THE ELECTRONIC PRESCRIPTION SERVICE and REPEAT DISPENSING e

THE ELECTRONIC PRESCRIPTION SERVICE and REPEAT DISPENSING (e. RD) Patrick Leppard MRPharm. S 01 November 2020

What is Electronic Repeat Dispensing (e. RD)? (Batch Prescribing) Prescribe up to 12 months worth EPS prescriptions in one go as a ‘batch’ for patients with repeat medication. Prescriptions will be available for the patient to collect from their pharmacy without having to order from the GP. Pharmacy is contractually obliged to carry out checks with patient before dispensing each issue NHS Community Pharmacy Contractual Framework essential service

What is Electronic Repeat Dispensing (e. RD)? (Batch Prescribing) Have you seen any healthcare professionals, (GP, Nurse or Hospital doctor) since your last repeat was supplied? Have you recently started taking any new medication on prescription or bought over the counter? Have you been having any problems with your medication or experiencing any side effects? Are there any items on your repeat prescription that you don’t need this month?

Why do we need Electronic Repeat Dispensing? Potential benefits are enormous NHS Patients GP Surgeries Pharmacies Massive Huge Great Significant

Repeat Prescribing (current position) Clinical decision to treat patient with medication until next review (up to one year) Unless something changes, there is no need to see that patient again until the next review. Patient needs access to medications so prescriptions must be requested, processed, generated, signed and issued every 28 or 56 days Slow, bureaucratic and inefficient Industry created to facilitate a clinical decision made once a year

Prescription Merry-go-round Patient generates request before current supply runs out and submits to pharmacy Pharmacy records request, sorts and submits to appropriate surgery Request transported to correct surgery Request unpacked, processed and used to generate next prescription New prescriptions sorted and sent to designated prescriber to approve and sign Signed prescriptions collected and sorted by destination - (post, collect, pharmacy collect) Prescription transported to correct pharmacy

Possible to predict from the original request what would A appear on the prescription BE O T Repeat Prescribing. A is: S ! ! ! H Y E A R E W H R T E T T BE Slow and inefficient (2 to 5 days from submitting request to receiving prescription) Repetitive (needed every 28 or 56 days) Labour intensive (paper request and/or prescription handled by more than 10 people) Over bureaucratic and largely pointless (confirms a prescribing decision already made)

Why we need Electronic Repeat Dispensing Potential benefits are huge NHS 2. 7 ü million hours of ü GP practice hours ü ü ü saved each year Efficiency Safety Savings Improved services Data processing

Why do we need Electronic Repeat Dispensing? Potential benefits are huge Patients üEasier access to medication üNo need to order 48 hours in advance üOne stop service üLess likely to run out of medications üNo need to hoard medicines just in case

Why do we need Electronic Repeat Dispensing? Potential benefits are huge GP Practice üSignificant reduction in administration üWorkload reduced – more time for patients üPrescribing decisions aligned with review üCompliance monitored by pharmacy üLess waste – reduced prescribing costs

Why do we need Electronic Repeat Dispensing? Potential benefits are huge Pharmacies üRxs available 7 days before they are collected üImproved stock control üReduced time collecting paper Rxs üNo need to store RA and RD script/tokens üItems automatically cancelled

Why do we need Electronic Repeat Dispensing? Potential benefits are huge Pharmacies X Rxs available 7 days before they are collected X Improved stock control ? Reduced time collecting paper Rxs ? No need to store RA and RD script/token üItems automatically cancelled

Why do we need Electronic Repeat Dispensing? Potential benefits are significant Pharmacies üItems (on Spine) automatically cancelled (safer) üPrescription available when needed üLess need for Emergency Supplies üMore control – easier to manage üBetter service to patients

Challenges to Electronic Repeat Dispensing? Potential problems are also significant Pharmacies ØExtra work ØPrinting tokens / confidential waste ØNew processes / different ways of working ØHardware / software issues ØExtra responsibility / managing patients ØPatient expectations ØUnsuitable prescribing

Challenges to Electronic Repeat Dispensing? Potential problems Surgeries ØNew processes (increased complexity) ØUnderstanding / Trust ØNeed to group items sensibly ØNeed to synchronise medications ØItems that can’t be prescribed by EPS ØPatients continuing to order Repeat Rxs ØPatient expectations

Challenges to Electronic Repeat Dispensing? Potential problems Patients ØUnderstanding / Trust / Preference ØNeed to request grouped items sensibly ØItems that can’t be prescribed by EPS ØConfusion if not all items on e. RD ØHCP expectations

Electronic Repeat Dispensing is a partnership Patients Surgery Pharmacy

Good vs Bad Repeat Dispensing? Rx Levothyroxine 100 mcg 1 od x 28 ✔ Number of issues for one year? 13 12 x 28 = 336 days ✗ 13 x 28 = 364 days ✓

