September 2018 Blog; Medicines Order Line (MOL)
Medicines Order Line (MOL)
Over recent decades medical practice has changed dramatically. A Cambridge University study recently found that around half of over 65-year-olds in England are taking at least five different daily medications.
The study examined changes in medication usage in the older generation over a 20-year period and revealed that 20 years ago only 12 per cent were taking as many. It was also noted that the proportion taking no pills at all had dropped from around 20 per cent in the late 1990s to just seven per cent today.
This huge increase in multi-medicating means more and more prescriptions must be dispensed. As well as processing the requests, it’s increasingly important for us to check medicines requested are both needed and current. Excessive or incorrect ordering and stockpiling can be a significant cause of wastage and with GP budgets under financial pressure this is increasingly relevant. It’s a fact that unused prescription medicines cost the NHS in Derbyshire over £6 million every year.
We are all familiar with the three options below for patients who request repeat medication:
- Handing in repeat slips to GP practice – which does mean being able to get to the practice easily and may require another journey to pick up the repeat prescription (unless arrangements are in place for the prescription to be sent to a nominated pharmacy).
- Handing in repeat slips at a community pharmacy – pharmacy staff can help manage the process, but some surgeries insist that the pharmacy is signed up to the “Derbyshire Repeat Prescription Code of Practice”, so this support may not be available if there is no local agreement in place.
- Online ordering or email request – but patients need to be comfortable with IT and be computer literate. The prescription is sent electronically to a nominated pharmacy or collected from the GP practice.
The Medicines Order Line or MOL however is relatively new, not available from every surgery and not everybody will be familiar with the way it operates. Therefore, I recommend that pharmacy staff familiarise themselves with the MOL operation, so that they can support those patients whose surgery has chosen to use MOL.
With the MOL telephone requests are made to a call centre handler who follows a ‘Script’ to identify exactly what medication is required. The requests are then sent to the patient’s surgery for sign-off. The prescription is then sent electronically to a nominated pharmacy or collected from the GP practice.
The service is provided on behalf of the GP practice and Derbyshire CCGs, between 9.30am and 2.30pm Monday to Friday. Dedicated, experienced and trained call handlers, with access to patients’ medical records, will answer the call. The aim is to ensure that patients order only what they need (includes the correct quantity of medication), in a timely manner, to reduce the amount of medication waste.
The rationale behind the MOL is to empower patients to self-care, high on the local CCG agenda, and manage their conditions, collaborate with GPs and CPs to improve the repeat ordering process. In addition, the call handlers can answer queries from community pharmacies about the status of prescriptions, although this is not a primary objective and pharmacy staffs are expected to have taken suitable measures to locate prescriptions before they call. To support healthcare professionals the lines will remain open after 2.30pm until 4.00pm, but this will not be promoted to the general public.
Currently, in Southern Derbyshire 15 practices are enrolled for MOL and 4 practices are in the process of enrolling. Signup to MOL must be managed and consists of two phases, which allows time for all parties to adjust to the new system.
Phase One – Practice joins and encourages patients to ring the order line to order their repeat medication, this is the preferential route. MOL operatives have direct access to the GP clinical system and can process the patients’ requests in real time, advise on medication review dates, overdue recall dates, etc. Orders will only be processed 7 days before a medication is due and no earlier unless there are mitigating circumstances. All PRN medicines are queried to ensure orders are placed for only what is needed. The MOL will also offer synchronisation of quantities and ensure the repeat template is accurate.
Phase Two (a) Pharmacies who have NOT signed the Code of Practice – six weeks written notice will be issued to all nominated pharmacies assigned to the GP practice and to inform them that the GP practice will no longer accept repeat prescription requests on behalf of their patients (supporting leaflets for patients are available). The nomination will remain the same unless patients request a change. If delivery arrangements are in place patients are advised to contact the pharmacies directly to confirm them.
If patients still require the support of a ‘managed repeat service’ the pharmacy should complete the exemption form and return to the GP practice. The GP practice will then enter a read code “MOL EXEMPT” onto the patient’s clinical record. The reasons for exemption may include, capacity, 7-day prescriptions. The pharmacy will then need to ring the MOL to order on behalf of these patients. If the exemption is not on the patient’s record the MOL will NOT accept orders from the pharmacies for patients. If a patient has a compliance aid orders will be accepted14 days before they are due, to allow time for dispensing the packs.
Phase Two (b) Pharmacies who HAVE Signed the Code of Practice – GP practices who enter into Phase 2 will contact all of these pharmacies with the notice date and request that they ring the MOL to order on behalf of all their patients for whom they have a ‘managed repeat system’ in place. The GP practice will no longer accept faxed/written or verbal requests for repeat medication for patients. Pharmacy staff will be asked the same questions as the patients when they call the MOL to order on the patient’s behalf.
With any system change there is always a period of adjustment until things settle down. Pharmacy staff can help in several ways:
- Ask patients to call the MOL directly for their next order (if the practice is registered for MOL)
- Ensure that patients are given the right-hand side of their prescriptions (some patients are reporting they don’t always get this, which causes ordering difficulties)
- Promote the use of electronic repeat dispensing (eRD) – project underway to look at practices and to increase uptake
- Emergency supply requests can be dealt with by the MOL (there could be future synchronisation issues if patients were to be ‘advanced’ any medication)
- Deliveries are not an NHS service, so ensure patients understand how any delivery service operates from the pharmacy