Under current legislation the NHS ceases to have responsibility for the medical care of patients when they leave the UK.  GPs are not required by their terms of service to provide ‘just in case’ prescriptions for the treatment of a condition that is not present and may arise while the patient is abroad.

Travelling out of the country for less than 3 months 

The NHS rules permit GPs to issue prescriptions for up to three months’ supply of a patient’s usual medication to cover temporary periods abroad. Prescribing of any medication for use outside the UK is at the discretion of the GP, and only when safe to do so. Some medications require frequent monitoring and may not be prescribed if there are safety concerns.

Travelling out of the country for more than 3 months 

If a person is going to be abroad for more than 3 months, they need to find an alternative supply of their medication as soon as possible.

Patients residing abroad for a period of more than 3 months will be removed from our patient list in line with NHS guidance but are able to re-register on return to the UK. 

Patients should not seek medication for themselves while they are abroad, and relatives should not request medication on their behalf as this constitutes NHS fraud.

Prescriptions for medicines in case of illness while abroad 

GP’s may prescribe NHS prescriptions for the treatment of exacerbations of pre-existing illnesses e.g. antibiotics for patients who have frequent infections secondary to an underlying lung condition.

GPs are not required by their terms of service to provide prescriptions for the treatment of any condition that is not present at the time of departure, or for any condition that may occur whilst the patient is abroad or arising because of travel abroad. This includes:

• ‘just in case’ medications for treating travel related illnesses e.g. travel sickness, diarrhoea, and requests for medication due to travel abroad
• postponement of menstruation
• travel sickness
• treatment of jet lag

These situations are not covered by the NHS. The GP is not obliged to provide treatment, but if they feel it is clinically appropriate, and the medication can be self-administered safely without medical assessment, a private prescription will be issued at a cost of £20. This does not include the cost of the medication.

• We do not prescribe medication for fear of flying, or to help sleep during flights (see below)

Patients should be aware that some drugs commonly prescribed in the UK may be illegal in certain countries and you should check with that country’s embassy before you travel. Some countries and some medicines (particularly those controlled under the Misuse of Drugs legislation in the UK) require additional measures before taking medicines abroad.

For further about travelling abroad with medication information see:

https://www.nhs.uk/common-health-questions/medicines/can-i-take-my-medicine-abroad/

https://www.nhs.uk/using-the-nhs/healthcare-abroad

https://www.gov.uk/take-medicine-in-or-out-uk

Patients occasionally request a prescription for benzodiazepine drugs, such as diazepam, lorazepam and temazepam, or zopiclone, to help them overcome their fear of flying or to help induce sleep during flights. These drugs are classed as controlled drugs because they can cause addiction problems and may be abused, but they also have side effects, which in an emergency, could prove very dangerous. The doctors at Holmes Chapel Health Centre have therefore made the decision to stop prescribing medication for the management of fear of flying or to aid sleep during flights.

When making this decision we have considered several factors:

1. Benzodiazepines are requested by patients who experience anxiety whilst flying because they cause relaxation. They can also cause drowsiness or induce sleep and this could have serious consequences in the rare event of an in-flight emergency. Reduced awareness and reaction times, impaired concentration or the ability to follow instructions, could put yourself or your fellow passengers at risk.
2. The sleep induced by benzodiazepines is an unnatural, non-REM sleep. Movements during this type of sleep are reduced, increasing the risk of developing blood clots (DVT) which are potentially fatal. This risk further increases for flights with a duration exceeding 4 hours.
3. In common with alcohol, patients respond differently to benzodiazepine drugs. Some become aggressive rather than more relaxed or sedated, and others become disinhibited and behave abnormally, causing safety issues for all passengers, and potential prosecution.
4. Benzodiazepines are only licensed for short-term use for treating a crisis in generalised anxiety. This does not include fear of flying occurring in isolation. National prescribing guidelines advise doctors against prescribing diazepam or other benzodiazepines for the management of phobias, including fear of flying. A doctor prescribing diazepam against this guidance would be taking a significant professional risk.
5. In several countries, benzodiazepines, including diazepam, are classed as illegal drugs. Anyone found in possession of an illegal substance would have their drugs confiscated and face prosecution.
6. Benzodiazepines can stay in your system for some time, which may affect performance and reaction times after landing. In occupations where random drug testing is a requirement, these medications can cause positive results.

We appreciate that a fear of flying can be very distressing and debilitating. However, we cannot make exceptions to this policy, even if patients have been prescribed benzodiazepines in the past without experiencing any problems.

A more effective and longest lasting way of dealing with fear of flying is to enrol on a Fear of Flying Course, provided by a number of airlines.

