Background
Previous research has shown that GPs may employ a number of strategies to help minimise the cost of prescriptions for those eligible to pay prescription charges, including prescribing a larger quantity of medication. Repeat dispensing (RD) is now an essential service under the new pharmacy contract (nPhS) and little is known about how the charge status of the patient may impact on the uptake and prescribing practices of this service.

Aim
To examine whether the prescription charge status of a patient influences enrolment in RD and the duration of the medication prescribed.

Methods
A prospective audit of repeat prescriptions was conducted at 36 community pharmacy sites involved in the RD pathfinder pilots. The number of batches issues and prescription interval period for each repeatable prescription presented to these pharmacies over a four month period was recorded on a specially designed data collection form. Data were coded and analysed using SPSS (v11.5). Cross-tabulations were used to examine interrelations between variables and the Mann-Whitney U test used to examine whether any differences were statistically significant (p<0.05). Semi-structured telephone interviews with GPs (n=18) and practice managers (n=3) were also conducted to capture views on prescribing decisions in relation to charge status. The interviews were tape-recorded, transcribed verbatim and analysed thematically with the aid of Nvivo (v 2.2) software.

Results
The audit collected data on 4029 repeat prescriptions. The majority of the prescriptions (87%) were for patients exempt from prescription charges and 73% were for those aged 60 or over. The average number of batch prescriptions issued per prescription was 6, with an average interval between batches of 28 days. Fewer batch issues per prescription was more prevalent amongst those exempt from charges, although this was found not to be statistically significant (p=0.11). However, a higher proportion of exempt patients were prescribed shorter interval periods (7 and 28 days) than those who paid charges. These differences were found to be statistically significant (p<0.01).

Conclusion
There is evidence from both the audit and interviews that GPs are more inclined to prescribe longer repeat prescription intervals for charge payers than those who are exempt from prescription charges. The low level of charge payers on the scheme may also suggest that some practices are purposely not entering charge payers onto the scheme because of cost related issues, consequently this group may be prevented from benefiting from the convenience of the service.

Acknowledgement: The authors would like to acknowledge Charles Morecroft for his assistance with data collection for this project.