At the start of the coronavirus crisis in March, GP practices faced a major challenge in dealing with its poorly patients. To prevent further spread of the virus, GPs had to ask people to take part in online or telephone consultations rather than physically attend the practice.
As the crisis developed, people were making calls to NHS 111 and then being referred to pharmacies as part of the Community Pharmacist Consultation Service to get urgent medication. This initiative proved invaluable at a time when community pharmacies became the only primary care service to be operating largely business as usual.
However, it was more important than ever for GPs to be kept up-to-date on what medication their patients were receiving so the GPs didn’t re-supply the drugs unnecessarily. GPs had been used to receiving these notifications from pharmacies by either NHSmail, fax or paper. This was an inefficient way of sharing information and meant practice staff had to manually update patients’ records – this took valuable time and was prone to transcribing errors.
Fortunately, a digital solution had been created last Autumn to ensure notifications were shared and received swiftly, accurately, safely and consistently for flu vaccinations administered by community pharmacists.
The new method of digital notifications was implemented for the flu season, initially with one GP system (TPP SystmOne) and one pharmacy system (Pinnacle PharmOutcomes) to ensure GPs knew which patients had received the flu vaccine.
Then, at the beginning of 2020, this initiative expanded to include the notification of urgent supplies of medicines via the Community Pharmacist Consultation Service. This allows patients who have run out of their prescribed medicines to get a supply directly from a community pharmacy if their GP surgery was closed, for example, over the weekend.
How does it work?
Up to now, it has involved working with four suppliers who own the two pharmacy systems, PharmOutcomes and Sonar Informatics, and two GP systems, EMIS Web and TPP SystmOne.
The notifications are sent as a structured FHIR message from a community pharmacy’s clinical system via the Message Exchange for Social Care and Health (MESH) directly to a patient’s GP practice, where it is received as a workflow task in the practice’s clinical system. The task has an attached PDF which contains all the details.
Structured information is the key to interoperability.
The task acts as a prompt for the GP to review the information and add a note to the patient’s record where necessary without having to manually process it. This is quicker and consistent with how GPs receive other forms of communication.
All the messages are sent with structured information. Structured information is the key to interoperability. It allows clinical information to flow across care settings and from one system to another seamlessly. The details are in a standardised format and are computer readable. TPP SystmOne can currently consume the structured element of the information, whereas EMIS are still working on this.
The content of the electronic notification is based on the pharmacy information flows data standard developed in partnership with the Professional Record Standards Body (PRSB).
Once added to the patient’s record, the practice can update the patient’s Summary Care Record (SCR) so the information is available to other care providers.
How does this help GPs?
The key benefits for the GP are:
timely information is shared electronically
it is received via MESH rather than an email, which is more secure and reliable
it is received as a workflow task and is therefore consistent with other forms of communication that the practice receives. The notification is more visible in the GP’s clinical system and there is no need to scan and manually process paper
Personal Demographic Service (PDS) syncing helps the right patients to be matched to the right practices
safety is improved as patient records are quickly updated and transcribing errors are reduced
How can we help GPs more?
The strategic solution for this work is to send and consume structured information as this is key to interoperability. Relevant information such as medication SNOMED codes, quantities supplied and sender details can be consumed directly into the patient record avoiding the need for manual coding. Subsequently the Summary Care Record is also updated automatically thereby allowing visibility of this information by other care providers.
What is next?
All four suppliers – TPP, Pinnacle, EMIS and Sonar – have achieved full roll-out approval for urgent supply notifications. Three of them have gone live across all their sites and EMIS are in the very last stages of going live.
TPP and Pinnacle are live with flu notifications. EMIS and Sonar are aiming to be ready for the coming flu season. The importance of receiving notifications in this way is likely to be greater this year. If the pharmacy has administered a flu vaccine for a patient, the GP updates the patient’s record and does not continue to contact that patient to offer the vaccine again.
This will be useful considering the government is introducing flu vaccinations for everyone over the age of 50. This amounts to around 30 million patients. Those over 65 and with medical conditions will continue to be a priority in the vaccination programme. It is good preparation for a busy winter when we might be subject to a potential second wave of COVID-19.