The Pharmaceutical Journal
Vol 270 No 7241 p395-396
22 March 2003

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Information technology could change pharmacy as much as the OFT report

While the Office of Fair Trading report is focusing minds on the existing community pharmacy service, developments in information technology within the National Health Service could have a major effect on pharmacy in the future. Jonathan Buisson and Lin-Nam Wang (on the staff of The Journal) report

Many opportunities for pharmacy are opening up in, for example, medicines management and supplementary prescribing, but these new roles will need new information technology systems to support them. At the same time, Government plans to modernise the National Health Service IT infrastructure could lead to major changes for pharmacy. The amount of information carried on packs and available to pharmacists is likely to increase markedly. Improvements in electronic communications could make location less important for providing some pharmacy services. Automation could take over some of the basic dispensing work in pharmacies. As ever, the key question behind all of this is one of money — who will pay for it all?

Geoff Mackay, customer technology and new product development manager at AAH Pharmaceuticals, believes that the arrival of electronic prescriptions could open the way for "virtual pharmacy" and "proxy dispensing" at remote locations.

"If the prescription is electronic and in cyberspace then it could go anywhere," he says. "You could see virtual pharmacies offering mail order services or dispensing warehouses undertaking proxy dispensing for local pharmacies." This could free time and space to undertake new services.

One example of how this might work is the local pharmaceutical services pilot established in Berwick-upon-Tweed (PJ, 15 March, p353). Installation of an automated dispensing robot has freed time for community pharmacists to provide a clinical service to patients at a small local hospital. Integration of the robot with electronic prescriptions could save pharmacy staff even more time for providing new services.

Steve Dunn, AAH group managing director, believes that electronic transmission of prescriptions has the potential to make location irrelevant. He can foresee small chains of pharmacies undertaking all their prescription dispensing at a single branch. Dispensed items could then be sent out to local branches to be handed out by a pharmacist as part of a medicines management scheme.

Daniel Lee is managing director of Pharmacy2u, which has been participating in one of the three ETP pilots. He says that he dislikes the term "virtual pharmacy" but he believes that pharmacy customers should be offered the choice of using a mail order service if that is what they want.

"Mail order will not be the choice for most people, but it will have benefits for some. If we can offer customers a good service, and they want to have their medicines delivered to them at home or at work, then they should be allowed to choose that."

Mr Dunn believes that the impact of IT on pharmacy will be nothing short of a revolution. The arrival of ETP should coincide with a new, two-tier contract for community pharmacy. This will put more emphasis and reward on providing patient services rather than just dispensing in larger volumes.

"ETP will give pharmacists time to provide these services," Mr Dunn says. "But pharmacists will need to use technology to show that they are adding value so that they can be paid for it. They will need to record the interventions they make." He expects that pharmacies will probably need to have their own small computer networks for this.

"We do not want a whole load of new paper records clogging up pharmacies. We need to capture this data and then do something with it. Understanding this is why we are taking part in the first medicines management pilots."

New IT for the NHS

Developments in electronic prescriptions are only part of a larger IT strategy for the NHS. In January, the Department of Health advertised in the Official Journal of the European Communities calling for interested parties to form consortia to bid for up to £2.3bn worth of work over the next three financial years. The financial press report that multinational IT companies are taking an interest in being part of these consortia.

Winning consortia will be responsible for work at either a national or local level. Examples of national work include providing infrastructure such as the NHSnet and its successors or providing national applications such as the electronic transfer and processing of prescriptions, electronic appointment booking or summaries of integrated care records. Local services could include maintaining integrated care records at a trust or health care site and providing support for NHS staff using an IT service.

Mr Mackay says that pharmacies will have to be aware of and take part in any changes in NHS IT. This includes making sure that they install any necessary equipment for connecting to appropriate NHS services.

Prescription processing

While mentions of how community pharmacies will fit into the new IT strategy are rare, the Department of Health has shown its commitment to modernising the Prescription Pricing Authority. This has been driven in part by a recognition that the system can no longer cope with the prescription volume growth that is expected (PJ, 8 March, p321).

