Reclaiming repeat prescribing to improve medicines safety, reduce waste and empower patients across the Neath Cluster

Neath Local Care Collaborative, Swansea Bay University Health Board

Project summary

The Neath Cluster Repeat Prescribing Project addressed concerns regarding the safety, efficiency and sustainability of community pharmacy–managed repeat prescription ordering. Evidence locally and nationally demonstrated that third‑party ordering could lead to over‑ordering, medicines waste and reduced clinical oversight. The project aimed to transfer responsibility for routine repeat prescribing back to GP practices, while protecting vulnerable patients, to improve medicines optimisation, patient safety and prescribing efficiency.

From February 2024, the intervention was implemented across seven GP practices and ten community pharmacies within the Neath Cluster using a phased approach. Clear governance arrangements were agreed, bilingual patient information materials were developed, and staff “champions” were identified in both practices and pharmacies. Vulnerable or ‘protected’ patients, such as those who were housebound, had cognitive impairment, or required monitored dosage systems, continued to receive pharmacy‑assisted ordering following individual assessment.

The project was evaluated using a mixed‑methods approach, incorporating qualitative feedback and quantitative prescribing data analysis. Early implementation data demonstrated high acceptability; 427 patient requests were reviewed in the first two months, 329 patients were added to protected lists, and no formal complaints were recorded.

Quantitative evaluation using a difference‑in‑differences methodology showed heterogeneous outcomes across practices. One practice demonstrated a sustained reduction in prescribing expenditure of £2,003 per 1,000 patients per month. For a list size of approximately 7,720 patients, this equated to an estimated saving of £15,463 per month over an 18‑month period. Other practices showed minimal change, reflecting variation in baseline prescribing systems and controls.

Patient outcomes included improved understanding of medicines, reduced stockpiling, reassurance for vulnerable groups, and strengthened relationships between practices and community pharmacies. Importantly, these outcomes were achieved without additional ongoing costs, demonstrating a favourable return on investment driven by process change rather than resource expansion.

Overall, the project delivered meaningful financial, safety and quality benefits and is now embedded as routine practice across the Neath Cluster.