Safe Repeat Prescribing: System‑Wide Oversupply Reduction Across 26 PCNs

Mid and South Essex Integrated Care Board

Project summary

In 2025/26, Mid and South Essex ICB undertook a system‑wide medicines oversupply audit across 26 Primary Care Networks (PCNs), reviewing 30,728 patients and identifying 5,431 cases of potential oversupply (17.7%). The project aimed to improve patient safety, reduce avoidable harm, strengthen repeat prescribing processes, and implement the national RPS/RCGP Repeat Prescribing Toolkit at scale.

Oversupply was most commonly linked to early patient requests, repeat dispensing batches overlapping, incorrect quantities, unsynchronised medicines (28‑ vs 56‑day cycles), and inappropriate inhaler/device issuing (e.g., Spiriva Handihaler/Respimat issued monthly instead of refill packs). High‑risk areas included COPD inhalers, DOACs, CGM sensors, GLP‑1 injections and SGLT2 inhibitors.

Each PCN analysed its data, identified its top causes, and developed a bespoke action plan. Examples of key improvements include: ensuring previous prescriptions/eRD batches are cancelled before re‑issuing, applying standardised quantities and synchronisation checks, correcting eRD setup errors, strengthening documentation of early issues, and improving governance around high‑risk medicines. Many PCNs introduced training for prescription clerks, pharmacists, nurses and administrative teams, alongside patient education to reduce unnecessary early requests. Several PCNs addressed device misuse by switching Spiriva prescriptions from “device + cartridge” to refill‑only, resulting in immediate reductions in oversupply risk.

Multiple PCNs identified the need for better partnership working with community pharmacies to reduce automatic early re‑ordering, improve clarity on issue dates, and ensure requests are clinically appropriate. Several PCNs implemented internal checklists, workflow protocols, and SystmOne alerts to monitor over‑ordering and maintain safe supply.

Importantly, 12 PCNs committed to re‑auditing within 6–12 months, and many are embedding quarterly monitoring into routine governance, demonstrating sustainability and ongoing quality improvement.

This project delivered clear safety benefits: reducing risk of overdose (e.g., DOACs, opioids), improving correct inhaler/device use, ensuring monitoring cycles are aligned, and reducing medicine waste through reduced duplication and early requests. While financial savings have not yet been fully quantified, reduced oversupply across high‑cost areas such as CGM sensors, GLP‑1 injections and COPD inhalers is expected to have a significant positive impact on prescribing budgets. The project has strengthened system‑wide processes by standardising safer repeat prescribing workflows across 26 PCNs.