Cetirizine capsules/branded tablets to generic tablets
Where cetirizine prescriptions are needed (and can’t be bought OTC), prescribe as generic tablets.
Generic cetirizine tablets are clinically equivalent to branded tablets or capsules but represent the best value for the Dorset NHS pound.
Run the SystmONE search provided to identify any patients on repeat supplies of cetirizine capsules/branded tablets, and if on-going supply is needed, change to generic tablets.
Communicate the changes to patients involved.
SystmOne has been updated so that new initiations of cetirizine capsules will be directed to tablets.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/presentation changes
Template patient text – NHS Dorset has asked all GP teams to review prescribing of cetirizine preparations and as such, your prescription has been changed to generic (unbranded) tablets. The packaging might be different to what you would normally expect to see, however these products are considered clinically interchangeable. If you have any questions about this change, please contact your GP/nurse/pharmacist.
Colecalciferol (vitamin D)
Change colecalciferol prescriptions of unlicensed tablets to licensed capsule products.
Prescribe colecalciferol as per Dorset Vitamin D guidance.
| Unlicensed product (part VIIID of drug tariff) |
|---|
| Colecalciferol 10,000 unit tablets |
| Colecalciferol 2,000 unit tablets |
| Colecalciferol 20,000 unit tablets |
| Colecalciferol 3,000 unit tablets |
Licensed formulations
Use of unlicensed products (not authorised by the UK Medicines & Healthcare products Regulatory Agency (MHRA)) puts prescribers at greater liability risk for unwanted medicine effects.
As a system we aim to save over £70,000 by adopting these changes.
Run the SystmOne searches provided to identify patients prescribed repeat unlicensed items, review prescription need and if required and change to a licensed alternative.
Communicate the changes to patients involved.
Discuss prescription changes with patients as part of Structured Medication Reviews.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation change
Template patient text message:
“NHS Dorset guidance has asked all GP teams to review prescribing of oral vitamin D preparations. Your prescription for tablets has been changed to capsules which have the same effect and is more cost-effective for the NHS. If you would like to discuss this change further, please contact the surgery.”
Co-codamol capsules to tablets
Where PCN teams need to prescribe co-codamol (codeine & paracetamol) capsules, please ensure that the more cost-effective generic tablets are prescribed.
The capsules are clinically interchangeable with the more cost-effective tablets. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for co-codamol (codeine & paracetamol) capsules and convert to tablets. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of co-codamol (codeine & paracetamol) capsules and convert to tablets. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Dorset formulary codeine & paracetamol
Estriol 0.01% vaginal cream to estriol 0.1% vaginal cream
Identify patients prescribed estriol 0.01% vaginal cream and switch to estriol 0.1% vaginal cream.
Estriol 0.1% vaginal cream delivers the same dose (0.5mg) per applicator as the estriol 0.01% vaginal cream but is more cost-effective and does not contain arachis oil & can therefore be used in peanut allergy.
Use the SystmOne search to identify all repeat prescriptions for estriol 0.01% vaginal cream and convert to estriol 0.1% vaginal cream. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of estriol 0.01% vaginal cream and convert to 0.1% vaginal cream. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Fluoxetine 20mg/5ml oral solution to dispersible tablets
Identify patients prescribed fluoxetine 20mg/5ml oral solution. Where a whole dose in multiples of 20mg is required and the patient does not have dysphagia, switch to fluoxetine 20mg dispersible tablets.
The fluoxetine oral solution and dispersible tablets are clinically interchangeable for oral use, and the dispersible tablets are suitable for patients without dysphagia. The dispersible tablets are more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for fluoxetine 20mg/5ml oral solution. Where deemed clinically and dose appropriate, convert to fluoxetine 20mg dispersible tablets for oral use. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of fluoxetine 20mg/5ml oral solution and convert to dispersible tablets for oral use. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Levothyroxine capsules to licensed tablets
Identify patients prescribed levothyroxine capsules and convert to licensed levothyroxine tablets.
The levothyroxine capsules and tablets are clinically interchangeable. The tablets are more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for levothyroxine capsules and convert to levothyroxine tablets for oral use. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of levothyroxine capsules and convert to tablets. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Levetiracetam, pregabalin and gabapentin
Identify patients prescribed branded Levetiracetam, Pregabalin and Gabapentin products.
