Hospital outpatient dispensing policy in the North West regional health authority

Downward pressure on prescribing budgets leads to tension at the hospital-general practice interface as to who, consultant or general practitioner, should prescribe for outpatients. Government advice is that hospitals should dispense a minimum 14 days' supply of drugs to outpatients and that written, shared care protocols should be introduced where hospitals expect GPs to prescribe medication not normally used within-general practice. Our aim was to assess the extent to which hospitals in the new North West regional health authority (NWRHA) have complied with this advice. The directors of pharmacy in all 39 major acute hospitals in NWRHA were invited to participate, The director, or his or her nominee, was interviewed by telephone to ascertain the quantity of drugs routinely supplied to outpatients, the exceptions made to this policy, whether hospitals request GPs to prescribe any of eight treatments not normally used within general practice and, if so, whether shared care protocols had been introduced for these drugs. All 39 hospitals participated, No hospital dispensed less than 14 days' supply of drugs to outpatients. Every hospital made exceptions to this policy either by agreement with consultants, or for specified drugs, or for particular types of patients. All but two hospitals asked GPs to prescribe one or more of the eight specialised treatments listed. Twenty-five hospitals had no written shared care policies for these drugs. Although all hospitals issued at least 14 days supply of drugs to outpatients, there was considerable variability in the exceptions made to this policy, leading to potential inequalities in service provision. Many hospitals expected GPs to prescribe specialised drugs without explicit, written guidance.