PrescQIPP

Quality Improvement Project for Repeat Prescribing of Controlled Drugs (2025)

Buckinghamshire, Oxfordshire and Berkshire West integrated Care Board (BOB ICB)

Project summary

Repeat prescribing accounts for more than 70% of all prescriptions issued within a GP practice and allows patients to request medication without the need for an appointment. Lack of oversight and poor management of repeat prescribing processes can lead to overprescribing, waste (which has a significant cost to the NHS) and diversion of some medicines to illegal supply routes. By ensuring that good procedures are in place, and that these are being followed by appropriately trained staff, the practice can help to minimise these risks and ensure patients are able to access their medication in a timely and clinically safe way.

Controlled drugs pose a particular risk of serious harm if issued inappropriately, and may be associated with overuse, misuse or addiction. They should have more stringent controls in place around prescribing and review of medication.

With this in mind, the Quality Improvement Project for Repeat Prescribing of Controlled Drugs was designed. The project involves 2 steps:

  1. Run the clinical system search provided (developed for Emis-web and SystmOne) to identify patients currently on repeat prescriptions for morphine, oxycodone or fentanyl. Select a random sample of patients to review based on practice size and download into the workbook provided. Complete the data review from the patient notes. 
  2. Carry out a quality improvement review using the findings from the data sampled. A summary of areas to improve, actions to be implemented and impact on the wider team should be considered and built in to ongoing process improvement.

Analysis of the data sample focused on the following areas:

  • ≤30 days’ supply of medication
  • ≤3 months’ supply authorised on repeat
  • patients showing overuse/ over-ordering of medication
  • Date of issue aligned to other repeat medication
  • patients prescribed other Controlled Drug medication

In total 84 GP practices completed the audit, reviewing a total of 1304 patients. The results of the actions taken have been collated and will be shared across all GP practices in the ICB.

At the launch of the project a webinar was recorded to guide users through the review process and documentation. Several drop-in sessions held to allow practices to access advice from the Medicines Optimisation team. The project was also supported by repeat prescribing training sessions, delivered over 11 sessions reaching approx. 400 staff.

The project has minimal cost implications for rolling out in other regions and has been published by NHSE SE region as part of their Guidance on Controlled Drugs for General Practices.