Prescribing remains predominantly paper based in Wales. In primary care, despite a 2D barcode being in place on prescriptions, GPs and other clinicians still need to print and sign hard copies before sending them on to pharmacies.
Electronic prescribing – often called ePrescribing - takes away the need for clinicians to physically sign these copies, replacing them with electronic signatures and prescriptions. These can then be sent from the prescriber directly to the pharmacy. As a result prescribers can use time saved signing physical copies on treating patients, who are in turn able to collect prescriptions from any location.
An early incarnation of ePrescribing was first proposed in England in 2005 and a fully electronic prescription service was introduced by Scotland in 2009. But the Welsh Government has been criticised for being “incredibly slow” to roll it out here. Community Pharmacy Wales and the Welsh Pharmaceutical Committee want to see the Welsh Government deliver its commitment to ePrescribing with a greater sense of urgency
Following an independent review by Digital Health and Care Wales last year, the Welsh Government confirmed plans in September 2021 to develop ePrescribing in Wales over the next three to five years, though the Health Minister has said she wants to see it go more quickly than that.
What are the benefits of ePrescribing?
According to NHS Digital in England the benefits of ePrescribing include:
- prescribers process prescriptions more efficiently;
- dispensers reduce waste, improve stock control and provide a more efficient service to patients; and
- patients can collect repeat prescriptions from a pharmacy without visiting a GP.
The introduction of ePrescribing improves patient safety by reducing errors in prescriptions,. In England, it has been estimated that automating repeat prescriptions may save 2.7 million hours of GP and practice time.
What had been done so far in Wales?
While much of the focus of ePrescribing is on primary care, it is also being rolled-out in hospitals. In 2017, Abertawe Bo Morgannwg University Health Board (now known as Swansea Bay UHB) was designated as a national pathfinder in ePrescribing by the Welsh Government.
The health board has now almost eradicated paper drug charts in 15 medical wards across Neath Port Talbot and Singleton hospitals by replacing them with Hospital ePrescribing and Medicines Administration (HEPMA).
HEPMA allows prescribers to complete a prescription digitally and nurses use computers to access full details of medication, dose, frequency and length of use. The electronic system also highlights patients’ drug allergies or if a particular drug is unsuitable to be taken with a medication a patient may already be taking.
The health board’s pilot programme found that between February and May 2021, the introduction of HEPMA reduced the time nurses spent on medication rounds in four Neath Port Talbot wards by 125 hours over the course of the trial. Potential errors in prescriptions were found to be reduced during the pilot, allowing nurses to provide more hands-on care during the COVID-19 pandemic.
What are the plans for Wales?
Digital Health and Care recommended in their 2021 review that ePrescribing should be delivered across four different domains: primary care, secondary care, patient access, and medicines data repository. They will take the lead on introducing the programme over the next 3-5 years.
Primary care clinicians are currently using various electronic systems to produce prescriptions but have to print and sign hard copies, which are archived for reporting by the NHS Wales Shared Services Partnership. Prescriptions will be entirely digitised removing the need for those hard copies and enabling direct transfer between prescriber and pharmacy.
Timeline: 1-2 years for core capabilities; 2-3 years full rollout
An electronic platform for prescriptions will be introduced within hospitals, including electronic drug charts to simplify administration. The Swansea Bay UHB HEPMA pilot will be used as a basis to shape the national programme.
Timeline: 1-2 years for first “Pathfinder”; up to 5 years for rollout in key hospitals
The ePrescribing programme will partner with the Digital Services for Public and Patients programme to develop new features in the NHS Wales app. The app will allow patients to order repeat prescription electronically, record when they’ve taken medication and potentially access information on administering their medication.
Timeline: 1-2 years for core capabilities, ongoing
Medicines Data Repository
The system will allow patients’ medication record to be accessed, under strict controls, by clinicians across different hospitals. This is irrespective of where they were issued in Wales or whether they were in primary or secondary care.
Timeline: 1-2 years for core capabilities
Is ePrescribing live across the UK and Europe?
In 2005, barcodes were added to prescriptions and the foundations and infrastructure for ePrescribing were established. By 2018, the Electronic Prescription Service (EPS) was live in over 99% of community pharmacies and over 91% of GP practices. ePrescriptions increased to 86% of all prescriptions in primary care settings in England during the first wave of the COVID-19 pandemic.
A new programme of Digital Prescribing and Dispensing across primary and secondary care was announced by NHS Scotland in April 2021. In 2009 Scotland was the first country in the UK to deliver an entirely electronic prescription service with over 90% of prescriptions submitted electronically and over 99% of pharmacies and GP surgeries able to use the system.
The European Union
The EU are introducing ePrescription and eDispensation across Member States, which allow EU citizens to obtain medication in a pharmacy located in another EU country. The first patients to use the service were in Estonia and Finland (January 2019), the service is expected to be used across 25 EU countries by 2025.
What are the barriers?
ePrescribing needs to be properly implemented into a health system to actually work and benefit patients. Poor financial support, a lack of staff training or poorly integrating a new process into an existing IT system are just a few of the barriers to implementation.
Failing to overcome these issues can lead to new types of errors, such as the incorrect entry of dosing directions, drug quantity or patient information. These errors may actually reduce efficiency and increase the cost of medication as a result of correcting computer errors.
The Covid pandemic has further highlighted the pressures the NHS faces. The introduction of ePrescribing may go towards freeing up precious time to deal with patient backlogs across the healthcare sector.
Article by Božo Lugonja, Senedd Research, Welsh Parliament