The Pharmaceutical Journal
Vol 279 No 7478 p560
17 November 2007

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The electronic prescription service: when will we get it together?

By Stephen Goundrey-Smith

Having spent a number of years working as a pharmacy domain specialist for a health care IT supplier, it is with some interest that I have been monitoring the progress of the electronic prescriptions service (EPS) and, more recently at grass-roots level as a locum community pharmacist.

For a number of years, EPS, otherwise known as the electronic transfer of prescriptions (ETP) in the community, was an optimistic proposition. Unlike other aspects of IT modernisation in the NHS, hampered by stakeholder buy-in, funding and NHS politics, ETP had a lot going for it.

There was a clear commercial imperative for ETP, given the need to streamline the community pharmacy workflow and the reimbursement of prescriptions, and there were organisations, such as community pharmacy multiples, wholesalers and community pharmacy software suppliers, willing to invest money in the ETP venture.

In the early years of this decade, a number of well-publicised pilots took place, although subsequently they were discontinued, pending the establishment of EPS, under the auspices of the NHS Connecting for Health (CfH) project. Now, with the roll-out of release 2 of EPS imminent, serious questions are being asked about whether EPS can be delivered within timescale or budget.

The reality is that the take-up of release 1 has not been as widespread as hoped, as only 31 per cent of pharmacy sites were “business live” as of July 2007, and many contractors have yet to implement release 1, even though release 2 is now ready for roll-out.

A number of factors have led to this current situation. First, there is the way in which CfH handled the project at the outset. Astonishingly, CfH did not consider community pharmacists to be key stakeholders in the implementation, and this is reflected in the way pharmacy business processes have been described in published CfH documentation.

For this reason, community pharmacists have been reluctant to adopt the EPS because they have been left with the impression that the system is being imposed on them by the Government, and they have not been convinced that EPS has been designed to serve their best interests.

Secondly, the medical profession has not been forthcoming in embracing EPS. Many medical practices have not implemented it, even though they have the software capability and have been given funding to do so.

The reluctance of GPs to move forward with EPS is, undoubtedly, because some doctors feel threatened by pharmacists taking on new roles and encroaching on their territory. This is often presented as being about GPs’ concerns for patient confidentiality.

This argument, however, does not withstand close scrutiny. Pharmacists routinely hold confidential patient information on their patient medication records and are bound by professional standards in maintaining that confidentiality.

Moreover, a comprehensive data link between a surgery and a community pharmacy may facilitate adoption of clinically focused enhanced services by community pharmacy, which may be of benefit to GPs as well as pharmacists.

Thirdly, there are, in my experience, issues with the co-ordination of stakeholders in ETP. In some areas, pharmacies are now “technically live”, with ETP functions on their pharmacy software, but medical practices are not ready, or willing, to move ahead with EPS. In others, GPs have adopted EPS software and are issuing bar-coded prescriptions, but pharmacies are not engaged with EPS.

In a few areas, both surgeries and pharmacies have the technology to run the EPS, but the local primary care trust is not ready to implement EPS in its area. Although some 19,000 pharmacists have been issued with EPS smartcards, many of these pharmacists may not be actively using them in live systems.

Many PCTs promptly issued EPS smartcards to pharmacists in their area but, because of the delay in implementing EPS, many pharmacists have forgotten their passwords and PCTs have the time-consuming task of reissuing them.

However, despite these difficulties, it is important to focus on the benefits that EPS will deliver. First, it will eliminate the archaic way in which the communication process between a doctor and a pharmacist, and between a pharmacist and the prescription reimbursement authority, relies on an A6 piece of paper, which can be lost, defaced or invalidated in some other way.

It will, therefore, help to address any safety issues surrounding the communication of prescription information between doctors and pharmacists (although, as yet, we have limited published data that assess this risk reduction).

Secondly, the electronic transmission of prescriptions direct to the pharmacy computer system will streamline the workflow through the pharmacy, in a time when, notwithstanding the emphasis on enhanced services in the new pharmacy contract, many pharmacies still rely on prescription volume for their remuneration.

Indeed, at a time when, in many localities, manually routed prescriptions can be misdirected or lost to the correct recipient, EPS has the potential to be a business tool to ensure the automatic delivery of prescriptions to a particular pharmacy, thus providing a stable business base for each pharmacy, and promoting customer satisfaction.

Furthermore, EPS will automate the payment process — an aspect of considerable importance given the time spent by community pharmacy staff on endorsing and submitting prescriptions, and the circumstances in which the NHS Business Services Authority may or may not reimburse prescriptions. Indeed, electronic optimisation of the reimbursement system will provide a measure of relief (albeit small) for those contractors who are reeling from the withdrawal of Category M generic product margin.

Thirdly, as indicated earlier, it is hoped that the EPS will facilitate comprehensive, two-way communication between surgeries and pharmacies, with future releases. This will have the potential to improve relationships between GPs and pharmacists, to improve the outcome of current pharmacist-led services, such as the medicines use review, and to promote new clinical services provided by community pharmacists.

Regardless of the causes of the current situation, it is imperative that all stakeholders work towards a uniform implementation of EPS, in a way that actively supports pharmacists’ business priorities. If this does not happen, EPS will be easily implemented in some areas, but not others and this will have a detrimental effect on the uniformity of patient care throughout the country.

The interests of pharmacists will be addressed in a number of ways: through the development of appropriate software by community pharmacy software suppliers; through the lobbying of pharmacy multiples, and through the representations of the recently formed pharmacy IT consultation group.

However, if we cannot get it together with EPS, in a way that supports the pharmacy profession, the entire pharmacy professional role may be in jeopardy.