NHS Digital has indicated that it is preparing to start the process of extending the Electronic Prescription Service to dispensing doctor practices. It is expected that an online survey will commence later this month seeking views on how dispensing doctors could use EPS; the DDA website will report on this and give the link once this is finalised.
In the meantime, dispensing practices may want to start thinking about some of the implications of EPS. This week, NHS Digital has published a set of figures with the headline that EPS has saved the NHS £130 million over three years.
In terms of the benefits arising from time saved on administration by those using the system – GP practices and pharmacies – NHS Digital says: “The biggest savings were recorded by prescribers who saved around £327 million between 2013 and 2016, while dispensers saved nearly £60 million.”
Figures relating to prescribers indicate that on average, GP practices saved:
- an hour and 20 minutes each day by signing electronic repeat prescriptions compared to paper versions;
- an hour and 13 minutes a day by producing electronic repeat prescriptions compared to paper ones;
- 43 minutes per day by not having to locate paper prescriptions within the practice;
- 31 minutes every day by not having to re-print lost paper prescriptions;
- 39 minutes every day by not having to wait for GPs to sign urgent paper prescriptions;
- 27 minutes every day by cancelling prescriptions electronically versus paper.
Feedback from pharmacies indicates that efficiency savings for the dispensing process include “around 54 minutes a day as result of faster dispensing under EPS and 43 minutes a day as a result of fewer trips to GP practices to collect paper prescription forms.”
NHS Digital also says:
- dispensing administrative staff reported that they are saving an average of 79 minutes every day as a result of faster dispensing;
- it takes 11.8 seconds less to enter details/demographics per item on EPS prescriptions rather than paper;
- it takes 7.3 seconds less per item to produce a prescription label from an EPS script than from a paper prescription.
Collectively EPS is also regarded as significantly benefiting patients. “An audit of patients using the system found that 72 per cent said their medicines were ready and waiting for them when they arrived at their pharmacy, with the average prescription collection around 20 minutes quicker under the EPS system,” says NHS Digital.
“Over the past three years the system has saved patients almost £75 million and has meant patients need to make fewer return trips to pharmacies as a result of their medications being out of stock.”
Dispensing practices can also take into account the findings from research conducted by PwC last year based on community pharmacy experiences.
The PwC study was commissioned by NHS Digital and agreed with NHS England and PSNC. It set out to assess the costs and benefits associated with EPS Release 2 compared to paper prescriptions. The researchers included visits to a range of pharmacies during 2015-16, held discussions with pharmacy team members and conducted a time and motion study of dispensing by EPS and by paper prescriptions.
PwC published two reports in April and June 2016 setting out its findings. PSNC has now published two briefings setting out key points from the PwC reports, for pharmacy contractors and for community pharmacy teams.
The briefing documents summarise several findings. PSNC’s briefing document for contractors includes the following:
- The PMR system being used made a difference to users’ perceptions about EPS. There were notable differences in the average time to process each prescription depending on the PMR system.
- There was a preference for EPS over the standard paper-based system – 61 per cent of community pharmacy respondents expressed a preference for EPS Release 2 compared to 24 per cent preferring paper.
- However, three quarters of respondents considered EPS Release 2 to have had no impact at all or just a moderate impact on the time to dispense prescriptions, and 14% felt that EPS was “significantly slower” than dispensing a paper prescription. PSNC notes that “the time and motion study undertaken by PwC found a negligible time saving to the average pharmacy as a result of implementing EPS Release 2.”
- The costs of running EPS were generally a concern, but more than half of respondents had not supplied specific details about which elements had the main cost implications. However, “operating system upgrades, Smartcard readers and new computers were the most frequently cited additional EPS costs.”
- From a patient perspective, pharmacy staff views were that patients generally didn’t need to spend as long in the pharmacy, improving the patient experience. “This improvement can, however, be undermined if the patient believes their medicines to be ready for collection but insufficient time has passed to allow that medicine to be dispensed.”
Points made in the briefing document for pharmacy teams include:
- Three quarters of dispensary teams felt EPS reduced data entry time needed for labelling. A majority (62 per cent) also felt that EPS reduced administration time, although 23 per cent felt it took longer. The study noted that “a common issue to remedy is pharmacy teams replicating some of the paper prescription submission process, where this was unnecessary for EPS scripts.”
- Staff reported that EPS reduced labelling errors.
- EPS allows dispensaries to plan the workload more efficiently as it allows more accurate prediction of when prescriptions would be available for dispensing.
PSNC’s briefing notes also include a number of tips and suggestions. These include:
- The dispensary manager should keep abreast of team members’ concerns about EPS so that issues can be addressed early on.
- A member of the team can also be made an ‘EPS champion’ to support training needs – staff will need EPS-specific training and will need to have their own Smartcard. Members of staff with enhanced computer literacy can be given more responsibility, while addressing the computer literacy needs of other staff members.
- Consider having more computer terminals so that dispensary staff can have their own workstation and not be waiting for a terminal to become free. Space constraints and costs may be a factor, though.
- Make sure that contingency plans are in place for when the system is down – power supply or software failures.
- Update Standard Operating Procedures to reflect the different dispensing processes with EPS and paper script processing needing their own SOPs. Note that “electronic prescriptions can’t be amended, they need to be cancelled and reissued. How will requests for prescription change be administered?”
- PMRs print EPS tokens in the same order in which they are received, but some pharmacies have generated efficiencies by printing EPS token in alphabetical order instead (although this depends on the functionality of the PMR system).
- Be aware of what is required in terms of endorsing, sorting and submitting EPS token to the NHS Business Services Authority – not all tokens are needed by the NHS BSA.
- Consider claiming for dispensed prescriptions at least once or twice a day, to save time at the end of the month; and report issues with claiming payment quickly to the PMR system supplier’s helpdesk.
The full PcW ‘Independent Review of the Costs, Systems and Usage of EPS in Community Pharmacies’ reports are available via PSNC’s website: Part 1 ‘Summary of findings’ from April 2016 and Part 2 from July 2016.