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Electronic prescribing helps reduce repeat scrip work

A huge benefit with EPS Release 2 is that it does away with repeat prescribing drudgery, says Dr Tony Kaye.

GPs can use one e-signature to prescribe 12 months' repeat scripts (Image: iStock)
GPs can use one e-signature to prescribe 12 months' repeat scripts (Image: iStock)

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.

Cancelling prescriptions

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

  • Over time there is a considerable workload reduction from recruiting patients to EPS, signing prescriptions in bulk, electronic repeat dispensing, and electronic cancellation.
  • Even if EPS is used at a basic level for normal acute and repeat prescriptions and without electronic repeat dispensing, there will be an immediate workflow benefit as a result of fewer paper prescriptions travelling around the practice.
  • Your receptionists can process prescriptions and send them to your prescription ‘mailbox’ for you to electronically sign and send on to the pharmacy.
  • The practice also saves on printer laser toner costs because there is less printing.

Benefits for patients

  • EPS is more efficient for patients as there is less waiting in the pharmacy and the full prescription can normally be dispensed, eliminating the need for return visits to the pharmacy.
  • The patient may be able to perhaps nominate a pharmacy near their home or workplace instead of one close to their GP practice. Pharmacies that are 'live’ can receive electronic prescriptions from any ‘live’ practice.

Benefits for pharmacies

  • They receive prescriptions directly into their IT system, with no need to re-enter the information so reducing errors and workload.
  • With repeat dispensing they can to order the medication and prepare it before the patient arrives and ensure better stock control with fewer prescriptions initially partially dispensed.

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.

Drug dictionaries

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

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