By Vishen Ramkisson. 3 May 2018
By Vishen Ramkisson. 3 May 2018
Digitising the prescribing and distribution of medicines has an enormous potential to improve patient care, increase safety and make our system in the NHS more efficient. As our world changes at a rate not seen since the industrial revolution, with vast swathes of our lives changing beyond recognition in just the last few years alone, pharmacy has been slow to adjust. We have made great progress, but there remains a reliance on inefficient, paper-based processes which slow us down, increase the potential for errors and cost money. This results in a huge administrative burden, not only on non-clinical support staff, but on pharmacists and primary care prescribers too.
The need for the NHS Digital’s Digital Medicines programmes of work to deliver the tools to change that is bigger now than ever. We spend £17.4 billion a year on medicines, over half of which is in primary care. Yet, up to half of patients don’t take their medicines as intended. This means their health is affected, often creating a vicious circle with more medicines being needed as a result. Indeed, use of multiple medicines is on the rise. Over one million people now take eight or more medicines a day and many of these are elderly. Medicines are the most common intervention made to support the treatment of patients and are also the most common source of avoidable adverse events. Between five and eight per cent of all hospital admissions are medicines related, many preventable. So, a failure to digitise medicines would be a failure to modernise a fundamental bedrock of our health and care system.
Taking action to digitise medicines
The Medicines Value Programme remains a key priority for the NHS in England, and here at NHS Digital, our Digital Medicines work has a crucial role to play in delivering this. To help people get the best results from their medicines, while also achieving the best value for the tax payer, we’re harnessing the power of new technology to transform pharmacy and medicines. Key on our list of priorities is helping pharmacy become more integrated in the patient journey and better connected to the wider NHS, with improved information sharing and new communication mechanisms.
In England, there are around 438 million health-related visits to community pharmacies each year – more than a million every day. Our teams are working hard to deliver in several areas.
Extending the Electronic Prescription Service
Dispensing prescriptions is still community pharmacy’s bread and butter and, with one billion items dispensed every year, reducing the administrative burden of prescribing, dispensing and providing pharmacy services is clearly vital. Less time spent on labour-intensive processes means more time for patient care.
That’s why we are extending and enhancing EPS to all eligible prescriptions and into other care settings – initially urgent care. This means prescribing will be quicker for everyone and there will be fewer errors. The burden and costs of using paper will significantly reduce. Exemption checks will be done digitally, and less NHS money will be lost to fraud. Controlled drugs are the next on the list. EPS in urgent care is already being rolled out.
Maximising the use of data
When we look at the bigger picture, the data we have on medicines use, efficacy and spend isn’t quite where it needs to be. The NHS doesn’t have enough comparable data about medicines to ensure people get the best health outcomes and best value for money. Quality, comprehensive data has the potential to do great things for medicines optimisation and improve safety and outcomes for patients, and we’ve already seen the huge savings identified in hospitals by NHS Improvement’s Model Hospital Top 10 Medicines work. But, until we have a comprehensive dataset that combines and collates all NHS prescribing and allows it to be linked to other datasets, we will never have the whole-system view we really need to make the most of this data.
Part of the solution is introducing improvements to hospital pharmacy computer systems, which will also ensure the supply of medicines within the NHS is cost-effective and efficient. Electronic prescribing and administration (EPMA) systems will offer further opportunities to collate meaningful data on medicine use. Introducing a single, consistent set of medicines data which is used by everyone in the NHS will allow the NHS to prescribe in the most effective and efficient way for patients. Clinicians will be better informed about what does and doesn’t work and which medicines provide value for money. Care will be more personalised because the NHS will know more about what is more effective for a person’s age and condition.
For all the work we’ve already done – on EPS, on NHSmail, on the Summary Care Record and much, much more – there is still much to be done. Pharmacy is being given an ever more important role in making sure the NHS provides the world class care its patients deserve. It needs the digital tools at its disposal to make that happen. We need all pharmacists to be e-pharmacists.