I believe we have found the ‘Holy Grail’ of efficient and rapid prescribing with the NHS Electronic Prescription Service Release 2’s system for issuing and dispensing repeat scripts.
With Electronic Repeat Dispensing (eRD) as it is called, the patient’s nominated pharmacy can automatically issue a repeat prescription before the patient’s medicine runs out.
GP workload reduction
The eRD system is in my opinion potentially the biggest benefit of electronic prescribing for GPs and patients.
My own practice did not use paper-based repeat prescribing much, finding this difficult, particularly when there were amendments to the medication regime. But in the electronic world eRD is a key system for reducing GP workload.
How it works
Assume a patient is stable on their repeat medication regimen, has received their annual clinical and medication review, and can now have 12 months’ worth of prescriptions.
You, as the GP, can simply process the entire 12 month’s prescriptions with a single electronic signature, and the prescription will automatically download to the pharmacy at the chosen intervals, seven days before it is due.
This gives the pharmacy time to ensure the medication is in stock, and to prepare it ready for the patient to collect.
If as is likely, the patient is on several medications and tends to request repeats at different times, the potential time saving for you is even greater.
Medication needed early
If the patient needs the medication sooner - perhaps because they are going away on holiday - they can ask the pharmacy to download the prescription early.
There is no problem dispensing the drug early if it is clinically safe to do so, which in the majority of cases it is.
If there is a change to the medication regime, the GP can simply cancel all outstanding issues, make the amendments and electronically sign a new series of repeat prescriptions.
Bigger pharmacist role
The eRD system passes the responsibility for the ongoing management of the patients’ medication to the pharmacist, so I would not recommend setting this up for the minority of patients for whom you feel this is inappropriate.
With eRD the pharmacist becomes more involved in the patient’s compliance with their medications. It can even be used as a mechanism for issuing weekly dosette pack/box prescriptions if this is best for certain patients.
Another great advantage is the GP’s ability to electronically cancel prescriptions – either single items or the all items prescribed.
The GP receives an electronic notification that the cancellation was successful or not.
If the pharmacy has already downloaded the prescription so the cancellation failed, you get an electronic notification telling you which pharmacy has the prescription together with contact details.
This is a big improvement on the paper-based prescription system under which you are unlikely to know where the patient has taken the script.
Another great benefit to GPs and patients, is that so far, no EPS prescriptions that have been signed and sent by GPs have gone missing.
|Advantages of electronic prescribing|
Benefits for practices
Benefits for patients
Benefits for pharmacies
Getting up and running
Practices need to approach their PCT to find out what is happening locally as the medicines management and registration authority (smartcard) teams at the PCT need to be involved.
GPs’ and team members’ NHS smartcards need to be updated with the appropriate roles and activities for EPS.
Only clinicians will be able to sign e-scripts but other staff can get some access: for example, allowing receptionists to view and issue prescriptions. If you have a trained prescription clerk, you might want their smartcard enabled to cancel prescriptions.
Restricted access via smartcards is technically called ‘role-based access control’ (RBAC) and PCTs need to understand what your practice’s EPS requirements are.
For more information, visit the EPS section on the Connecting for Health website.
With EPS the drug dictionary in your clinical systems needs to be the NHS dictionary of medicines and devices (dm+d) that has been chosen for EPS. (You can have only one drug dictionary across all systems to avoid mix-ups.)
GPs and staff members involved with EPS require training from the practice’s system supplier and PCT to ensure everyone understands the business process changes EPS has brought about.
• Dr Kaye is a GP in Manchester at the Davyhulme Medical Centre