- Invite patients and/or carers to discuss the possibility of switching to a generic formulation. Switch patients prescribed branded levetiracetam, pregabalin and gabapentin for non-epilepsy indications to generic formulations
- For patients with epilepsy who are prescribed branded levetiracetam, pregabalin and gabapentin:
- Invite patients and/or carers to discuss the possibility of switching to a generic formulation
- Any generic formulation switch should be made through a shared decision-making process with the patient / carer, to reduce the risks of nonadherence and anxiety caused by the switch
- Base the need for continued supply of a particular manufacturer’s product on clinical judgement and consultation with the patient and/or carer, taking into account factors such as seizure frequency and treatment history. Consider patient/carer related factors such as their negative perceptions about alternative products and/or other issues related
- Secondary care specialists should initiate new patients on generic anti-epilepsy drugs (AEDs) where these are available
Generic (non-branded) medicines are more cost-effective versions of products which have the same active ingredient, dosage, strength, quality, safety and effect as branded medicines. Use of generic medicines enables the NHS Dorset drugs budget to treat a greater number of patients and reduces the risk of drug shortage issues impacting on care.
The Medicines and Healthcare products Regulatory Agency (MHRA) sets out advice on switching between different manufacturers’ products for the three categories of anti-epilepsy drugs (AEDs). This advice should be followed when considering switching branded AEDs to generic AEDs.
Levetiracetam, pregabalin and gabapentin have been categorised as category 3. For these drugs, the potential for clinically relevant differences to exist between different manufacturers’ products is extremely low. These agents are therefore suitable for generic prescribing and a branded medicine does not need to be continued.
However, consider other patient/carer-related factors, such as negative perceptions about alternative products, seizure frequency, risk of nonadherence, anxiety and/or other issues related to the patient.
Run the SystmOne search provided to identify any patients on repeat prescriptions for branded medications which can be safely changed to generic prescriptions.
Utilise the relevant template patient letters/text messages to contact patients affected and where necessary invite them for a medication review.
Conduct medication review and switch to a generic alternative where possible, as a shared decision-making process with the patient and/or carer.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes
Template patient text message:
- For patients prescribed branded levetiracetam, pregabalin and gabapentin without a diagnosis of epilepsy:
“NHS Dorset has asked all GP teams to review prescribing of branded medicines and where clinically suitable, switch to a generic (non-branded) medicine. We would like to discuss this potential change to your medicine with you, please contact the surgery to make an appointment to have a medication review. Thank you.”
2. For patients prescribed branded levetiracetam, pregabalin and gabapentin with a diagnosis of epilepsy:
“NHS Dorset has asked all GP teams to review prescribing of branded epilepsy medicines and where clinically suitable, switch to a generic (non-branded) medicine. We would like to discuss this potential change to your medicine with you, please contact the surgery to make an appointment to have a medication review. Thank you.”
Template patient letters.
MHRA Antiepileptic drugs: updated advice on switching between manufacturers’ products
Liothyronine
Identify patients who are taking liothyronine tablets and transfer them to capsule formulations.
The tablets and capsules are clinically interchangeable but the capsules are significantly more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for liothyronine tablets and convert to capsule formulations. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message: “NHS Dorset has asked all GP teams to review prescribing of liothyronine tablets and convert to capsules. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Gaviscon liquid to peptac liquid
Identify patients prescribed Gaviscon Original Aniseed Relief Liquid and Gaviscon Peppermint Liquid Relief and convert to peptac liquid.
Gaviscon liquid and peptac liquid are clinically interchangeable. Peptac liquid is first choice on the Dorset Formulary and therefore more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for Gaviscon Original Aniseed Relief Liquid and Gaviscon Peppermint Liquid and convert to peptac liquid. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of Gaviscon Liquid and converted to peptac liquid. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Generic medicines
Where clinically suitable, prescribe medications in their generic (non-branded) form.
Generic (non-branded) medicines are more cost-effective versions of products which have the same active ingredient, dosage, strength, quality, safety and effect as branded medicines. Use of generic medicines enables the NHS Dorset drugs budget to treat a greater number of patients and reduces the risk of drug shortage issues impacting on care.
Run the SystmOne search provided to identify any patients on repeat prescriptions for branded medications which can be safety changed to generic prescriptions.
Communicate the changes to the patients involved.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of branded medicines and where clinically suitable, switch to a generic (non-branded) medicine. Your prescription has been updated. Your medicine may look slightly different, but these products are interchangeable and help the NHS budget treat more patients. Thank you.”
Template patient letter
Ghost brand generics
Change prescriptions for ‘ghost branded generics’ (generic items prescribed with a manufacturer’s name) to a generic product without a brand name in its description.
e.g.
