One of the targets specified in Information for Health,1 published in 1998, was that community prescribing with electronic links to the GP and the Prescription Pricing Authority (PPA) would be introduced.
In the NHS Plan published in July 2000,2 the Government announced that electronic prescribing of medicines would be introduced by 2004, giving patients faster and safer prescribing as well as easier access to repeat prescribing.
A significant part of modernising the NHS is dependent on the implementation of new information systems, and electronic prescribing is an important part of the modernisation agenda.
Recently, when asked his view on electronic prescribing, a GP replied: "That's no problem, I already do most of my repeat prescribing by computer, so it will not affect me." Nothing could be further from the truth.
The majority of repeat prescribing is currently carried out by the patient requesting medication recorded on their electronic patient record (EPR). The prescription is then printed on a computer-generated FP10.
Acute prescriptions issued in the surgery are also mainly produced via a computer-generated FP10. Many prescriptions issued in a patient's home, however, are still handwritten.
The patient takes the printed FP10 (which at least is more legible than most GPs' handwritten prescriptions) to a pharmacist. The pharmacist then enters all the data from the FP10 onto a computer and dispenses the medication.
The FP10 is then sent to the PPA, in Newcastle, where the data from the FP10 are entered onto another computer. The PPA uses this information to calculate the pharmacist's payment and to monitor the medication issued by each GP, producing monthly practice-based expenditure against budgets for prescribing and also more detailed quarterly prescribing analyses and cost (PACT) data for each GP.
It is not therefore surprising that there is a considerable delay between GPs submitting FP10s for personally dispensed items and being reimbursed for doing so.
The NHS Plan proposes that by 2004 there will be repeat dispensing schemes nationwide to make it easier for patients with chronic conditions to obtain repeat prescriptions.2
Why transmit prescriptions electronically?
Under the current system, similar data are entered onto three separate computers. This is costly to the NHS in terms of each item of medication dispensed to the patient. The risk of data error is also increased with multiple entries of the same data.
Electronic transmission of prescriptions (ETP) will allow a fundamental reform of the repeat prescribing system. The GP could retain the responsibility and overall control of a patient's medication and ensure that regular review was carried out where necessary, but could avoid having to issue an FP10 every month or two for stable chronic conditions.
The majority of FP10s are printed on dot matrix, traction feeder printers. As these are no longer manufactured, it has become necessary to produce a new FP10 form that can be printed via a laser printer or inkjet printer. The cost of the printer, ink and paper is not insignificant.
Security and confidentiality
A digital signature will replace the physical signing of prescriptions in the future. Adding a unique PIN number before issuing the electronic prescription could facilitate this.
Amendments to the current NHS Regulations will be required to allow GPs to transmit and sign electronic prescriptions using approved encryption software.
In December 2000, Health Minister Lord Hunt announced that seven potential pilot proposals had been received to test different methods of ETP. In April 2001, it was announced that three pilots had received approval to test the costs, risks and benefits of ETP.
The pilots will start later this year and will run for at least 6 months, following which an independent evaluation will be performed to test the risks, benefits and costs of ETP, and help decide how best to roll out ETP across the NHS.
Who are the pilots and how will they work?
The 'TransScript' Consortium
This consortium consists of: British Telecommunications plc; Gehe UK plc (AAH/LloydsPharmacy/PharMed); Phoenix Medical Supplies Ltd; and UniChem Ltd.
This model will use direct messaging from the GP to a pharmacy of the patient's choice for repeat prescriptions (see Figure 1, below). Bar-coded prescriptions containing prescription data and a digital prescription will be used for acute prescribing.
|Figure 1: The 'TransScript' consortium|
This consortium consists of: Pharmacy2U; North West Co-operative; Health Global Worldwide; RSA Security; and Hadley Healthcare.
This model will use direct messaging from the GP to the nominated pharmacy for both acute and repeat prescribing (see Figure 2).
|Figure 2: The Pharmacy2U consortium|
The Sema consortium
This consortium consists of: Sema; Boots the Chemist; National Cooperative Chemists; Cable & Wireless; and Microsoft.
In this model, both repeat and acute GP prescriptions are sent to a central server (see Figure 3). The pharmacist then downloads the prescription when the patient goes to the pharmacy.
|Figure 3: The Sema consortium|
The scheme has built-in flexibility for patients so that they can choose which pharmacy they want to have their prescription dispensed at.
The legislation that covers prescription-only medicines, and also NHS Regulations, requires modification to allow these pilots to proceed.
The electronic transmission of data will be via NHSnet.
Each pilot should consist of at least 50 GPs and at least 50 pharmacies. The areas covered will include repeat and acute prescribing as well as dispensing GPs and personally administered items.
These pilots should ensure that a solution for ETP will emerge. ETP will start to be rolled out in 2004. It is difficult to envisage that any GP would be using computer-generated or handwritten FP10s by 2008.
- Information for Health – An Information Strategy for the Modern NHS 1998-2005. NHS Executive 1998.
- The NHS Plan - A Plan for Investment, A Plan for Reform. Department of Health, 2000.
Figures 1, 2 and 3 have been redrawn from 'Electronic Transmission of Prescriptions (ETP) Update' on the Prescription Pricing Authority website at http://www.ppa.org.uk/news/etp.htm