By Ryan, Digital Health Policy
Darllenwch y dudalen hon yn Gymraeg
On 17 November, the Minister for Health and Social Services announced that the first primary care prescriptions in Wales had been authorised via smartcard and sent digitally. This seems a straightforward and logical thing to do, so why the big fuss?
Why?
Firstly, let me give you some context. There are around 40 million paper prescriptions handled every year in Wales – with a country of around 3.1m people, that’s almost 13 prescriptions per person per year. Most of them are generated on a computer by a GP, printed out, physically signed, and taken to a community pharmacy for dispensing. The completed prescription is then boxed up and sent off to be paid. This means that a patient and three different organisations handle one piece of paper! And after that, the paper copy needs to be kept in case there are queries about it.
This improvement has come about following an independent review initiated by the Minister for Health and Social Services to improve prescribing, how medicines are administrated and patient access to information about their medication. Following the review, the Minister launched a new programme (now called the Digital Medicines Transformation Portfolio, DMTP) to digitise prescriptions and medicine administration for patients in primary and secondary care being that:
- to make it easier for patients to know what medicines they are prescribed, to track them through the prescribing journey and receive notifications when they are ready to collect,
- for clinicians to have better access to data and to share it more easily,
- to improve clinical safety, including preventing the prescribing of medications to which patients are allergic,
- to increase efficiency so that staff have more time to care for patients, and
- to reduce drug expenditure because there’s less waste.
Swansea Bay University Health Board has been trialling electronic prescribing in secondary care and is already realising benefits.
How?
So, how did we get to the beginning of the end of paper prescriptions in Wales?
One of the early decisions we took was to repurpose and reuse the Electronic Prescription Service (EPS) used in England. Using a proven technology provided us with a big leg-up, and we have a good working relationship with our counterparts in NHS England. We have tailored their service to meet the needs of Wales. We are also working closely with another digital health service developed in Wales – the NHS Wales App, so that shortly patients will receive notifications via the App that their prescribed medicines are ready to collect. I’ll do another blog on that once the service is live!
Getting EPS ready involved Wales needing to change the law so both policy and digital delivery staff needed to work closely together to make this happen. The whole point of taking a digital approach is not about technology but about people. It’s about putting people at the heart of all we do, and an integral part of developing the service (supported by the Centre for Digital Public Services) was listening to the views of GPs, pharmacies, NHS colleagues and patients, to hear what they wanted from a digitised medicines service and how they would use it. We also worked closely with suppliers so that they were kept up to date on of our goals and key timelines.
What happens next?
17 November was a pivotal date in the journey from paper to ePrescriptions, something that should be celebrated. With the first GP and pharmacy in Wales successfully exchanging prescriptions digitally, what’s next? First off, there’s the small matter of rolling the system out to the remaining approximately 380 GP practices and 700 pharmacies across Wales. The rollout will be phased to make sure changes happen as smoothly as possible. When the system has been adopted by GPs across Wales, we will then work with other primary care settings that prescribe (dentists, high-street optometrists, and Allied Health Professionals) so that we can understand how they and their patients can also benefit from using digital prescriptions.
Whilst we do all of this, we are also rolling out electronic prescribing and medicines administration across all Welsh hospital wards and developing patient-facing medication management features in the NHS Wales App I mentioned earlier. We are doing this in conjunction with implementing a shared medicines record which will bring together all prescriptions from every setting to provide clinicians with a single view of all medication, past and present for each patient – to enable them to make better-informed clinical decisions.