Deborah Evans, Managing Director of Pharmacy Complete, looks at the instruction to stay at home, GP surgeries closing their doors and consumers rethinking how they shop has accelerated the use of electronic prescribing.
The Electronic Prescription Service (EPS) allows prescribers to send prescriptions electronically to a pharmacy of an individual’s choice, flagged by a patient nomination. Whilst the potential for electronic prescription transmission has long been recognised, the development and deployment of EPS as a national system has taken over 16 years. By September 2019, 70% of all prescriptions in primary care were prescribed electronically, stubbornly short of the goal to transfer almost all items this way. Fast forward to earlier this year and the proportion jumped from 79% in February to 85% in April 2020. It is anticipated that the latest stage of roll-out (phase 4), which allows electronic prescribing without a patient nomination, will increase electronic prescribing to over 95%. The green ‘FP10’ will be consigned to the past.
“Amazon’s designs on the pharmacy industry in the UK have recently taken another step forward after the company’s trademark application was approved for the next stage of the registration process”
EPS as a more efficient prescribing and dispensing process, brings many benefits for NHS, patients, GPs and pharmacy. One benefit is that the patient does not need to be physically present at either surgery or pharmacy as part of the process. This has been critical during the pandemic, particularly for shielding vulnerable patients. Medicines can be ordered online, authorised by the doctor, ‘pulled down’ from the NHS spine by a nominated pharmacy and delivered directly via the Pandemic Delivery Service (due to end on 31 July). The patient does not need to leave their house.
As part of EPS and in response to the pandemic, NHS England is hastening the adoption of electronic repeat dispensing (eRD). This allows the prescriber to authorise and issue a batch of repeatable prescriptions for up to 12 months with just one digital signature. All issues of eRD prescriptions are held securely on the NHS spine and automatically downloaded by the patient’s nominated community pharmacy at intervals set by the prescriber.
Patients are also driving change. The pharmacies ‘nominated’ by patients for their prescriptions provides an indication of this trend. In just three months post-lockdown, nominations by patients had increased by 12.1%.
Patients are also looking at online options for dispensing their prescriptions. The nominations to Distance-Selling Pharmacies (DSPs) or ‘internet pharmacies’ have grown by 44.5% since December 2019 and 29.7% since lockdown. Whilst DSPs have seen their market share increase during lockdown, these items still represent a small proportion (3.2%) of the one billion items dispensed by community pharmacy each year. Latest data shows that the largest of the DSPs, Pharmacy2U has seen a growth of 116,000 nominations since March, now dispensing over three-quarters of a million items every month. Together with ECHO (part of McKesson), and Well Pharmacy, these three companies have over two-thirds of the DSP market and dispense over a million items monthly.
Should this trend continue then bricks and mortar community pharmacies will see a reduction in prescription items, and associated revenue. Add in the recent reduction of funding into the sector and a number of businesses are at risk unless they change their health service model.
A game-changer could be the launch of Amazon Pharmacy. Amazon’s designs on the pharmacy industry in the UK have recently taken another step forward after the company’s trademark application was approved for the next stage of the registration process.
There is no doubt that the coronavirus pandemic has focused minds and accelerated change which may otherwise have taken months if not years to achieve. The supply chain for medicines is changing; what will be the implications for the industry and how will it respond?
Deborah Evans FFRPS FRPharmS FRSPH is Managing Director of Pharmacy Complete, a training and consultancy company working with pharmacy, the NHS and industry. Go to www.pharmacycomplete.org