Fear of Flying Courses Easy Jet

www.fearlessflyer.easyjet.com

Tel: 0203 8131644

British Airways

http://flyingwithconfidence.com/

Tel: 01252 793 250

Having a repeat prescription means you can obtain your prescription without having to see your GP.

It is important that the use of medication is monitored and repeat prescriptions are reviewed at least annually, to ensure that the medication is still appropriate. This process requires your GP or practice pharmacist to check any necessary blood tests, BP checks etc have been done. If they have not, this may delay your repeat prescription. Please ensure you leave plenty of time before ordering your medication so that any delays do not leave you without medication.

In line with NHS guidelines the practice prescribes a 28 day supply of medication. If you require a supply to last over a holiday period please inform us when making your request so that this can be authorised by your GP. Please note, if you have outstanding monitoring checks such as blood tests or BP checks your holiday request may be declined. 

All patients who live in Goostrey, and any patient who lives more than one mile from a pharmacy, are eligible to use the Dispensary to collect their medication. Patients using the Dispensary will be sent a text message when their medication is available for collection. For all repeat prescriptions timescales please allow 1 week from making the request. Please please allow extra days if affected by Bank Holidays.

For all non-dispensing patients prescriptions are processed electronically via EPS. If you have nominated a pharmacy your prescription will be sent there for collection, but if you have not yet nominated a pharmacy you may use any pharmacy. A paper token or prescription is not required and will no longer be issued. 

The dispensary operates a free delivery service for housebound patients. Delivery is also provided by other pharmacies - ask at your pharmacy for further details.

How to undertake this request: 

• Order your repeat prescription online
• Use your current repeat prescription slip or complete a request form, available in the foyer or at the dispensary.
• Place your request form in the collection box in the health centre, post it to the surgery.
• Send an email to: hchcscripts@nhs.netor hchcdispensary@nhs.net if a dispensary patient - please only use these to contact the dispensary about prescribing queries.

Dispensary Leaflet

There are several reasons why patients may choose to use the dispensary:

• Patient convenience: one stop health care –medication may be collected before leaving the Health Centre.
• Safe and efficient service: the dispensary uses the same computer system as your doctor. This allows rapid transfer of information, reducing your waiting time, and enables your prescription to be checked against your medication and medical history.
• Helping us help you: every time you use the dispensary you generate income for the practice. This helps us provide extra services for all our patients.
• Dispensary delivery service: available to patients who have difficulty collecting their medication.

The Holmes Chapel Health Centre Dispensary can be contacted directly on 01477 533100 then listen to the phone options for the Dispensary.

It is the patient’s choice whether or not to use the dispensary; alternative local pharmacies are available to all of our patients.

Download the NHS App, or open the NHS website in a web browser, to set up and log in to your NHS account. Owned and run by the NHS, your NHS account is a simple and secure way to access a range of NHS services online.

Help with NHS costs

In England, around 90% of prescription items are dispensed free. This includes exemptions from charging for those on low incomes, such as:

• those on specific benefits or through the NHS Low Income Scheme
• those who are age exempt
• those with certain medical conditions
• More information is available at NHS Choices

The Department of Health and Social Care has announced that NHS prescription charges will be frozen for the first time in 3 years to help with the cost of living.

Charges for prescriptions will remain at £9.90 for a single charge or £32.05 for a 3-monthprescription prepayment certificate (PPCs). 12 month PPCs will remain at £114.50 and can be paid for in instalments, meaning people can get all the medicines they need for just over £2 a week.

The prescription freeze will also apply to NHS wigs and fabric supports. The current exemption categories remain unchanged and the NHS Low Income scheme remains in place.

These charges apply in England only. In Northern Ireland, Scotland and Wales prescriptions are free of charge.

• Prescription (per item): £9.90
• 12-month prepayment certificate (PPC): £114.50
• 3-month PPC: £32.05
• HRT only pre-payment certificate £19.80

If you are exempt from paying for your prescription, or if you have purchased a prepayment certificate, it is necessary that you sign the back of your prescription form, indicating why you are exempt. 

There has always been an obligation for staff to check exemption status, but occasionally this is overlooked.  Signing is necessary to reduce the number of fraudulent exemption claims. Within the Dispensary we have asked our reception staff to ensure all patients who are exempt, including those with a prepayment certificate, sign the back of their prescription form. Unless they do this they must pay the prescription fee.

• When you sign the back of a prescription form, you are confirming free entitlement to NHS prescriptions. If this is not true, signing the form is an act of fraud and you will be liable to a fine of £100 to the Prescription Pricing Authority, plus the outstanding cost of any unpaid prescription fees.
• If you do not sign the back of the prescription form, you will have to pay a prescription fee.

