By Dr Jonathan Lake, General Practitioner (GP) at Sunnyside Medical Centre
Hello, I’m Jonathan, a GP at Sunnyside Medical Centre (in Portsmouth, if you’re wondering). I’ve been a GP at my practice for 10 years.
Where it all began
The NHS Business Services Authority (NHSBSA) works with various partner organisations to help prescribers and dispensers realise the benefits of increased Electronic Prescription Service (EPS) use, particularly through electronic Repeat Dispensing (eRD). These partnerships run from the ground up, which is how I came to hear about both EPS and eRD.
I have been interested in doing this ever since I attended a presentation at a GP event ran by our CCG. A presenter (another GP) had managed to move about 80% of his patients on repeat prescriptions to electronic repeat dispensing. This figure really surprised me! He then went on to share how much time this saved and how it improved safety for the patients. How did it do this? Well, prescriptions are updated more systematically via EPS and there is no need for patients to request their medicines every month or two, this is carried out annually. This doesn’t just simplify the process for patients, but for the GP surgery and pharmacies alike.
When technology advances met my GP practice
My initial enthusiasm for eRD was met with a little scepticism from our team as they’d (unsuccessfully) trialled this with patients previously. Why? Because the amendments required for their paper repeat prescriptions meant that the system wasn’t as efficient as it could be, for those particular cases. This led to disillusioned patients, admin staff and GPs.
Subsequently, my request to move to eRD was met with a flat refusal!
I bided my time and saw another opportunity when we changed our clinical system to ‘SystmOne’. It was also the time when electronic prescribing was implemented, meaning that paper scripts could be gone and changes to scripts could be made much more easily.
For those who are unsure, paper scripts are simply prescriptions issued on pieces of paper that are either taken to the pharmacy by patients or sent to the pharmacy by the GP practice. They are difficult to make changes to once issued and can be hard to track down once lost (hence the benefits of EPS!).
We began to look at patients who picked up their prescriptions at two local pharmacies (who we also had good working relationships with) and once identified, worked in collaboration with them to move the selected patients over to eRD, initially for a 4 week pilot.
Nothing seemed to go wrong, and we were all delighted (especially as it was over Christmas when it can be difficult to order repeat prescriptions)! This pilot solved the problem straight away. It was a quick, early win for all involved.
The next phase was to look at other patients with 7 day scripts. We contacted the relevant pharmacies and slowly moved all of these patients to eRD and began to extend the number of repeats issued from 4 to 8 to then 12.
My colleagues and I noticed an immediate reduction in the number of prescriptions we had to sign, a welcome relief.
Just to note; we had limited success in moving people with stable medications over to eRD as many of them already had their medication ordered by the pharmacy, so were already receiving a smooth service.
The support I received has been above and beyond my expectations
When we hit the challenges, we were a little bit stuck and were very fortunate to be offered some support from the Wessex AHSN and the NHSBSA.
We had visitors from the NHSBSA to do a time and motion study of our (then) repeat prescribing process. Clare Howard from Wessex AHSN and Steve Ogley from NHSBSA also spent time with our admin team who were very positive about their experience too. We received value-adding guidance about how to communicate with pharmacies and co-authored a letter to encourage repeat nominations from local pharmacies for patients who are still ordering their medication on paper.
We also had support from the South Central LPC, EPS lead, Patrick Leppard, who began to visit local pharmacies and to encourage them to use eRD, something that we had not addressed properly with pharmacies outside our usual catchment area.
Bringing everyone along the journey
- Step 1: I realised that the bedrock of eRD was getting as many people nominated on EPS as possible. I reminded my colleagues how GPs and nurses could nominate their patients and we continue to work together on this.
- Step 2: Our operations Manager, Simon Evans, had set up a screen reminder for us to follow (it simply reminds clinicians to speak to patients about nomination who do not have an EPS nomination on their records).
- Step 3: Once this was complete, Steve from the NHSBSA supplied four different text messages to send to patients who were on repeat medicines, but not EPS. We identified four sub-groups and sent these off, auditing the uptake of EPS across the groups.
- Step 4: We began to identify patients who are on stable medications to find suitable patients for EPS and eRD. Once receiving the list, I worked through this and segmented the patients into who were and who were not suitable. This also required us to have an IG sharing note (a notice which we have to put up to notify patients of how their information is being used) on our practice website, which we were able to sort out quickly.
What have I learnt?
Being part of the EPS and eRD journey has made me realise quite how complex it is. In particular, how it is only going to work if we link up well with our pharmacy colleagues, something which I do not think we have a good history of in primary care, outside the one or two pharmacies that we deal with most regularly.
The support we received from the NHSBSA to develop a list of suitable patients was really worthwhile and it helped to be a part of this. The development of new materials for GPs to have in their surgeries will hopefully help increase EPS and eRD across the board.
Personally, I’ve seen many benefits in my day-to-day life as a GP. I have fewer paper scripts to sign each day, have a safer and better organised process for reauthorising medicines when they are based around eRD and we have better relationships with our community pharmacy colleagues because of the links we have from working on eRD.
And, what’s next?
We’ll be starting to look at eRD as a routine part of our Long Term Condition review process, meaning that suitable patients will be asked if they are happy to move to ERD in their annual review and it will be automatically facilitated after that appointment.
This will make the process ‘one-stop’ and timing wise, we hope to start this in around February this year. To help the administration of this, we have employed a Pharmacy Technician who will liaise with patients, pharmacies and clinicians and oversee the process.
We’re all looking forward to where the EPS and eRD journey will take us.
If you have any questions on the above or would like any further information, please email the NHSBSA on firstname.lastname@example.org