Pharmacy Voice: DH must ‘exercise caution’ in EPS 2 roll-out

Maybe a longish term trial with EPSr2 fully implemented in one confined geographical area of the country (preferably many miles from me) is needed.

The pros and cons could then be fully assessed before a decision of a national roll out is made.

It would also be nice if Pharmacists were more fully consulted in this……the rules on smartcards (see current C&D article) illustrate well how little the impact of EPS on Pharmacy has been thought about from its inception.

C&D agenda? There are 3 negative headlines on the website currently and no positives (which the report does contain) on a report that is now very much out of date. Things have moved on a lot since the 4 practices in the report did the first of type piloting for system providers.

After a decade of pilots and slow progress I think that now is the time to start to embrace rather than resist EPS. Or are we really saying as a profession that in the 21st century we should stay with an antiquated and broken paper process?

Mr Hodgson seems unaware of how things are progressing well beyond the pilot stage now. All major pharmacy systems and GP systems are accredited to roll out. There are now 250 GP practices live with EPS. There are entire PCTs enabled in Greenwich, IoW and Bexley. Other geographical areas are now planning their roll out and issues such as smart cards are being worked out on the ground by pharmacies and their PCTs. I am sure that a more up to date report carried out in these high volume areas would paint a far more positive picture. It will be interesting to see if the C&D publish that.

Hi Mark,

I presume you are Mark Pedder who is a senior manager of the mail order/internet Pharmacy2U (please correct me if wrong).

Obviously the rapid roll out of EPS would especially be in the interest of a business like Pharmacy2U which would explain your somewhat rose tinted view of EPS.

For community pharmacists however, I think the great majority are very concerned that the rapid roll out of EPSr2, in its present form, could be a nightmare with the potential for a greatly increased workload, with many problems to be encountered and solved and with so many weak links any of which could bring the dispensing process to a halt when they fail.

And as for your comment about the “antiquated and broken paper process”…….well those green bits of paper worked very well in my pharmacy a few months ago during a several hour power cut. I doubt EPS would have coped as well

Regards

Clive

Hi Clive

Indeed and I appreciate that different individuals will have differing views on this, however my criticism was aimed at the C&D. They as healthcare journalists should be balanced in their reporting. It is a fact that EPS is moving forwards significantly in certain areas and that the process is well beyond pilot stage. Not acknowledging the facts, teasing out three negative headlines from a report on very early stage pilots and not mentioning any of the positives from the report, does not make for balanced reporting.

I agree a power cut would be problematic to most pharmacies. But that is the case currently without EPS in place. Doing any decent volume of dispensing would be very difficult without a PMR, lights, till, printers, e-bnf etc etc. As a first world country we haven't historically chosen not to progress with technology (often in critical areas of society) because of concerns over electricity supply. Power cuts are a rare event in this country.

On a rare occassion of a power cut with EPS, as is the situation now, there is always the fall back emergency supply and handwritten labels for the very few cases where clinical need for medicines (rather than convenience) is urgent.

Hi again Mark,

I still maintain EPSr2 is a potentially very fragile system compared with the primitive but highly robust paper system which I think is far from broken.

You could substitute smart card failure / spine failure / in pharmacy computer hardware failure for power cut (all happened to me and several of my pharmacist friends). There are NO easy workarounds for these situations when EPSr2 is fully deployed.

Then you have to add on the extra workload that EPSr2 brings......100's of sheets of paper to be printed daily for exemption tokens and hard copies of prescriptions for checking (which later would have to be shredded). Add on the potential for abuse of the nomination process and the staggering cost of its implementation and perhaps you can see why there are few upbeat reports in the likes of the C&D.


Also please remember that it will be community pharmacists on the front line when it fails.

I am not anti EPS in principle it is just that I am very unsure that the benefits to pharmacist/patient of EPSr2 are outweighed by the costs and disadvantages.

I suspect we will have to agree to disagree on this one!

Take care

Clive

The non-practical aspects are:- e.g. 5 scripts in at once... line them up on a bench and then the labels can be produced whilst the items collected. With ETP (unless you do print every one out) then dispensers need to look over labeller's shoulder to see the items. Still have to print out the backs of many for exemption signing. We have also had corruptions of prescriber's name (eg Dr Bloggs Joe), non-recognition of generic availability, 3rd line down of directions doesn't show on screen so paper still needed. But the biggest problem is with collect/notify. When do we do this in practice. A member of staff would have to come inform the computer operator that a script has been collected.... they would have to stop what they are doing to find that supply and then click collect and notify. ... there are many other issues we have found and thus, I agree with Clive that the paper system is not broken. In a similar vain we have politicians telling us not to pay cash to tradesmen at home and at the same time they are going to phase out cheques...... the technology is not robust or reliable enough.

Only this week we have had to ring Cegedim as the details of a prescriber were replicated 17 times in a day by ETP1. Also, last Friday in an audit of our ETP1 we had 72 barcoded prescriptions and 4 for a particular patient took over 8 minutes to be "requested" ,one hadn't been reset by another pharmacy and one for losarten insisted on picking cozaar even though we tried to override it. Frustrating !

A typical Friday! From 4.15pm to 4.30pm the six ETP1 scripts we had took between 6 to 28 minutes to release (with an average of 12 minutes) . No damn good at all if this is with only about 2% of scripts being done in this way

You should find that your R1 scripts will download faster once R2 is switched on. That's what our pharmacies are finding as we roll out R2 around our group.

If anyone else can support this or did not find downloads quicker once R2 switched on, let us know.

We use Pharmacy Manager as well.

Don't think you can blame ETP for pharmacies not sending scripts back to the spine. They should follow their SOPs. I assume they had one in place.

Multiple entries for a GP are a problem which Cegedim seem unable to rectify, blaming everyone else. They will give you reasons for it occuring but will not actually fix things or escalate the issue so someone else can fix things. By fix things I mean get rid of all the multiple entries for that GP.

Losartan selecting Cozaar usually happens if you match items from the PMR and patient's previous script was dispensed as Cozaar. If that is not the case, the Cegedim EPS team should escalate that issue to CfH.

Collect/notify - do this in batches through the day from tokens that were attached to the bags of medicines. Don't forget you will have time to do this from time saved normally spent counting and sorting FP10s.

Also in the "Interim report of the findings from the evaluation in early implementer sites" mentioned by C&D recently, it states there could be more paper generated with R2 than there is now with FP10s.

Unless you are dispensing around 2,000 items a month you will not be in a position to receive and dispense an R2 script solely from information on a screen. It is easier to print a token every time whilst Nomination is the only game in town.

Another solution would be to use suitably encrypted drop-on-the-floor-friendly hand held devices to dispense from linked back to your server. There would be more to such a system and how it could be used than I've indicated, but that's the way the future might lie.

If nothing else this article has provoked an interesting debate on EPS and as such makes me quite concerned to hear others experiencing problems with pharmacy system suppliers not reporting or escalating issues. I can appreciate their concerns of giving an impression that there is something not altogether right with their system, but if we really are going to move EPS forward properly we have got to get past this. My experience is that although some of these issues may seem benign at first they can result in an unacceptable risk to patients.