PrescQIPP

Increasing Rates of Electronic Repeat Dispensing Across South Tees CCG (2018)

North of England CSU

Introduction

The aim of the project was:

To increase rates of electronic repeat dispensing across South Tees Clinical Commissioning Group (a key element of South Tees CCG QIPP plan, the GP Forward View and GP Contract) by:

  • GP practices and community pharmacies working collaboratively to help to reduce unnecessary workload and improve patient care by increasing the level of electronic repeat dispensing across South Tees Clinical Commissioning Group.
  • Reduce waste and unnecessary ordering of 'when required' medication.
  • Tacking pharmacy managed repeat systems and processes.

How was the project established? / How is it currently being established?

The project started in January 2018 and after discussing the aims and desired outcomes of the project with South Tees Clinical Commissioning Group, a team of three members of staff from the NECS Medicines Optimisation Team (two pharmacists and a pharmacy technician) were tasked with visiting every doctor's surgery within the clinical commissioning group.

Visits at each practice included:

  • A presentation (developed by the team) on why and how electronic repeat dispensing can improve workload and reduce waste.
  • How to set up electronic repeat dispensing on the clinical system.
  • A question and answer session including but not exclusively:
    • How to highlight patients
    • Which patients and drugs are suitable
  • The team running searches on the clinical systems and highlighting potential patients eligible to be set up on electronic repeat dispensing.
  • On going support by the electronic repeat dispensing team and practice allocated medicines optimisation staff.
  • Graphical data showing where practices currently were compared to their CCG colleagues.

But the visits were each tailored to the needs of the surgery. For example if a surgery was already well established with using electronic repeat dispensing the visits included more information and support regarding highlighting additional patients.

The team is also providing additional help and support throughout the process of repeat dispensing after the visits, so that if a surgery has any problems or questions they always have a point of contact to discuss anything.

To further support the surgeries the team are currently carrying out revisits and aim to have these completed by the end of September 2018 with a second revisit carried out by the end of December 2018.

As a result of the work carried out, a member of the team, Donna, volunteered to support training events for GP practice and community pharmacy staff to encourage the uptake of electronic repeat dispensing in South Tees and Hartlepool and Stockton Clinical Commissioning Group. The events were held outside of work time and Donna delivered a presentation to an audience of community pharmacists, the Local Pharmaceutical Committee and GP practices. Using her own initiative Donna developed a series of case studies to stimulate discussion and these turned out to be an essential part of the evenings, receiving some excellent feedback from Cleveland Local Pharmaceutical Committee, NHS Digital and other attendees. As a result of the success of the case presentations, Donna has been asked to present at South Tees CCG's education sessions for prescribing clerks and also similar events planned in Darlington CCG to promote electronic repeat dispensing.

Who are the main beneficiaries of the project? How would they benefit?

Patients:

  • Their medication is sent to the nominated community pharmacy of their choice, increasing patient choice.
  • Medication is synchronised
  • Medication is supplied in a timely manner
  • Patients do not have to request medication monthly from their surgery, therefore less unnecessary visits/phone calls to the practice

GP surgeries:

  • Reduction in time spent processing and issuing prescriptions
  • Streamlining of prescription processes in GP surgeries
  • Upskilling of prescription staff
  • More focus on medication reviews

Community pharmacies:

  • Reduction in time spent ordering and collecting prescriptions
  • Facilitates stock management
  • Ability to target more MURs

Hospital pharmacy/be bureau:

  • Identification of patients on electronic repeat dispensing on SCR with no changes to their medication, has lead to patients being discharged quicker.

South Tees CCG:

  • Potential reduction in ordering and issuing of unnecessary prescription items
  • Hopeful reduction in medicines budget over the year
  • Ongoing QIPP delivery through medication reviews targeting potential electronic repeat dispensing patients

What were the main outcomes and / or achievements of the project?

  • Increase in the level of repeat dispensing across South Tees CCG.
  • Better usage of the skills of all people involved in the prescribing process.
  • For example prescription clerks identifying potential suitable patients and challenging prescription requests.
  • Collaborative working of community pharmacies and GP surgeries.

We are awaiting more data regarding:

  • ASTRO-PU for surgeries that have increase their level of electronic repeat dispensing
  • Waste reduction and spend
  • Quarter 1

Due to the work carried out in this project Donna received company recognition and received the award of employee off the month.

There is also the potential for this project to be expanded to a greater area and the team have already been asked to provide additional training.

Case Studies and Success Stories:

After one of the lead pharmacist's practice visits, the GP practice became fully engaged in the uptake of electronic repeat dispensing (eRD) and they targeted patients initially who were already established on pharmacy managed repeat systems, offering the added benefit of reduced prescription waiting times. This was of particular significance when storm Emma hit the North East of England, leaving treacherous conditions for weeks in March 18. Once the storm had settled, Calum received a phone call from a husband and wife who live on an isolated farm. The gentleman explained that he was incredibly grateful for him and his wife to have been set up on eRD, because if they had not been, he did not feel he would have been able to have obtained a supply of their medication before they ran out. As his wife is on medication for her heart, it was of greater importance that her medication was not missed or stopped abruptly.

A 42 year old diabetic gentleman who works in sales contacted the surgery after being set up on eRD explaining that since the new system was put in place, he has been a lot more compliant with his medication due to being able to pick up his medication at a pharmacy local to where he is working around England. With him often needing to travel down to London and Bristol, it was difficult for him to remember to get his medication due to getting home late. As a result he would often not take his tablets for a few days whilst waiting to get to his regular pharmacy. After Calum explained the system to him, and he was set up for six months, he has never missed a dose which has reflected favourably in his HbA1c.

During the first round of eRD visits, the team visited a GP practice and it soon became apparent that the practice didn't have any processes in place for repeat prescribing and re-issuing of repeat medications. There were various items on repeat that had not been issued to patients for a number of years and patients who had not had their medication reviewed by a GP for a long time. This practice has now had a lot of input from the project team as well as pharmacists working within the practice, which has made the prescription clerks more aware of what to do when managing patient's repeat prescriptions and the monitoring required. The GP practice now has a medication review process in place and their prescribing rates have come down significantly. In turn this has been recognised by the practice and the CCG, and the team have received complements for the work they have done. The practice still remains lower with regards to eRD than the other GP practices in the CCG, but they are now actively identifying patients who are suitable, and the evidence of this should be apparent in the coming months.