- Generic name – Naratriptan 2.5mg Tablets
- Ghost branded generic name – Naratriptan 2.5mg Tablets (Teva UK Limited)
When an item is prescribed generically, the dispenser is reimbursed at the price in the Drug Tariff; but when a manufacturer is stated, the reimbursement price is usually more expensive.
NOTE: In some cases, ghost branded generics may be prescribed intentionally e.g. for items with a narrow therapeutic index, however, these comprise a tiny majority of the total ghost branded generic prescriptions.
Use the SystmOne search provided to identify repeat prescriptions and change to generic options.
To avoid future issues of ghost branded generics use the Dorset formulary within SystmOne as default.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes
Template patient text message:
“NHS Dorset has asked GP teams to review prescribing to ensure generic (non-branded) items are issued. Your prescription has been updated to a non-branded version which has the same effect and is more cost-effective for the NHS. If you would like to discuss this change further, please contact the surgery.”
Isosorbide mononitrate MR tablets to capsules
Identify patients prescribed isosorbide mononitrate MR tablets and convert to isosorbide mononitrate MR capsules.
The isosorbide mononitrate MR tablets and capsules are clinically interchangeable. The capsules are more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for isosorbide mononitrate MR tablets and convert to isosorbide mononitrate MR capsules. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of isosorbide mononitrate MR tablets and convert to capsules. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Macrogol
Cease prescribing of Macrogol 3350 SF and prescribe as the generic Macrogol Compound NFP SF, or as branded Movicol or Laxido.
There is a £95.00 difference in price between the products:
- Macrogol 3350 SF (TransiSoft)) = £99/28 sachets
- Macrogol Compound NFP SF =£4.20/30 sachets
If used regularly each prescription costs an additional £1,100 per year, compared to standard therapy.
SystmOne has been updated so that initiations of Macrogol 3350 SF or TransiSoft® will be directed to Macrogol Compound NFP SF.
Run the SystmOne search provided to identify any patients on repeat prescriptions for Macrogol 3350 SF and update the product supplied.
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of Macrogol and switch to the most cost-effective brand. These products are clinically interchangeable, but this change will help the NHS budget to go further. We have updated your prescription but if you have any concerns, please contact the surgery.”
Mesalazine – Asacol MR to Octasa MR tablets
Review patients currently prescribed repeat generic or Asacol® branded modified release (MR) tablets and transfer to the equivalent dose of the Octasa® brand.
The Asacol® MR brand is clinically interchangeable with Octasa® MR tablets.
Run SystmOne search provided to identify patients receiving repeat Asacol® branded or generic mesalazine MR prescriptions and change to Octasa®MR.
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing to ensure modified release (MR) mesalazine tablets are prescribed as the Octasa® brand. These are clinically interchangeable with your previous prescription but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Paracetamol capsules to tablets
Where PCN teams need to prescribe paracetamol capsules, please ensure that the more cost-effective generic tablets are prescribed.
The capsules are clinically interchangeable with the more cost effective tablets. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for paracetamol capsules and convert to tablets. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of paracetamol capsules and convert to tablets. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Dorset formulary – paracetamol.
Prednisolone soluble tablets to plain tablets
Identify patients prescribed prednisolone soluble tablets and convert to prednisolone plain tablets.
Prednisolone soluble tablets are a costly choice, and their use should be reserved for only when absolutely necessary. The standard tablets can be dispersed in water in two to five minutes (enteric coated tablets are not suitable to be used in this way). Please note dispersing standard prednisolone tablets is considered an “off label “use.”
The plain tablets are more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for prednisolone soluble tablets and convert to prednisolone plain tablets. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of prednisolone soluble tablets and converted to prednisolone plain tablets which can be dispersed in water (may take 2-5 minutes). These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
UMI Tretn Medicines Information Centre.
NHS Business Services Authority. Drug Tariff February 2024 NHS Electronic Drug Tariff.
Prednisolone gastro-resistant tablets to plain tablets
Identify patients prescribed prednisolone gastro-resistant tablets and convert to prednisolone plain tablets.
The prednisolone gastro-resistant tablets and prednisolone plain tablets are clinically interchangeable. The plain tablets are more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for prednisolone gastro-resistant tablets and convert to prednisolone plain tablets. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of prednisolone gastro-resistant tablets and converted to prednisolone plain tablets. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
NHS Business Services Authority. Drug Tariff February 2024 NHS Electronic Drug Tariff.
Tolterodine modified release (MR) to immediate release (IR) preparations
Cease prescribing of MR tolterodine preparations and prescribe as an IR preparation.
