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Electronic prescriptions - Dispensers unable to issue e-scrips

Scotland's dispensing practices fear becoming 'second-class citizens', reports Ailsa Colquhoun.

Increased efficiency and a better patient experience are the selling points of Scotland's new electronic Acute Medication Service - eAMS - which launched officially in July, the first such service in the UK.

Among Scotland's 130 dispensing GP practices, however, the launch is seen as yet another example of how they are being excluded from NHS health strategy.

Each week in Scotland, some 900,000 electronic prescriptions are put into the new high-tech prescription system, yet not one can be electronically processed in-house by a GP surgery on behalf of its dispensing patients.

And now Scotland's pharmacies have crossed the negotiated threshold for the number of electronic claims they make, they are also in receipt of a special contract preparation payment that runs to up to £900 per pharmacy.

Dispensing doctors say they are worried about the impact the disparity will have on their patients and the Dispensing Doctors' Association (DDA) is now calling for more system uniformity.

Electronic transfer
In Scotland, around 200,000 paper prescriptions are issued every working day on average, accounting for more than 77 million prescription items in 2006.

In a bid to deal safely and efficiently with these numbers, the past eight years have seen the development of the Electronic Transfer of Prescriptions (ETP) - a technology platform electronically underpinning both the Acute Medication Service (AMS) and the forthcoming Chronic Medication Service (CMS).

In the ETP process, bespoke systems allow the GP to produce a barcoded paper prescription and an associated electronic message carrying the details printed on the prescription form. The message is sent by the GP system to a message store, called the ePharmacy Message Store (ePMS), where it sits until the patient presents the prescription for dispensing.

The message is retrieved by scanning the barcode on the prescription form. The information is used to support the dispensing process and, afterwards, an electronic claim for reimbursement.

ETP is intended to bring benefits to patients, prescribers, dispensers and payers. By using the UK Dictionary of Medicines and Devices, it introduces a common, recognised code for almost all medicines and devices.

When fully operational, dispensers will no longer have to transcribe all the information contained on the prescription into their patient medication record system because some of the information will be prepopulated automatically.

From a patient perspective, ETP will reduce the risk of communication errors between GPs and dispensers by improving the accuracy of data transfer.

For dispensers and payers, ETP also makes the processing of prescriptions for payment more efficient and improves the quality and availability of prescribing data and associated trend analysis.

Priority for pharmacies
However, as it stands, these benefits will only be realised by dispensers and patients in community pharmacies.

Dispensing practices may represent 12 per cent of practices in Scotland but their remote and rural nature means they provide services to only 3 per cent of the total population.

ETP has, therefore, been implemented as a priority in pharmacies, and the first service to which it has been fully applied, the Acute Medication Service, is an essential service of the community pharmacy contract, negotiated and paid for specifically 'to provide patients with access to the pharmacy of their choice for the dispensing of acute prescriptions'.

This issue aside, so far, things are going well: smaller patient populations, a less ambitious programme and (suppliers would argue) better stakeholder relationships compared with those in England, have allowed good progress with ETP in Scotland.

The eAMS is enabled in 99 per cent of Scotland's GP practices and pharmacies, and more than 90 per cent of prescriptions are now submitted electronically.

Pharmacies are now claiming more than 60 per cent of all AMS GP10s electronically but until ETP is built into the dispensing GP contract in Scotland, frustratingly, it remains paper scrip business only for the practices' dispensing patients.

For most Scottish dispensing practices, distance to the nearest pharmacy will prevent the majority of their patients from opting to have a prescription dispensed under the eAMS in a pharmacy. However, the lost workflow and payment system efficiencies - not to mention the inherent risks to patient safety wrapped up in manual information transcription - are much more of an immediate concern.

This is set to become even more pertinent to business when pharmacies roll out the CMS, which will allow patients with long-term conditions to register with a community pharmacy and receive a package of care designed to produce optimal therapeutic benefit from their medicines. Full nationwide adoption is expected by April, 2010.

Both the DDA and the BMA believe dispensing doctors should be able to provide services that mirror those provided by community pharmacies. And when the nearest pharmacy is more than 50 miles away, as it is for patients at the Aultbea and Gairloch Medical Practice in the Scottish Highlands, it is understandable that staff want action taken swiftly.

'Dispensing doctors want to have the same status as pharmacists,' says practice manager Andrew Vickerstaff. 'They should not be seen as second-class citizens when it comes to pharmaceutical services.

'We are sidelined in favour of pharmacy, and our patients do not see the benefits that the patient at a pharmacy sees. That cannot be right.'

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