The Pharmaceutical Journal
Vol 269 No 7217 p455
28 September 2002

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UniChem convention 2002 summary

Driver for ETP may be cost savings rather than patient convenience

Are pharmacists being manipulated into using some technologies for the sake of political agendas? That question was put to the convention by Ian Shepherd, group head of information and strategy, Royal Pharmaceutical Society.

He suggested that electronic transfer of prescriptions (ETP) is not about sharing information: the aim of the pilots is to replicate the existing prescription system in an electronic form. For ETP to be a vehicle towards electronic health records, common standards of nomenclature and structure of the information must be adhered to, he said. "There will a significant cost in ensuring that any pharmacy messaging is commensurate with technical standards applied elsewhere in the NHS. These are only just emerging and I forecast they will take some years before they can be universally adopted."

Much of the scope of the ETP projects was concerned with providing data for reimbursement and statistical analysis. "Providing the data in electronic format saves the enormous keying operation [at the Prescription Pricing Authority] — saving significant costs within the process." Perhaps this was the driver for change, he suggested.

Although the public might agree with the savings achieved through better management of medicine costs and reduced costs of calculating pharmacy reimbursement claims, as soon as they become patients the costs become less important to the individual. "[As patients] the public require quick access to the complete range of medicines, the choice by their prescriber of the most effective treatment for their condition."

Mr Shepherd pointed out that only two of the pilots offered patients freedom to choose their pharmacy up to the point of dispensing. The others required selection of the pharmacy before or as the prescription was written. "While it may be argued that the issue of patient registration with pharmacies is long overdue for resolution, it remains the stated objective of these pilots to replicate the existing system — which should surely include this element of free choice," he said.

In addition, any change to the present system should not impact on the ability of patients to obtain quick access to medicines. "What happens if an electronic prescription arrives at the patient's choice of pharmacy and that pharmacy is either closed or is temporarily out of stock of an urgently required medicine," he asked.

Mr Shepherd suggested that this was why several of the pilots concentrated on repeat prescriptions, since it could be argued that these were not so time dependent. But this was not acceptable, again, because the pilots should completely replicate the present paper system. "The technological solution must not so fundamentally force change to the patient's behaviour," he said. And any systems that locked patients into a particular mechanism must be avoided until the full extent of the impact is known.

Mr Shepherd commented that repeat dispensing was the source of much frustration by companies involved in the ETP pilot systems. They all wanted to evaluate mechanisms to increase the ease with which patients were able to order and receive repeat medication. But to date this had been resisted by the project sponsors. The invitations to take part in medicines management pilots funded by the Department of Health had explicitly excluded bids employing ETP. The reasons behind this were unclear.

He added that opportunities to share information had so far been thwarted by requirements to keep the ETP pilots insular.

In an interactive debate, conference participants were asked what they believed was the main driver for the Government's enthusiasm for ETP. Most (72 per cent) thought it was to reduced cost. The integration of pharmacists into the primary health care team and patient convenience were cited by 12 per cent of participants as the reason behind the Government's enthusiasm.