Tolterodine MR preparations are significantly more expensive than the immediate release preparations and offer no clinical advantage.
As a system we aim to save over £6,000 by adopting these changes.
Use the SystmOne search provided to identify patients being prescribed tolterodine MR preparations and switch to an appropriate IR twice daily regimen.
Communicate the changes to patients involved.
SystmOne search: Dorset System One GPs > Medicines Optimisation > Quality, Safety Cost Eff 23 24
Template patient text message:
“We are currently reviewing the medication used to treat urinary incontinence, particularly tolterodine modified release (MR) tablets. In line with national guidance, we will now prescribe immediate release tolterodine twice daily.
The doctors have reviewed your records and your prescription has been updated. You will need to take one dose in the morning and one dose in the evening but you should not expect any difference in treatment effectiveness. This choice is supported by NHS Dorset and a letter will be sent to you with further information”.
Prescqipp bulletin 58: drugs for urinary frequency, enuresis and incontinence
Prescipp briefing 58: drugs for urinary frequency, enuresis and incontinence
Tamsulosin MR tablets to capsules
Identify patients prescribed tamsulosin MR tablets and convert to tamsulosin MR capsules.
The tamsulosin MR tablets and capsules are clinically interchangeable. The capsules are more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for tamsulosin MR tablets and convert to tamsulosin MR capsules. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of tamsulosin MR tablets and convert to capsules. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Ursodeoxycholic 250mg tablets to capsules
Identify patients prescribed ursodeoxycholic acid 250mg tablets and convert to capsules.
The ursodeoxycholic acid 250mg tablets and capsules are clinically interchangeable. The capsules are more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for ursodeoxycholic acid 250mg tablets and convert to capsules. Notify the patients involved by text or letter using the templates provided
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of ursodeoxycholic acid 250mg tablets and convert to capsules. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Proton Pump Inhibitors (PPIs)
Identify repeat prescription for high-cost prescription only Proton Pump Inhibitors and convert to best value formulations as per the Dorset formulary.
Different formulations of proton pump inhibitors are clinically interchangeable but there is a significant difference in cost. Use of the most cost-effective formulation will help the Dorset NHS pound go further and care for more patients.
Run the SystmOne search provided to identify the patients who are receiving high cost PPI formulations and convert them to best value options:
- Omeprazole tablets to capsules
- Esomeprazole tablets to capsules
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes
Template patient text message:
NHS Dorset has asked all GP teams to review prescribing of omeprazole and esomeprazole tablets, and convert them to capsule formulations. These are clinically interchangeable with your previous prescription but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Rosuvastatin capsules to tablets
Identify patients prescribed Rosuvastatin capsules and convert to rosuvastatin tablets.
The rosuvastatin capsules and tablets are clinically interchangeable. The tablets are more cost effective. Use of this formulation will help the Dorset NHS pound go further, and care for a greater number of patients.
Use the SystmOne search to identify all repeat prescriptions for rosuvastatin capsules and convert to rosuvastatin tablets. Notify the patients involved by text or letter using the templates provided.
SystmOne searches: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/Presentation changes.
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of Rosuvastatin capsules and convert to tablets. These are clinically interchangeable but are more cost-effective for the NHS. Your prescription has been updated but if you would like to discuss this change further, please contact the surgery.”
Hyloforte eye drops
Where a prescription of sodium hyaluronate 0.2% (preservative free) eye drops cannot be bought OTC and a prescription is needed, ensure that prescribing is not as the Hylo-Forte brand. If needed, provide a Dorset formulary brand.
- Eyeaze (preservative free) 0.2% or
- Hydramed (preservative & phosphate buffer free) 0.2%
Hylo-Forte is twice the price of the other Dorset recommended sodium hyaluronate brands.
Most cases of dry eye syndrome/disease self-resolve. Self-care advice and treatment options are available over the counter and therefore prescriptions should not routinely be offered in primary care.
Use the SystmOne searches provided to identify patients prescribed.
Advise patients that mild/moderate dry eye syndrome or sore tired eyes can be self-managed with good eyelid hygiene and avoidance of environmental factors. Recommend that lubricant eye treatments are available over the counter in a range of drops, gels and ointments.
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F9 Formulation/presentation changes
Template patient text message – Hylo-Forte to formulary choice:
“NHS Dorset has asked all GP teams to review prescribing of dry eye drops and switch to the most cost-effective brand. These products are clinically interchangeable, but this change will help the NHS budget to go further. We have updated your prescription but if you have any concerns, please contact the surgery.”
