Patients with long term catheters, sheaths or who require leg and night bags should have one month's supply.

Patients who require continence products for time limited periods should have the quantities adjusted accordingly to ensure sufficient supplies but to reduce the possibility of waste.

Patients requiring continence or stoma appliances can have these dispensed either by a dispensing appliance contractor (DAC), a pharmacy contractor or a dispensing doctor.

• Prescriptions should only be issued at the request of the patient/patient's carer
• Requests for new or amended prescriptions should only be accepted from appropriate clinical staff such as a continence specialist nurse/stoma specialist nurse
• No appliances should be supplied to a patient without a signed prescription
• Retrospective prescriptions should not be issued by the prescriber
• No emergency supplies should be made without prior agreement with the doctor or nurse prescriber

Overview of Service Provision

For items that every dispensing appliance contractor and pharmacy contractor in England supplies in the normal course of their business, they are required to provide the following as part of essential services. (Full details are in The National Health Service (Pharmaceutical Services) Regulations 2012 - Regulation 11(2)(a)(i) -Terms of service of NHS appliance contractors) Some points to note:

• A repeat dispensing service: DACs will have to provide this service; pharmacy contractors already provide it.
• A dispensing referral: if the DAC or pharmacy contractor cannot dispense the item prescribed or cannot provide the required stoma appliance customisation, he or she must, with the patient's consent, refer the prescription form or repeatable prescription to another DAC or pharmacy contractor. If the patient does not consent to this, then the DAC or pharmacy contractor must provide contact details for at least two other contractors, if they have the details, who may be able to dispense the required item or service. DACs and pharmacy contractors should not accept or receive any gift or reward for making such referrals.
• A home delivery service and supply of wipes and disposal bags: certain items specified in the Drug Tariff must be dispensed with a reasonable supply of wipes and disposal bags, whether by home delivery or otherwise, and the contractor:
  • Must ensure that the patient, if they wish, consult a person to obtain expert clinical advice regarding the appliance; or
  • If appropriate, the contractor must refer the patient to a prescriber; or offer the patient an appliance use review service.
• 'Specified appliances' are:
  • Any of the following appliances listed in Part IXA of the Drug Tariff:
    • A catheter appliance (including a catheter accessory and maintenance solution),
    • A laryngectomy or tracheostomy appliance,
    • An anal irrigation system,
    • A vacuum pump or constrictor ring for erectile dysfunction, or
    • A wound drainage pouch;
  • An incontinence appliance listed in Part IXB of the Drug Tariff; or
  • A stoma appliance listed in Part IXC of the Drug Tariff.
• Where the Electronic Prescription Service is available through appliance contractor premises, the contractor must, if requested to do so by any person, enter in that person's entry in the NHS Care Record:
  • Where the person does not have a nominated dispensing contractor, the dispensing contractor chosen by that person; and
  • Where the person does have a nominated dispensing contractor
    • A replacement dispensing contractor, or a further dispensing contractor, chosen by that person.
• Provide appropriate advice: the DAC or pharmacy contractor shall ensure that appropriate advice is given to patients about any appliance provided to them in order to enable them to utilise, store and dispose of the appliance appropriately. DACs and pharmacy contractors must also provide appropriate advice to patients to whom they provide appliances via a repeatable prescription on the importance of requesting only those items, which they actually need.

Responsibilities of the GP Practice

• Practices should be aware of the number of requests for repeat prescriptions from appliance contractors, as well as the quantities requested. A check should be made to ensure the quantities requested seem appropriate to prevent waste. Guidance on quantities to be issued for appliances can be found in the section above
• Prescriptions should be issued only at the request of the patient/patient's carer. There is an obligation when issuing any prescriptions including appliances, that the patient should be appropriately advised on the importance of requesting only items they actually need by the pharmacy or DAC. Most patients will be advised by the relevant specialist nurse to request their prescriptions monthly but this will be dependent on their personal circumstances. If requests for appliances are more frequent than this then the prescriber should discuss this with the patient and if required further advice sought from the specialist nurse
• It may be useful to allocate one receptionist and one GP to deal with all contractor requests for prescriptions requesting appliances
• Requests for new or amended prescriptions should only be accepted from appropriate clinical staff such as a continence specialist nurse/stoma specialist nurse
• Retrospective prescriptions should not be issued by the prescriber. If a contractor requests a prescription "post supply" GPs are entitled to refuse to supply a prescription. If issues arise as a result of this standard please see template letter to DACs/Pharmacy Contractors that can be used to help with any problems encountered
• There may be some occasions where patients have difficulty in managing their repeat prescriptions. In these cases the stoma specialist nurse/continence specialist nurse/District Nurse will inform the surgery of any arrangements they have made on behalf of the patient with a community pharmacy or DAC. This arrangement should be recorded in the patient's notes and should not involve the issuing of retrospective prescriptions
• Prescriptions for continence and stoma appliances should be issued on a separate form from the rest of the patient's medication to avoid dispensing problems if a patient chooses to use a dispensing appliance contractor and not a pharmacy contractor
• Ideally the DAC or pharmacy contractor used by the patient should be recorded in the patient's medical records by the prescriber in addition to their preferred supplier for other prescribed items

Responsibilities of the Dispensing Appliance or Pharmacy Contractor

• Dispensing appliance or pharmacy contractors must not dispense continence or stoma appliances before receiving a valid prescription, except in the dispensing of urgent supplies. In this exceptional circumstance, urgent supplies of continence or stoma appliances may be dispensed by the contractor before receiving the prescription only at the request of the prescriber in line with Regulations
• Dispensing appliance or pharmacy contractors must not contact prescribers to provide retrospective prescriptions to cover a non-urgent situation.
• No appliances should be supplied to a patient without a signed prescription
• Some pharmacy contractors and appliance contractors operate a repeat medication service for their patients. At the time of each repeat request the pharmacist/appliance contractor must also provide appropriate advice to patients on the importance of requesting only those items which they actually need to ensure that unnecessary supplies are not issued
• When dispensing an appliance, the patient should be provided with a written note of the pharmacy/DAC contractor name, address and telephone number. Dispensing labels or other methods can be used
• The pharmacy/DAC must offer to deliver specified appliances to the patient's home; delivery must be made with reasonable promptness and at a time agreed with the patient. In addition the pharmacy/DAC must provide a reasonable supply of disposable wipes and bags for specified items in the Drug Tariff (See section 2 for additional details). The method of delivery must not indicate the type of appliance being delivered. Home delivery could be made by pharmacy staff, Royal Mail or another carrier could be used

Patients may obtain their supplies from either:

• Dispensing contractor (Community Pharmacy, Dispensing Doctor)
• Dispensing Appliance Contractor (DAC)

When prescribing or recommending products for prescribing, the patient's needs must be considered and the quantities should be sufficient to reflect the patient's requirements but minimise waste.

Patients requiring continence appliances can have these dispensed either by a DAC, a pharmacy contractor or a dispensing doctor.

Retrospective prescribing i.e. requesting delivery of a product before the prescription is submitted to the contractor must not occur.

On discharge from hospital you will have been supplied with the products and accessories required for immediate use. Your stoma, continence or ward nurse will have discussed the options available to you for obtaining future supplies and will also give you a list of your products and their relevant order code so that you are able to obtain prescriptions from your GP. They will also provide a catheter passport where necessary. Additionally they will provide product and code details to your GP surgery and/or community nurse.

Please bear in mind that in all cases, a prescription needs to be obtained before any supplies can be sent out. To arrange repeat prescriptions there are a number of options out lined below:

1. The Supply Company handles everything: You can call them when you need to place an order, or very often they will call you on a monthly basis. They will then contact your surgery to get the prescription for your order and with that in hand will send out the order to your home, in unmarked packaging. Where appropriate they will include complementary wipes, disposal bags and will also cut flanges to size if needed. The Supply Company will also offer advice on request.
2. You get the prescription and your pharmacy fulfils the order: If you want to use a chemist then you will need to arrange for the prescription from your GP. Repeat prescriptions can usually be handled online and can be sent to the chemist of your choice. Chemists then provide two levels of service. All chemists have to offer Essential Services and they will provide you with complementary wipes, disposal bags, a home delivery service and advice. If they are signed up to Advanced Services they will also cut the flanges for you.
3. You get the prescription and send it to the Supply Company to fulfil: You get the prescription from the GP and then send it in a Freepost envelope (supplied by the Supply Company) to the Supply Company and then the order, complete with complementary wipes, disposal bags and flanges cut to size will be delivered to your home.
4. You ask the GP to send the prescription to a Supply Company: You contact the GP to ask for the prescription which the surgery then sends to a Supply Company which could be one they use or one that you specify. Again Supply Companies supply Freepost envelopes and the order complete with complementary wipes, disposal bags and flanges cut to size will be delivered to your home.
5. Your GP practice is a Dispensing Practice: If your GP practice is a Dispensing Practice they may fulfil the order through the Dispensing/Chemist arm of the practice. If not, they will offer you alternative methods to obtain your supplies. Your GP will raise the prescription – you may be able to make a request for a repeat prescription online. The GP will then pass the prescription to the practice dispensary. If they are signed up to offer Essential Services they will provide you with complementary wipes, disposal bags, a home delivery service and advice. If they are signed up to Advanced Services they will also cut the flanges.

Dispensing Appliance Contractors (DACS) must supply all ostomy and urology products which are on the official NHS drugs and appliances list (The NHS Drug Tariff). If they do not have them in stock, medical product wholesalers can supply the DACs with these products at short notice.

DACs are often integrated within stoma care product manufacturers/companies, such as:

• Bard = ScriptEasy
• CliniMed = SecuriCare
• Actreen B Braun = Emerald
• Coloplast = Charter
• ConvaTec = AmCare
• Hollister/Dansac = Fittleworth,
• Salts Heathcare = Medilink

There are several other independent DACs, e.g. Wilkinson Healthcare. If the DAC or Chemist (also called a Pharmacy Contractor) cannot dispense the item prescribed or cannot prescribe the required stoma appliance customisation, they must, with the patient's consent, refer the prescription form or repeatable prescription to another DAC or Chemist. If the patient does not consent to this, then the DAC or Chemist must provide contact details for at least two other contractors who may be able to dispense the required item or service.

Emergencies/Urgent Supplies

In an emergency you can get supplies from a DAC or a Chemist without them being in possession of a prescription as long as your GP has agreed to give them a prescription for the items within 72 hours. If you can't get hold of your GP then the DACs will very likely help you out and get you some supplies to tide you over, although without a prescription and unable to get a retrospective prescription they would have to bear the cost.

Note: please allow a sufficient period of time from placing the order with a DAC until it is delivered to your home.

Prescription charges

Colostomates living in the UK whose stoma is permanent are entitled to apply for a Medical Exemption Certificate, which entitles them to obtain all prescriptions free. Ask your GP, specialist nurse or pharmacy for Form FP92A.

Colostomates with a temporary stoma DO have to pay prescription charges for stoma appliances unless they are otherwise exempt from prescription charges. It may be worth considering a Prepayment Certificate to save money. See the NHS prescriptions web page http://www.nhs.uk/NHSEngland/Healthcosts/Pages/pre... for more detail.

Key Points

• Always check your name and address are correct
• Check your prescription details match your requirements as discussed with your stoma care nurse
• Check the doctor has signed the prescription
• Sign the back of the prescription if you are exempt
• If you choose to use a delivery company to obtain stoma care equipment remember to ask your GP to write it on a separate prescription from your other medicine
• Always store your pouches in a cool dry place