Good vs Bad Repeat Dispensing? Rx Levothyroxine 100 mcg tab 1 od x 56 Bisoprolol 2. 5 mg tab 1 od x 56 Aspirin 75 mg tab 1 od x 56 Number of issues for one year? 6 x 56 = 336 days ✗ 7 x 56 = 392 days ? ✓

Good vs Bad Repeat Dispensing? Rx Levothyroxine 100 mcg tab 1 od x 56 Bisoprolol 2. 5 mg tab 1 od x 56 Aspirin 75 mg tab 1 od x 56 Number of issues for one year? 6 x 56 = 336 days ✗ 7 x 56 = 392 days ✗ ✓

Good vs Bad Repeat Dispensing? Rx Levothyroxine 100 mcg tab 1 od x 56 Bisoprolol 2. 5 mg tab 1 od x 56 ✓ Aspirin 75 mg tab 1 od x 56 Number of issues for one year? 6 x 56 (e. RD) plus 1 x 56 (2 x 28 e. RD) ✓ ✓

Good vs Bad Repeat Dispensing? Rx Levothyroxine 100 mcg tab 1 od x 56 Ramipril 5 mg cap 1 od x 56 Aspirin 75 mg tab 1 od x 56 Paracetamol 500 mg 1 or 2 prn x 200 Ventolin Evohaler prn x 2 GTN spray 180 dose x 1 Oilatum Emollient 300 ml x 2 ?

Good vs Bad Repeat Dispensing? Rx Levothyroxine 100 mcg tab 1 od x 56 Ramipril 5 mg cap 1 od x 56 Aspirin 75 mg tab 1 od x 56 Paracetamol 500 mg 1 or 2 prn x 200 Ventolin Evohaler prn x 2 GTN spray 180 dose x 1 Oilatum Emollient 300 ml x 2 ✗

Good vs Bad Repeat Dispensing? Rx Levothyroxine 100 mcg tab 1 od x 56 Ramipril 5 mg cap 1 od x 56 Aspirin 75 mg tab 1 od x 56 Paracetamol 500 mg 1 or 2 prn x 200 Ventolin Evohaler prn x 2 GTN spray 180 dose x 1 Oilatum Emollient 300 ml x 2 ✓

Good vs Bad Repeat Dispensing? Less about what is prescribed and more about how it is prescribed Rx Levothyroxine 100 mcg tab 1 od x 56 Bisoprolol 2. 5 mg tab 1 od x 56 Aspirin 75 mg tab 1 od x 56 Paracetamol 500 mg 1 or 2 prn x 200 Ventolin Evohaler prn x 2 GTN spray 180 dose x 1 Oilatum Emollient 300 ml x 2 ?

EPSR 2 – Repeat Dispensing Which patients ? • • • On regular repeat medications with clearly defined doses On regular repeat medications with less clearly defined doses On irregular repeat medications with less clearly defined doses

EPSR 2 – Repeat Dispensing Which patients ? • • • On regular repeat medications with clearly defined doses On regular repeat medications with less clearly defined doses On irregular repeat medications with less clearly defined doses

Electronic Repeat Dispensing GOOD PRACTICE– what pharmacy needs! 1. Once started on e. RD patients stay on e. RD 2. All repeat medications, not just some, should be moved to e. RD. 3. Print the associated “RA” token and give this to the patient 4. Prescribe in dose equivalent quantities 5. Prescribe regular medications together 6. Prescribe less predictable items separately

Electronic Repeat Dispensing GOOD PRACTICE– what pharmacy needs! 7. Specify the number of issues based on expected usage derived from previous supplies 8. Rationalise quantities at the start (or get the pharmacy to do so) 9. 28 -day prescriptions easier to manage than 56 day ? 10. Prescribe for the full expected duration (13 x 28) 11. Communicate and collaborate with your local pharmacies.

Electronic Repeat Dispensing GOOD PRACTICE– what patients need! 1. Consistent and continuous service - once started on e. RD patients stay on e. RD 2. Requests for renewal of e. RD prescriptions should be dealt with in a timely manner - request may appear to be (very) early but still need to be processed - may require review, consultation, examination, tests - start of next batch timed (post-dated) to coincide with end of previous batch?

Electronic Repeat Dispensing GOOD PRACTICE– what pharmacies need to do Provide an efficient, patient-centred e. RD service • Provide convenient access to all necessary regular medications • When they are needed • All of the time

Electronic Repeat Dispensing GOOD PRACTICE– what pharmacies need to do Provide an efficient, patient-centred e. RD service • ALL necessary regular medications • ONLY if they are needed • ONLY when they are due Managing patients rather than just dispensing Rxs

Electronic Repeat Dispensing “change is not made without inconvenience, even from worse to better. ” Richard Hooker 1554 – 1600