Researchers from Queen Mary, University of London, analysed how four UK surgeries organised repeat prescriptions.
They found that receptionists used their knowledge and experience to make a computer-based process run safely.
Training should not just focus on technology, says the study.
Repeat prescriptions are defined as prescriptions issued without a consultation between the GP and patient.
They account for up to three-quarters of all drugs prescribed and four-fifths of drug costs in UK general practice. Around half of all registered patients receive treatment by repeat prescription and rates are rising, the authors of the study say.
With electronic records and computer systems in most GP practices, patients assume that issuing these prescriptions is a simple, automated process.
But this study, in which researchers spent 395 hours directly observing the work of receptionists and other administrative staff, found repeat prescribing to be a complex, technology-supported social practice, requiring collaboration between clinicians and administrative staff.
Continue reading the main storyReceptionists in some practices expressed concern that doctors did not check prescriptions thoroughly before signing”End Quote Deborah Swinglehurst Deborah Swinglehurst, lead study author and research fellow at the Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry at Queen Mary, University of London, said there was a gap between formal procedures and what actually happened on the ground in doctors' surgeries.
"This includes important 'hidden' creative work by front line reception staff."
'Tacit knowledge'The study found that over half of the requests for repeat prescriptions were for items that either were not listed as repeats on the patient's electronic record or were listed by a different name, at a different dose, or as due earlier or later than the date they were requested.
As a result, issuing repeat prescriptions without first passing them to a GP for their attention "required explicit and tacit knowledge", the study said.
"For example, many were adept at using a formulary to match brand names with generic equivalents; they often telephoned patients to clarify ambiguous requests, and many kept (individual or shared) notebooks containing knowledge they had gleaned on the job."
Some receptionists, the study found, were aware of having to make up for the failings of their doctors.
"Receptionists in some practices expressed concern that doctors did not check prescriptions thoroughly before signing. They believed that because of this they had a heavy responsibility to undertake safety checks themselves, although these were not recognised or remunerated."
Despite not being accountable for certain aspects of quality and safety, reception staff still considered themselves informally accountable to the patient, the study added.
The study authors conclude that there is no best way of running repeat prescribing.
But they highlight the importance of ensuring that training for repeat prescribing goes beyond simply training receptionists on how to use their practice's computer system.
Writing about the research in an editorial in the BMJ, Professor Anthony Avery, professor of primary health care, University of Nottingham Medical School, said it was important to establish whether prescribing error rates vary much between general practices.
"If they do, the complex factors identified by Swinglehurst and colleagues need to be taken into account when designing and testing interventions aimed at improving safety.
"This might then produce better evidence to help guide general practices on the best ways of running their repeat prescribing systems to ensure safety while being responsive to patients' requests."
A spokeswoman from the British Medical Association said: "GPs recognise that receptionists have a very important part to play in the whole process."
