This article relates to the CQC key question: Is your practice safe?
Blank computer prescription forms were originally considered to be of a low security risk but there are now an increasing number of instances when theft and computer software has been used to generate fraudulent prescriptions.
This article has been shared with the BMA and RCGP.
NHS Protect has published guidance to help develop local systems to ensure the security of prescription forms against theft and misuse. These systems need to be designed with the needs of local staff and their working environment in mind.
The guidance supports providers, both NHS and private, authorised by their commissioner to order prescriptions.
Organisations holding stocks of prescription forms are responsible for their management and use by:
- preventing theft and misuse through secure storage
- developing an organisational policy outlining roles and responsibilities
- developing local protocols outlining what actions to take in the case of loss, theft or missing prescription forms/paper
- controlling and recording prescription form movement, including recording serial numbers.
The guidance discusses a range of measures to prevent and tackle the problem of prescription form theft and misuse and outlines the recommended actions when an incident occurs. It is intended for the following roles in all settings:
- prescribers of medicines (including contractors and locum staff)
- independent prescribers
- supplementary prescribers
- dispensing staff
- staff who manage and administer prescription form stock
What is the problem?
The problems associated with traditional pre-printed prescription pads are well known. A prescription form can be seen as a 'blank cheque' and in the wrong hands misuse can lead to loss of valuable NHS resources and potentially result in serious harm. Forms can be used to illegally obtain controlled drugs (CDs), as well as other medicines, either for illegitimate personal use or to sell on.
Cases of fraud or theft using these forms are not always complex or on a large scale; forms can be stolen from the prescriber’s bag, car, home or desk.
In the past, blank computer prescription paper has been seen as a lower risk. However, we are now starting to hear of an increasing number of instances where blank computer- generated prescription forms are used fraudulently. The theft often only becomes apparent when fraudulent prescriptions are presented at pharmacies and work is carried out to identify how and from where they have been stolen.
Methods used to obtain the blank computer prescription forms have included tactics based on distracting busy staff with what appear to be genuine patient requests. The offender gains access to, or is left in, a consulting room and steals blank prescription paper from an unattended computer. The offender then scans a genuine prescription and prints out copies on the stolen forms. These can be very difficult to detect.
We would expect GPs (including locums), other prescribers in the practice and all staff involved in the management of prescription forms to be able to tell us how the practice manages and secures blank prescription forms and paper.
We would expect that:
- Clear and unambiguous records are maintained of prescription stationery stock received.
- Prescription form stock is checked on delivery and then securely stored as soon as possible. As a minimum this should be in a locked cabinet within a lockable room or area. Access to forms should be restricted to authorised individuals.
- A record is kept of the distribution of pre-printed prescription form stock within the practice including the serial numbers, where, when (date/time) and to whom the prescriptions have been distributed.
- For prescribers using individualised forms, there is a clear system for where forms are stored (not with patients’ notes, and in a locked space) and a record is made at the end of each session (serial number of first remaining form).
- Measures are in place to maintain the security of forms used in printers when the printer is left unattended such as overnight or when the surgery/consulting room is not in use. The simplest solution is that rooms are locked when unoccupied. Alternatives include using a lockable printer cover, storing a printer in a lockable drawer or storing forms in a lockable drawer and only placing them in a printer when needed.
- Regular stock checks on prescription forms are undertaken and where possible there is a separation of duties between ordering, receiving and stock checking the prescription forms.
- There is a system in place that addresses how prescription forms will be stored when the prescriber sees patients outside of the practice premises.
- Staff know what to do if they suspect that prescription forms/paper have gone missing.
Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection