The Standing Medical Advisory Committee highlighted published evidence supported that the treatment of uncomplicated cystitis with antibiotics should be limited to three days. Therefore the Prescribing Incentive Scheme included an audit of Trimethoprim prescribing to assess concordance with this.

However, due to certain legal obligations which have been introduced it is proving impossible for dispensing practices to issue a 3 day supply of Trimethoprim. These can be summarised as follows-:

1. Legislation dictates, that every supply of medication must be accompanied by a patient information leaflet.

2. Trimethoprim is only supplied in a pack of 14 tablets (7 days supply), which includes a leaflet.

3. Manufacturers will not supply extra leaflets and do not encourage the duplication of their leaflets as they will not accept responsibility if the incorrect leaflet is supplied with their product.

Therefore, to supply 6 tablets (three day course) the options are-:

1. Split the pack and have no leaflet which would mean breaking the law.

2. Prescribe 6 tablets. Supply an original pack of 14 with a leaflet and suffer a financial loss.

3. Prescribe and supply 14 tablets and tell the patient to take a three day course.

The PCG cannot encourage the dispensing practices to break the law, or advocate a financial loss so I recommend that this part of the Incentive Scheme is withdrawn.

The dispensing decision made by a community pharmacy against a prescription for 6 tablets is not part of the PCG responsibility, so prescribing practices are less affected by this decision.