| With under five weeks to go before the new community pharmacy
contract comes into effect pharmacists will want to know that they have
the support
of robust IT systems behind them.
It is undisputed that the National
Programme for IT has the potential
to provide great opportunities for pharmacists in terms of access to
patient care records, better communication pathways and benefits expected
to result from the electronic transfer of prescriptions (ETP). However,
time scales appear to be slipping, implementation looks patchy and communication
between the programme, pharmacists and the NHS as a whole leaves a lot
to be desired.
The All-Party Pharmacy Group met in Westminster this week, together with
representatives from the Pharmaceutical Services Negotiating Committee,
the Department of Health, MPs and other members of the pharmacy profession
to debate areas of concern.
Over the next few months NPfIT will be testing the national roll out
model for ETP through a number of early adopter sites. The PSNC says
that it is still in discussions with the Department of Health about time
scales for this but expects that it will be progressively rolled out
across England between this summer and December 2007. There is now general
concern about what interim measures will be put in place to ensure that
pharmacies that do not adopt the new systems until later are not disadvantaged.
Lindsay McClure: A gradual evolution |
Lindsay McClure, head of information services at the PSNC, explained
that different suppliers are currently at different stages of upgrading
their systems to support ETP, which has led to concerns about what will
happen while there is a mix of ETP-enabled and non-ETP-enabled pharmacies. “It
is essential that there is a level playing field for pharmacies during
the roll out and that the roll out plan chosen does not negatively impact
on patient choice or access to medicines,” she said. However, since
arrangements for the national roll out have not yet been finalised, the
PSNC is unable to specify how this will be ensured.
Ms McClure said that, although the PSNC supports the Government’s
view on competition between pharmacies, it is important that that does
not interfere with patient choice. She says that robust systems need
to be put in place to prevent abuse of the system and to avoid problems
such as prescription direction (PJ, 19 February, p200).
Ms McClure said that the initial benefits for pharmacy from ETP are limited,
although the pilots carried out in 2002 demonstrated the potential for
ETP to increase the efficiency of dispensing and help manage pharmacy
stock levels. However, the Prescription Pricing Authority is likely to
benefit financially from automation of systems. “We hope that these
savings will be translated into benefits for community pharmacy such
as improved accuracy of prescription pricing and quicker payments,” she
explained.
An issue that remains to be resolved is how private prescriptions will
be handled under the new system since they are prescribed outside the
NHS. Neither is it clear how Controlled Drugs will fit into the new plans,
since schedule 2 and 3 CDs will not initially be included in ETP arrangements.
However, the handling of CDs is likely to change in the near future following
recommendations from the Shipman
inquiry (PJ, 24 July, p109).
Care records
Access to patient care records is another key area that is yet to be
finalised, and a Department of Health consultation on it is expected
shortly. Under the new pharmacy contract pharmacists will be obliged
to keep records of all NHS supplies made and to record advice given
when the information is clinically significant, Ms McClure explained.
She pointed out that advanced services such as medicines use reviews
will also necessitate record keeping. “Initially this will be
paper-based,” she said, “But it would be more effective
in the long term if pharmacists could upload summary information about
their contact with the patient to the care record so that other health
professionals can access this.”
However, when considering enhanced services the situation becomes more
complicated, since these are locally commissioned. Pharmacy representatives
suggested that a consultation was needed on a national requirement specification
for IT for enhanced services in the new contract. For example, what facility
will there be for systems to be adapted to meet local need? It is becoming
apparent that system suppliers will need to develop their own model specifications
to support specific services.
Harry Cayton, director for patients and the public at the Department
of Health and chairman of the Care Record Development Board, said that
it has set out an NHS care record guarantee (formerly called the information
sharing guarantee) outlining the relationship between patients, the NHS
and care providers. This outlines how records are created and shared
and how they are to be used. He said that the draft was approved by NPfIT
last week and he is hoping for approval by ministers shortly.
“
The perception of many is that NPfIT will be an overnight revolution,” said
Ms McClure,“In reality it won’t be a revolution, it will
be an evolution. New functionality will gradually be added over a number
of years and as more and more clinical information is added to the national
spine, the programme will deliver an increasing number of benefits for
patients, health professionals and the NHS.”
Other issues and suggestions raised at the meeting
Another suggestion raised at the meeting was that patients could
hold and be responsible for their own records. This would save
money and the onus would be on the patient as to who then had
access to this information. Harry Cayton, chairman of the Care
Record
Development Board, said that although the concept of a patient
taking away the information in some form of microchip may be
a possibility in the future, for most purposes direct and duplicate
access to information will be needed by health care professionals,
for example by the ambulance service in an emergency.
Lindsay McClure, head of information services at the PSNC, said
that pharmacists should also have access to all areas of the
NHS National
Electronic Library for Health, instead of being restricted to the
public areas of the site. The PSNC also suggests that pharmacists
should have NHS e-mail addresses, which, in addition to improving
communication of confidential information between health professionals,
would also support the NHS branding of community pharmacies. This
could also improve patient safety by increasing the speed of communication
of drug alerts for example.Ms McClure also pointed out that the “choose
and book” programme for booking NHS appointments could be
used by patients booking appointments with pharmacists for medication
reviews, for example, or could be used by pharmacy staff to signpost
customers to other health professionals (an essential service under
the new contract). |
|
The
Pharmaceutical Journal