak to another appropriate healthcare professional by either:

• Referring the patient to their own general practice; or
• By contacting a local out of hours provider.

An entry should be made in the Pharmacy First IT system and a consultation fee can be claimed in this instance.

View additional myths on our Pharmacy First myth busting page