Speaking at a conference organised by the PPA last month, its chief executive Nick Scholte said that the introduction of the Primary Care Drug Dictionary (PCDD) is an important step on the way toward implementing ETP (see Panel below).

Having a unique code for each size of pack of a product that is prescribed will allow automation of the processing and pricing of prescribing and dispensing data. Including these codes on packaging will allow better tracking of products from the factory to the patient and should reduce dispensing and administration errors. It also means that more information could be associated with the barcodes for products.

However, introducing these codes is not with out problems or costs for the pharmaceutical industry and for pharmacy.

Speaking at the PPA conference, Martin Anderson, commercial affairs director at the Association of the British Pharmaceutical Industry, said that, for example, getting regulatory approval to change packaging processes takes both time and money. There will also be a need for community pharmacies to upgrade their IT systems so that they can read the codes and make use of the information on them, he added.

Who will pay for new IT?

Community pharmacies will need to upgrade their computer systems if, as well as still providing a dispensing service, they are going to be able to:

• Connect to the NHSnet or its successor

• Receive or send electronic messages and prescriptions

• Read advanced barcodes

• Create and use clinical records

All of this will cost money, so who will pay for it? According to Geoff Mackay of AAH, systems such as these already exist in the Netherlands, but they cost between £10,000 and £50,000 a pharmacy.

"Free systems do not exist in the Dutch market and free systems are not sustainable for much longer here." If pharmacy computer systems are to be accredited for connection to some of the forthcoming NHS systems, then computer suppliers will have to be in a position to charge for them, he believes.

Under the new contract for general practitioners, GP practices will have their IT costs met by primary care organisations. The contract is to be put to a ballot of GPs but this has been postponed while concerns about the financial effects of the contract are explored (see p388).

Should a similar funding approach be adopted for community pharmacy when its new contract is negotiated?

Mike King, head of professional development at the Pharmaceutical Services Negotiating Committee, accepts that if the new contract is to be based more on services than on dispensing volume, and if new IT is required for these services, then discussions on how this is funded will have to form part of the negotiations.

"The general view is that the costs of new IT will be significant but that investment is necessary if better use is to be made of pharmacists' skills."

He believes that the Government will have to provide funding for new IT in pharmacy in one form or another.

"The funding could come either as specific IT funding or it could come from a recognition of the increased costs for providing new services. Whichever way, it has to be new funding."

One of the main uses of new IT will be to access patient' notes or the proposed electronic integrated care records. Without access to these records, pharmacists' involvement in medicines management and supplementary prescribing will not be possible, an issue highlighted by the Crown report into pharmacist prescribing.

Ian Shepherd, an independent IT consultant and formerly head of IT policy for the Royal Pharmaceutical Society, says that there is a bit of a "chicken and egg" problem surrounding the funding of new IT for community pharmacy.

"Should pharmacy have to pay for the infrastructure so that it can carry out the new services like medicines management that both it and the Government want? Or should it be the other way round and should there be investment by the Government so that the benefits to patients of a higher quality service can be recognised?"

He adds that in the past Governments have viewed pharmacy as a commercial operation that should fund its own investment in IT based on its profits from dispensing in volume. But, if the profession is moving towards a more clinical model of services, this commercial model may no longer be sustainable, bringing the funding requirements back to the Government.

Taking IT forward

Can the Government really deliver a joined-up electronic NHS? If so, where will pharmacy fit into it?

Earlier this month, Lord Hunt, then junior health minister with responsibility for IT, said that in the early 1990s the NHS lost confidence in its ability to drive forward IT programmes: "The result is that we went for 10 years into a highly decentralised mode. Now we have hundreds of different systems, none of which seem to talk to each other." According to Lord Hunt, the only way to deal with this legacy is to have an IT programme with national direction.

If pharmacy is to take on the new clinical roles that it has talked about for so long then must ensure that it has a place in any national plans for NHS IT. Both the issues of payment for new equipment and the ongoing costs of using it will have to be addressed. And the consequences of introducing new technology must be faced.

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