The Government’s recently published A Plan for Digital Health and Social Care brings together goals for increased utilisation of data and technology for the NHS. The plan comes after (now former) Health Secretary Sajid Javid described the NHS as "A Blockbuster system in the age of Netflix". It’s not surprising then that the electronic prescribing and medicines administration (EPMA) is a component of these plans, and is something that the healthcare system has been integrating for some time now.
The What Good Looks Like (WGLL) framework provides standards for EPMA and establishes increased digitisation as a goal within the ICS framework and the broader NHS digitisation pathway. The WGLL has 7 core success measures, and EPMA are mentioned in 2 of these, demonstrating the perceived importance of EPMA utilisation not only for future-proofing patient services, but also ensuring safety and quality of care. This message has been amplified in recent news stories, with an investigation into the death of a patient highlighting a reliance on paper records as a contributing factor.
Not only will patients and providers benefit from digitisation, but so will pharma. Greater digitisation will enhance the proliferation of data, allowing pharma companies to understand their domain. By empowering the patient and making prescriptions convenient, EPMA adoption may increase compliance and therefore sales volumes.
So where are we with EPMA adoption in the NHS currently? Let’s take a look at some of the data published in the NHS Business Services Authority’s Electronic Prescription Service (EPS) and electronic Repeat Dispensing (eRD) utilisation dashboard. The latest version of the dashboard provides access to 13 months of prescription data, with values for total items, EPS items, and ERD items. This data includes a robust sample of 6,648 practices and 11,194 pharmacies, meaning that the data covers nearly all of England. Using this data we can pull together some insights into the adoption of digitisation.
Trended data over the 12 months to April 22 show a general high level of total EPS adoption, with averages of 89.6% for prescribing and 95.5 for dispenses. Over time we see a slightly increasing trend, with prescribing up 0.5 ppts in the latest 6 months versus the prior period, and dispenses up 0.2 ppts. This suggests that we are seeing a stable long-term trend of adoption of EPS within this data. It is worth noting that the data shows a slight but widespread drop in October 2021, possibly suggesting a data collection issue.
Repeat prescriptions account for two thirds of primary care prescriptions; it is estimated that 80 percent of all repeat prescriptions could be placed with eRD, saving 2.7 million hours of GP time. Considering these facts, it is not surprising that the NHS introduced eRD repeat prescriptions in 2009 to drive time efficiencies in prescribing and dispensing.
However, the view from the data here is quite different. Overall we see that eRD numbers are only a tiny fraction of total items and EPS items around 15% in both prescribing and dispensing. This is a far cry from the NHS’ estimates of total repeat prescription numbers, suggesting that there is either a very low adoption of eRD - and that practices and pharmacies are using an alternate system - or that there is a data quality or coding issue. Either way, it is interesting to note the questions surrounding eRD adoption in the data provided.
Setting aside eRD adoption now, looking at prescriptions data by practice shows that there is generally a high level of adoption of EPS systems, however there is a small but significant number of practices lagging behind. Around 13% of total practices have less than 80% EPS adoption, suggesting that there is still an opportunity for significant improvement.
Dispensing shows a slightly better picture, with only 4% of pharmacies putting less than 80% of prescriptions via EPS.
Given the efficiencies that can be accessed via EPMA adoption, and the patient safety aspect, we should expect practices that are behind the curve to prioritise digitisation. Perhaps there are lessons to be learned from how pharmacies have adopted these systems.
So what does this tell us about progress on prescription digitisation? An article published in Pharma Times highlights the NHS App’s recent milestone of enabling 1.8 million repeat prescriptions to be ordered in June 2022 alone, with more than 16 million repeat prescriptions ordered via the NHS App in the last year. This is clearly showing how technology is being used to help patients take control of their healthcare.
There is also a question around using eRD data as a measure for digitisation of repeat prescriptions, when the NHS app is now generating significant numbers of repeats. As Dr Timothy Ferris, NHS director of transformation, says: “The NHS App is already in the pockets of millions of people, providing easy access to crucial everyday NHS services like repeat prescriptions.” A comprehensive view of digitisation in the future will entail the combination of both of these sources.
While the plans for ICS’ do not give a quantifiable level of adoption that regions or ICS’ must meet, the general trend is of increasing digitisation. However, the full benefits will not be realised fully in practices that are behind, resulting in the potential for inefficiencies, adverse patient outcomes and substandard care.
Looking to the future, the recently published “The safer management of controlled drugs: Annual update 2021” gives us some insight into how professionals will be able to use this data to improve patient outcomes. The report outlines a new opiates prescription dashboard that allows the monitoring of opiates prescriptions. The dashboard uses EPS data to publish regular updates on opiate prescriptions, which are of key importance to improving patient outcomes given the potential for dependence and abuse in long-term users. Going forward, it will be interesting to see what other initiatives emerge for the NHS to exploit the data assets resulting from EPMA adoption.
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