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Full-scale pilot trials of the electronic transfer
of prescriptions (ETP) should be under way in the autumn after the Department
of Health announced that three consortia had been chosen on March 29.
The consortia contain a mixture of well-known pharmacy and multinational
companies and some less well known technology partners.
The Department expects the first pilots to start between March and December,
2001, and to be completed by the end of June, 2002. All three pilots will
be subject to an independent evaluation looking at the costs and benefits
of ETP, what lessons were learnt from the pilots and how ETP could be
rolled out nationally. A final report is expected in December, 2002.
Among the benefits that the Department says might be seen are
- releasing general practitioners' and pharmacists'
time
- safer prescribing and dispensing
- collection of additional data on fraud and prescriptions
which are not dispensed
- more efficient processing by the Prescription
Pricing Authority
Costs could include increased computing costs and
higher risks of fraud.
Each of the three consortia will be evaluating a different model for ETP
(see Panel below).
The Sema-led consortium will be looking at the so-called “relay”
or “pull” model. Phil Hurst (senior ETP project manager, Boots
the Chemists) said that the relay model allowed patients to have complete
freedom of choice as to where their prescriptions were dispensed. The
pilot would start with a single GP practice and a single pharmacy, but
the consortium wanted all community pharmacies in the Peterborough area
to join the pilot. A second phase of the pilot would look at the use of
ETP in medicines management schemes.
The Pharmacy2u-led consortium is following the “push” or direct
transmission to pharmacies model. Alternatively, patients will be able
to opt to have their prescriptions dispensed through Pharmacy2u's internet
operation with the dispensed medicines delivered directly to their home
or place of work.
Andrew Tucker (ETP project manager, Pharmacy2u) said that once the basic
operation of ETP had been established, the consortium would be looking
at providing additional services to patients using internet and mobile
telephone technology. This could take the form of reminders to patients
to take their medicines at specific times sent by e-mail or text messaging
to mobile phones. The consortium was planning to transmit its first proper
electronic prescription on September 1, Mr Tucker said, and about 150,000
would follow over the next 12 months.
The Transcript consortium is using a hybrid model, combining a “push”
model for repeat prescriptions with barcoded forms for acute prescribing.
Martin Strange (operations director, Pharmed) said that the consortium
had examined the relay model but found it difficult to implement efficiently
and effectively, particularly as the pilot projects would have to use
the NHSnet.
Since repeat prescribing made up about 60 per cent of all prescriptions,
the consortium was replicating existing prescription collection services
with its model. This had already been trialled in London two years ago.
Ian Shepherd (group head of information management and strategy, Royal
Pharmaceutical Society) said that it was encouraging that a full range
of solutions was to be trialled during the pilots. The Society had always
supported models for ETP that were based on protecting patients' freedom
of choice without any predetermination of where any particular prescription
was dispensed.
He hoped that the evaluation of the three models would provide reliable
information on the most appropriate composite model for a full national
roll out, together with information on how patients used pharmacy services
and different options for them under ETP.
Comment, p447
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Pushing or pulling: electronic transfer of prescriptions in action
The initial aim of all three consortia is to replicate the existing prescription
system (GP writes prescription, patient takes it to pharmacy, pharmacy
dispenses it and sends it to the Prescription Pricing Authority for payment)
in an electronic form. Once this has been achieved, other uses of ETP,
including repeat dispensing and medicines management schemes, might be
examined.
Sema
- Members Sema, Boots the Chemists, National Co-operative
Chemists, Cable & Wireless, Microsoft
- Model Relay or pull model with prescriptions sent by
GPs to a central server and then downloaded when the patient goes to
a pharmacy. Copies sent to the PPA
- Area North and South Peterborough Primary Care Trusts
- Claimed advantages Little change for GPs. Allows freedom
of choice for patients. System allows feedback so could be used for
medicines management or repeat dispensing
Pharmacy2u
- Members Pharmacy2u, 93 GPs, 133 pharmacies (including
123 North West Co-operative), Health Global Worldwide, RSA Security,
Hadley Healthcare, academics from King's College London and University
of Leeds
- Model Push model with prescriptions sent directly from
GPs to nominated pharmacies. Prescriptions can also be dispensed through
the Pharmacy2u internet operation
- Area Stockport and north London
- Claimed advantages Patients can have home delivery of
prescriptions and order repeats via internet
Transcript
- Members Gehe UK (AAH Pharmaceuticals, Lloyds Pharmacy,
Pharmed), Phoenix Medical Supplies, UniChem, British Telecommunications
- Model Hybrid. Uses push model for repeat prescriptions
sent directly to nominated pharmacies. Acute prescriptions have barcodes
with prescription data and digital signature
- Area To be decided. In discussion with several PCTs
and health authorities
- Claimed advantages Pharmed already has experience with
ETP trials. Paper prescriptions provide fall back in case of technology
failure
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