Practices should find it relatively easy to achieve maximum points for the new contract’s medicines management indicators, as Dr Nigel Watson explains

Most practices have spent considerable time and effort ensuring that they are ready for the challenges of the 10 clinical areas of the quality and outcomes framework of the new GMS contract. These clinical areas are worth 550 points out of a total of 1050 on offer.

Practices also need to spend time ensuring that they gain maximum points in the non-clinical areas, and this should be easier to achieve than in the clinical areas.

Medicines management

The medicines management section of the organisational indicators is worth 42 points, or the equivalent of £3150 for the average practice of 5891 patients in 2004/5 and £5040 in 2005/6. The section should lead to improved prescribing systems in practices and in turn the following benefits should follow:

  • Improved quality of prescribing
  • Improved patient convenience and access to medicines they need
  • Improved patient safety
  • Better and more appropriate use of relevant professional and practice staff skills and time
  • Decreased GP workload
  • Optimum efficiency in the processes involved
  • Increased patient/carer involvement and responsibility
  • Better use of NHS resources.1

Medicines 1

This indicator refers to surgery consultations and does not include home visits. It is essential that all prescribers in the practice – nurse prescribers as well as GPs – know what medication a patient is taking. The practice should have a description of where prescribed medication is recorded.

Medicines 2

Good Medical Practice for General Practitioners, published by the RCGP, states that an excellent doctor "has up to date emergency equipment and drugs,” and that anaphylaxis constitutes an emergency that may occur on practice premises.2 The practice should produce a list of equipment and drugs that are available to enable a practice to deal with anaphylaxis. The equipment could include:

  • IV cannulas
  • IV fluids
  • Nebuliser
  • Oxygen.
Table 1: Medicines management indicators
Indicators Points
Medicines 1
Details of prescribed medicines are available to the prescriber at each surgery consultation 2
Medicines 2
The practice possesses the equipment and in-date emergency drugs to treat anaphylaxis 2
Medicines 3
There is a system for checking expiry dates of emergency drugs on at least an annual basis 2
Medicines 4
The number of hours from requesting a prescription to availability for collection by the patient is
72 hours or less (excluding weekends and bank/local holidays)
Medicines 5
A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed four or more repeat medicines, standard 80% 7
Medicines 6
The practice meets the PCO prescribing adviser at least annually and agrees up to three actions related to prescribing 4
Medicines 7
Where the practice has responsibility for administering regular injectable neuroleptic medication, there is a system to identify and follow up patients who do not attend 4
Medicines 8
The number of hours from requesting a prescription to availability for collection by the patient is
48 hours or less (excluding weekends and bank/local holidays)
Medicines 9
A medication review is recorded in the notes in the preceding 15 months for all patients being
prescribed repeat medicines, standard 80%
Medicines 10
The practice meets the PCO prescribing adviser at least annually, has agreed up to three actions
related to prescribing and subsequently provided evidence of change

Drugs could include:

  • IV/IM steroids
  • IV/IM antihistamine
  • Adrenaline.

Although GPs may have access individually to these drugs, it is worth considering having a box set aside specifically for anaphylaxis, which includes the drugs required as well as a chart with instructions on what to do and the drug doses to use. This box should be readily available to everyone in the practice.

There is an excellent educational resource on anaphylaxis at:

Medicines 3

Good Medical Practice for General Practitioners states that it is unacceptable for GPs to have drugs that are out of date.2

Practices should establish a system to ensure that all drugs held on the premises or in doctors’ bags are in date, and it is a good idea to computerise this information. By using a spreadsheet it is simple to establish recall dates, and a regular check will identify drugs that are about to become out of date. It may be best to make one member of staff responsible for the system.

Medicines 4

Practices should have a repeat prescribing system that enables patients to collect a prescription within 72 hours of making the request. The practice leaflet should give full details of the service the practice provides; at the assessment visit, practices will need to demonstrate this. They must also have a written policy on the topic, which practice staff may be asked about at assessment.

Medicines 5

Repeat prescribing accounts for 60-75% of all prescriptions written by GPs in the UK, and for about 80% of their costs.1 Approximately 50% of all patients registered with a practice will be receiving a repeat prescription. 3 An average GP will generate 200 repeat prescriptions per week.4 Medication review is important to assess whether there is a continuing need for medication and to see if the condition for which the medication is prescribed may need monitoring. This indicator relates to patients who are being prescribed four or more medications.

The medication review does not need to take place face to face; in many practices it takes place when repeat medication is requested. It can be carried out by GPs, nurse prescribers and pharmacists.

The review must be recorded, and the Read code 8B3V. is used for this.

Medicines 6

If the PCO prescribing adviser is unable to visit the practice within the year and there has been no contact with another PCO-recognised source of prescribing advice in that time, the practice is exempt from this indicator.

Medicines 7

The number of patients for whom an individual practice is responsible for administering injectable neuroleptic medication (depixol, modecate and clopixol) will be small; however, the consequences of failing to follow up patients who do not attend can be serious.The practice should therefore identify these patients and implement a robust call and recall system. It is a good idea to work closely with the patient’s mental health worker.

Medicines 8

Practices can gain three quality points for a repeat prescribing system that enables the patient to obtain a prescription within 72 hours from request to collection (see Medicines indicator 4). Medicines indicator 8 offers an additional six points for a 48-hour repeat prescription service. For the average practice these nine points are worth £675 in 2004/5, rising to £1080 in 2005/6.

Medicines 9

This indicator is an extension of medicines indicator 5, for which practices are able to gain seven points.Whereas indicator 5 relates to medication review of patients who are receiving four or more repeat prescriptions, indicator 9 calls for medication review of all patients who receive a repeat prescription; the standard set for this is 80%. Achieving this indicator brings another 8 points.

The key to achieving these indicators is to have a well run and comprehensive repeat prescribing system in place. Consider using macros to add the Read code for review automatically as this will prevent points being lost if anyone forgets the code.

Medicines 10

For medicines indicator 6, practices can gain four points by meeting the PCO’s pharmaceutical adviser and agreeing three actions. Medicines indicator 10 offers four more points if these actions are achieved.

It is important to make sure that the actions are relevant and important to the practice – you are more likely to achieve them if they are.


The medicines management section provides the opportunity to obtain maximum points for little additional work. Practices need to establish well run systems, for example for repeat prescribing, and to ensure that all essential data are recorded.


  1. National Prescribing Centre. Saving time, helping patients. A good practice guide to quality repeat prescribing. Liverpool: National Prescribing Centre, January 2004.
  2. Royal College of General Practitioners and General Practitioners Committee of the British Medical Association. Good Medical Practice for General Practitioners. London: RCGP, September 2002.
  3. Harris C, Dajda R.The scale of repeat prescribing. Br J Gen Pract 1996, 46: 649-53.
  4. Making a difference. Reducing the burden on General Practitioners, 2nd report. London: Cabinet Office, 2002.

Guidelines in Practice, April 2004, Volume 7(4)
© 2004 MGP Ltd
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