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Electronic prescription service: the problems

Yesterday, our writer Rachel Mountain talked us through the aims of EPS. Join us today as we’ll be discussing what problems can arise from the digital service

Posted: 3 February 2016

If you missed yesterday’s episode of our weekly feature, click here.

Problems arising out of EPS can roughly be divided into those resulting from technical difficulties and those that come about adopting the new system into current working practices. While the reliability of EPS has improved since the migration from Spine – the part of the NHS infrastructure that holds patient data and allows for electronic messaging - to Spine 2, technical issues can still hinder smooth dispensing.

John Palmer, the national IT lead at Pharmacy Voice, says a common stumbling block for pharmacists is when they are simply not able to find the prescription, potentially because it could be delayed somewhere in the electronic system waiting for authorisation.

“Pharmacy staff are customer facing, yet rely on a long electronic prescription pipeline from GP to GP system, over Spine to the central EPS service, over Spine to the dispensing system suppliers, via the N3 (NHSnet) aggregators to the pharmacy Patient Medication Record (PMR),” he said.

As of August 2014, Spine had transmitted more than 1.3 billion EPS prescription messages and 50 million EPS dispense notifications.

Palmer says: “Often, electronic repeat dispensing doesn’t appear automatically on the appointed day and has to be searched for and manually downloaded. Prescription tracker can be used to help track down a prescription but it is extra work.”

The Health and Social Care Information Centre (HSCIC) aims to reset lost prescriptions within 48 hours but this can feel slow for waiting patients. Pharmacists, notes Palmer, while may be experts in medicine and health but they are often not in IT.

Other problems that arise out of the EPS roll-out can be attributed to a hesitance of prescribers and dispensers to adopt digital working into their practices. In some cases, pharmacy owners are reluctant to make the changes because they are approaching retirement or changing ownership. On the other hand, the case for EPS has to be fought against competing priorities in the GP surgery. The latest statistics released by the HSCIC show that, as of 2 November 2015, 11,567 (98.3 per cent) of pharmacies had gone live compared to 5,526 (70.1 per cent) of GP practices and 95 (84.8 per cent) of DACs.

Rachel Habergham, the programme head for EPS at HSCIC, says: “We recognise that initially the progress in the GP space was slower. We have to recognise that GPs have a number of competing priorities and that going live with EPS has to fit in as part of their overall increasing use of IT.

“It is reassuring that the numbers of practices going live are now rising substantially as GPs recognise the benefits to them and to their patients..”

Dr Imran Rafi, chair of the Royal College of GPs' Clinical Innovation and Research Centre, points out there are around 60 new ‘go lives’ in GP surgeries each week but that it is “not a priority for everyone”.

"There is some necessary initial investment in terms of resources and training for the GP practice team,” he says.

“Personally, I have found learning to use the system fairly straightforward, but with general practice under such intense workforce and resource pressures, it is easy to understand why this is not a priority for everyone.”

The rate of GPs adopting the service is “really gaining momentum”, says Habergham with the percentage of GPs going live increasing by 21 per cent and usage of EPS increasing by 13 per cent between March and October 2015.

Meanwhile, Palmer voiced concerns about the “atrophy of EPSR2 skills in pharmacy” while they wait for the remaining prescribers to go live. To address the problem and keep dispensing skills up-to-date, an EPS masterclass is being delivered in 800 sessions nationwide. Habergham says: “The most challenging part is to ensure everyone recognises that this is not an IT project, it’s a business change programme.

“It’s vital GPs and pharmacists consider the way they operate as part of preparing to go live with EPS. Attendance at business change sessions and training events will help to ensure everyone gets the best out of EPS.”

Join us tomorrow as we’ll be discussing the benefits of EPS