Archived: Medical Prescription Services Limited

Updated 27 December 2018

Medical Prescription Services Ltd. develops patient group directions (PGDs), written instructions which allow healthcare professionals to supply and administer specified medicines to pre-defined groups of patients, without a prescription. The PGDs are made available for use in community pharmacies through two community pharmacy trade associations, and allow pharmacists to offer an extended range of services such as travel vaccines to their customers. The service works closely with the trade associations to ensure that the PGDs are accessed only by pharmacists who are suitably trained, and they provide templates for recording the consultations. The service does not provide direct patient care, and medicines are supplied and administered under the governance arrangements of the community pharmacies.

Our inspection team was led by a member of the CQC medicines optimisation team. The team included a second member of the medicines optimisation team.

Before the inspection we reviewed information from the service. During the inspection we spoke to the Registered Manager who was the medical director, a member of the management team and a pharmacist who developed the PGDs. We also spoke to two pharmacists about their experience of using PGDs developed by Medical Prescription Services Ltd., but we did not inspect the provision of patient services as they are separately regulated.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 27 December 2018

We carried out an announced comprehensive inspection on 10 October 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.  The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.  The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low.

Are services caring?

We were unable to assess this question as the service did not provide direct patient care.

Are services responsive?

We were unable to assess this question as the service did not provide direct patient care.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations

Medical Prescription Services Ltd. develops patient group directions (PGDs), written instructions which allow healthcare professionals to supply and administer specified medicines to pre-defined groups of patients without a prescription. The service does not provide services directly to patients, but supplies a range of PGDs for use in community pharmacies. It does this via two community pharmacy trade associations which make them available to their members. Individual pharmacists who have completed the appropriate training can use the PGDs to extend the range of services available to their patients.

The medical director is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• The provider risk assessed the treatments offered and did not develop patient group directions for medicines which were not suitable for supply by this route
• There was an effective system for recording and acting on significant events
• The provider carried out audits which led to quality improvement
• Patient group directions were only made available to pharmacists who were suitably trained
• There was a process for obtaining patient consent, and for informing the patient’s usual GP of treatment
• Staff provided information and support to the pharmacists who used the patient group directions
• The provider worked closely with partners to develop the range of services available
• There was a range of policies which were reviewed regularly and available to staff
• The service did not need access to patient information and ensured that it was redacted before information was shared with them

There were areas where the provider could make improvements and should:

• Review the monitoring of patient safety alerts to ensure the new process is fully implemented
• Review the systems for ensuring that they have staff with the current knowledge and experience to support the full range of patient group directions they produce.
• Review the process for ensuring that staff have the appropriate indemnity arrangements

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice