Prescription-Only Medicines (POMs)

• POMs are legally defined as medicines listed in the POM Order or whose marketing authorization lists them as POM, obtainable only with a prescription or under pharmacist supervision.
• The classification of a medicine can be found on its packaging, information leaflet, and in the British National Formulary (BNF).

Definition of a Prescription

• Prescription is a "patient-specific direction" (PSD).
• It is a written instruction from a prescriber for medicine supply or administration to a named patient, following individual assessment.
• The majority of medicines are supplied this way, with 1.21 billion prescriptions in England in 2023/4, costing £10.9 billion.
• A PSD is very different to a 'patient group direction' - PGD

Definition of an Appropriate Practitioner

• Doctors and dentists.
• Community Practitioner Nurse Prescribers and supplementary prescribers
• Nurse, pharmacist, optometrist, physiotherapist, podiatrist, therapeutic radiographer and paramedic independent prescribers.

Legal Requirements for POM Prescriptions

• The prescription must be signed in ink by an appropriate practitioner, unless it is an electronic prescription.

• Must be written in ink or be indelible (carbon paper or similar material is allowed for NHS prescriptions of non-controlled drugs in schedules 1,2 or 3).

• Prescriptions must include:

• Address of the appropriate practitioner

• The date when it was written

• An indication of the type of practitioner

• Name and address of the patient

• If the patient is under 12, their age must be included

• Valid for 6 months from the appropriate date.

• The practitioner must be registered in the UK or be an approved health professional from an approved country.

Additional Considerations

• Medicines must be fully supplied within the prescription's legal validity.
• Outstanding quantities must be supplied with an owing slip, and the remainder must be collected within the same validity period.
• The medicine must be dispensed exactly as written; brand names must be followed, and therapeutic equivalents are not allowed.

Important Meanings

• "An indication of the kind of appropriate practitioner giving it": refers to specifying the type of prescriber.
• "The appropriate date": important for NHS prescriptions, especially regarding post-dated prescriptions.
• Legally required information includes drug name, strength, dose, and quantity.

Electronic Prescriptions

• All legal requirements for POM prescriptions still apply.
• Signature is the most problematic part.
• Prescriptions must be signed with an advanced electronic signature and sent electronically.
• The advanced electronic signature requirements:
• Uniquely linked to the prescriber.
• Capable of identifying the signatory.
• Created with means under the signatory's control.
• Linked to the data to detect any changes made.
• All drugs can legally be sent on electronic prescriptions
• NHS electronic prescriptions are sent to pharmacies via the NHS spine.
• Pharmacies print these out on a "dispensing token" (FP10DT).
• Errored tokens or undispensed ones can be sent back for cancellation by the GP.

Fate of Dispensed Prescriptions

• NHS prescriptions are submitted to the NHS Business Services Authority (NHSBSA).
• The NHSBSA reimburses pharmacies for drug costs, dispensing fees, and other professional payments.
• Private prescriptions are not submitted to the NHSBSA

Faxed Prescriptions

• Not legally valid
• Since April 2020 the use of fax machines is not recommended in NHS settings to transmit confidential information
• The pharmacist must ensure they obtain the original prescription in short period of time
• Dispensing controlled drugs (schedules 2 and 3) from a fax is a criminal offence

Photos or Emails of Prescriptions

• Not legally valid prescriptions.
• Printing out the photo or email of the prescription is rather like the printed fax - the printed document is not the original, legal copy
• They should not be considered as legal prescriptions for dispensing purposes

Forged Prescriptions

• Dispensing a prescription which you know to be a forgery is a criminal offense
• But this is not the case 'provided the pharmacist has exercised all due diligence and believes on reasonable grounds that the prescription is genuine' (this is called the 'due diligence clause')
• Altering details on a prescription is fraud and the NHS Counter Fraud Service, and possibly the police, should be contacted
• The prescriber should also be informed of any alteration to a prescription that they have issued

Administration of a POM

• Unlawful to administer a parenteral POM other than to yourself unless you are an appropriate practitioner or you are acting in accordance with the directions of an appropriate practitioner

Patient Group Directions (PGDs)

• PGDs allows POMs to be legally supplied without a prescription
• PGDs are not a form of prescribing.
• Definition of PGD : a written instruction for the sale, supply and/or administration of named medicines in an identified clinical situation. It applies to groups of patients who may not be individually identified before presenting for treatment

Qualified Professionals Who May Supply or Administer Under a PGD

• Chiropodists and podiatrists.
• Dental hygienists and dental therapists.
• Dieticians, midwives, nurses, occupational therapists, optometrists, orthoptists, orthotists and prosthetists.
• Paramedics, pharmacists, physiotherapists, radiographers, speech and language therapists and pharmacy technicians but only as named individuals.

Details That Should Be Included in a PGD

• The name of the business that owns the direction.
• The start and end date of the PGD.
• A description of the medicine(s)
• The class of the health professional who can supply or administer the medicine
• A signature of a doctor or dentist (as appropriate) and a pharmacist
• A signature by an appropriate organization
• The clinical condition or situation to which the direction applies
• Exclusions from treatment; when to seek more advice; and details of dosage, quantity, form, strength, route, and frequency of administration.

Further PGD Information

• Multi-disciplinary group should write the PGD including a doctor, pharmacist and a representative on behalf of any professional group intended to supply medicines under the PGD
• Expiry should not be more than 3 years dating back from the authorisation date.
• Security and labelling of all medicines, secure system to record and monitor how medicines are used.

Medicines Included on a PGD

• All POMs, Ps, GSLs, some controlled drugs, or unlicensed if justified

Application of PGDs

• Suitable for acute conditions, emergency contraception, antimicrobials, analgesia, immunisation, antivirals, or similar.
• Less suitable for long-term conditions or those needing frequent dose adjustments.
• The health care professional is responsible for assessing that the individual meets the criteria set out in the PGD and the supply/administration must exactly follow the PGD for it to be legally undertaken

Labelling a Medicine Supplied on a PGD

• In a pharmacy, medicines supplied via PGD should be labelled same as dispensed medicines supplied on prescription.