Please be aware that when you pay a prescription fee the money is passed on to the NHS. It is not retained by the practice, but we are required to ensure the correct fees are collected. However, if we fail to charge a prescription fee when this is due, the practice is held responsible for this payment, and the NHS deducts the fee from practice income. Obviously, this is not something the practice can afford, and for this reason you may be asked to show current proof of exemption, even if you have shown this before.

If you are unable to provide proof of exemption when you collect your medication, we will hold it for seven days until you can return with the necessary evidence. If you need your medication urgently, you have the option of paying the prescription fee or taking your prescription elsewhere. Provided you return with 48 hours with proof of exemption your prescription fees will be refunded.  

If you think you should be entitled to free prescriptions check on line at Free prescriptions booklet (V3) 09.2018.pdf (nhsbsa.nhs.uk)

If you would like to know if you could save money by purchasing a prepayment certificate visit Save money with a prescription prepayment certificate (PPC) - NHS (www.nhs.uk)

The practice uses the Electronic Prescription Service (EPS). This is an NHS service that allows your prescriptions to be sent to a pharmacy or dispenser of your choice. They will be signed, sent and processed digitally, without having to be handled by you.

What does EPS mean for you?

• If you use a pharmacy to collect your medication you can order online or via your pharmacy and you will not have to visit the Health Centre to collect your prescription; it will be sent electronically to the place you choose, saving you time.
• If you have stable chronic health condition you can set up a regular prescription order, so that the only time you need to visit the Health Centre is when you need to see a GP or nurse.
• You can choose to collect your medicines from any pharmacy or dispensing service in England. If you are on regular medication, it will always be quicker for you to nominate a pharmacy so that your prescriptions can be sent there to be dispensed before you collect your medication, but you can nominate a pharmacy local to where you work or shop, or choose to use an online pharmacy.
• Your GP will use EPS every time you require a prescription, no matter how often this is. Your prescription will be sent to the secure NHS database, where it will remain until you ask a pharmacy to dispense it.
• The software required to download prescription information from the NHS database is only available to pharmacies at present. If you are a dispensing patient will continue to benefit from a one-stop dispensing service that enables you to order and collect your medication without having to handle your prescription.

How do you use EPS?

• When a prescription is generated by a doctor using EPS it is given a unique code which is sent electronically to the NHS database, known as the NHS 'spine'. EPS allows you to obtain your prescriptions from any pharmacy in England. You can choose to have your prescriptions sent automatically to a preferred pharmacy each time – this is known as your "nominated" pharmacy.
• If you have nominated a pharmacy the prescription code will automatically be sent there to enable the pharmacy to start the dispensing process and provide your medication as quickly and efficiently as possible, without the need for paper prescriptions or tokens. 
• If you have not yet nominated a pharmacy you can still use EPS. Your prescription will be sent electronically to the NHS 'spine' where it will remain until you ask any pharmacy in England, including an online pharmacy, to retrieve the information in order to dispense your medication.
• To use a pharmacy that you have not nominated you will need to provide them with details to confirm your identity so they can securely retrieve your prescription details from the NHS spine. This will be your name, date of birth and NHS number. You can find your NHS number on your medical card, your prescription reorder form, and it is available on the NHS App which you can also use to order your prescription online and find health information. 
• Once your prescription code has been sent to your nominated pharmacy, or if have asked a pharmacy to download your prescription code from the NHS spine by a pharmacy you cannot go to any other pharmacy for the same prescription until it has been 'released' back to the spine by the pharmacy.
• You no longer need a paper prescription or token to obtain your medication from a pharmacy, and for this reason, and to help save resources for the planet, the practice no longer issues paper tokens other than in exceptional circumstances.
• You can only use EPS to obtain your medication from any pharmacy in England. If you want to use a pharmacy in Scotland, Wales, or Northern Ireland you will still require a paper prescription. Paper prescriptions will therefore only be issued very special circumstances, and not on demand. 
• I the unlikely event that a pharmacy is unable to locate your prescripton on the NHS spine using your name, DOB and NHS number a unique code can be provided which the pharmacy may use. In exceptional circumstances it may be necessary to issued a paper 'token' which includes all the information on your electronic prescription including your unique code for use by the pharmacy.
• The software for EPS is currently not available for use with practice dispensaries. We will therefore continue to issue paper prescriptions for patients using the Dispensary until this situation is updated, but for all other patients paper prescriptions will only be issued in special circumstances
• Click NHS App to read more and download the App.

How do I add or change my nomination?

• You may have already nominated your usual pharmacy, possibly without realising it, and this will be recorded in your GP medical records
• You can ask any pharmacy or dispensing appliance contractor that offers EPS, or staff at the Health Centre, to add your nomination for you. You may have already nominated your usual pharmacy, possibly without realising it, and this will be recorded in your GP medical records.
• If you want to change or cancel your nomination speak to any pharmacist or our practice staff. Tell them before your next prescription is due or your prescription may be sent to the wrong place.
• Once your prescription has been sent to the NHS spine you can ask any pharmacy to retrieve the information in order to dispense your medication. If you this isn't your nominated pharmacy you will need to provide the pharmacy with details to confirm your identity - this will be your name, date of birth and NHS number. You no longer need a paper prescription or token to obtain your medication from a pharmacy, and for this reason, and to help save resources for the planet, the practice will no longer be issuing paper tokens.You can find your NHS number on your medical card, your prescription reorder form, and it is available on the NHS App which you can also use to order your prescription online and find health information. Click NHS App to read more and download the App
• We will continue to issue paper prescriptions for patients using the Dispensary until software is available, but otherwise paper prescriptions will only be issued in special circumstances

Is EPS reliable, secure and confidential?

• Yes. Your electronic prescription will be seen by the same people in GP practices, pharmacies and NHS prescription payment and fraud agencies that see your paper prescription now.
• Sometimes dispensers may see that you have nominated another dispenser. For example, if you forget who you have nominated and ask them to check or, if you have nominated more than one dispenser.

Dispensing patients

• All patients living in Goostrey, and anyone who lives elsewhere but more than one mile from a pharmacy is permitted under NHS rules to obtain their medication from the Dispensary within the Health Centre.
• As a dispensing patient you are not required to nominate a pharmacy, as your prescription will automatically be sent to the dispensary. In fact, EPS will not make any difference to your current prescription service as this is already effectively ‘paperless.’ Although paper prescriptions will continue to be generated and processed within the dispensary, all medication will be dispensed without the need for you to handle your prescription.

Prescription team

Prescriptions for all patients will continue to be generated by our prescription team within the Dispensary. Prior to EPS being available it has been necessary to collect a paper prescription from the Dispensary, resulting at times in a long wait and frustration. Now that all prescriptions are sent electronically to your chosen pharmacy or dispenser the footfall within the Dispensary should be greatly reduced. In this way, EPS will enable us to improve the service we are provide to all patients using the Dispensary.

Ordering your prescription

EPS will ensure your prescriptions are sent electronically to the pharmacy or dispenser of your choice, but there is no change to how you order your prescriptions:

• Order your repeat prescription online using patient access, accessible via the practice website or the NHS App.
• Use your current repeat prescription slip or complete a request form, available in the foyer or at the dispensary.
• Place your request form in the collection box in the health centre, post it to the surgery.
• Send an email to:hchcscripts@nhs.net or hchcdispensary@nhs.net if a dispensary patient

Your electronic prescription is available for a pharmacy to download from the NHS database as soon as it has been generated. However, please check with your nominated pharmacy how long they require before collection. If you are a dispensing patient, please try to allow us one week to dispense your medication, and extra days if affected by Bank Holidays.

EPS is reliable, secure, and confidential. Your electronic prescription will be seen by the same people in GP practices, pharmacies and NHS prescription payment and fraud agencies that see your paper prescription now.

For more information talk to your community pharmacist, staff at the Health Centre, or you can read more about EPS on the NHS website and watch a video about EPS using this link to YouTube.

In the past there have been problems regarding the availability of antibiotics, particularly liquid forms. Not all children will require a liquid form and the recommendation is that the liquid is reserved for babies and small children.  There are some useful resources about how to encourage children to swallow solid dosage forms

• https://alderhey.nhs.uk/application/files/3416/1797/9787/Guide_for_Tablet_Capsule_Swallowing_PIAG_067.pdf
• https://www.e-lfh.org.uk/wp-content/uploads/2020/11/KidzMed-archdischild-2019-317512.full_.pdf
• https://vimeo.com/778281427 

In addition to this, the Specialist Pharmacist Service (SPS) has some useful information about using solid dosage form antibiotics in children. It provides guidance about dispersing and crushing many antibiotics along with how to disguise the taste! Interestingly whilst for many antibiotics the advice is to give one hour before food, however this may not be necessary and is not practical in this situation and as such they can be given with food. 

• https://www.sps.nhs.uk/articles/using-solid-oral-dosage-form-antibiotics-in-children/