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Why NHS Digital needs all pharmacists to become 'e-pharmacists'

Vishen Ramkisson: "As our world changes, pharmacy has been slow to adjust"

NHS Digital's Vishen Ramkisson outlines the organisation's vision for further integrating community pharmacy into the health service

At NHS Digital, we believe that digitising the prescribing and distribution of medicines has enormous potential to improve patient care, increase safety and make our healthcare system more efficient.

As our world changes at a rate not seen since the industrial revolution, with vast swathes of our lives changing beyond recognition in just the last few years, pharmacy has been slow to adjust.

We have made great progress, but there remains a reliance on inefficient, paper-based processes which slow us down, increase the potential for errors and cost money. This results in a huge administrative burden, not only on non-clinical support staff, but on pharmacists and primary care prescribers too.

So the need for NHS Digital’s digital medicines programmes of work – which includes the electronic prescription service (EPS) and the summary care record (SCR) – to deliver the tools to change that is greater now than ever.

The NHS spent £17.4 billion on medicines in 2016-17, over half of which was in primary care.

Yet up to half of patients don’t take their medicines as intended, meaning their health is affected, and often creating a vicious circle with more medicines being needed as a result.

Indeed, the use of multiple medicines is on the rise. Over a million people now take eight or more medicines a day, many of whom are elderly.

Medicines are the most common intervention made to support the treatment of patients, and are also the most common source of avoidable adverse events. Between 5% and 8% of all hospital admissions are medicines related, and many of these are preventable.

So a failure to digitise medicines would be a failure to modernise a fundamental bedrock of our health and care system.

Taking action to digitise medicines

The Medicines Value programme remains a key priority for the NHS in England, and here at NHS Digital, has a crucial role to play.

To help people get the best results from their medicines, while also achieving the best value for the tax payer, we’re harnessing the power of new technology to transform pharmacy and medicines.

Key on our list of priorities is helping pharmacy become more integrated in the patient journey and better connected to the wider NHS, with improved information sharing and new communication mechanisms.

In England, there are around 438 million health-related visits to community pharmacies each year – more than a million every day. Our teams are working hard to deliver:

  • Integrating community pharmacy into the wider NHS to make better use of their clinical skills by providing NHSmail, SCR, Skype and the EPS prescription tracker. Local pharmacists and their teams will be able to access relevant clinical information quickly, and communicate with patients and other health professionals more easily.
  • Community pharmacies contributing to patient healthcare records, meaning pharmacists, doctors, nurses and other health professionals will have more information about their patients, to better inform consultations, care and treatment.
  • Allowing NHS 111, GPs and hospitals to refer patients directly to local pharmacies, which will relieve the pressures on GPs, speed up hospital discharge, and ensure patients have the support they need once they arrive home.
Extending EPS

Dispensing prescriptions is still community pharmacy’s bread and butter. With one billion items dispensed every year, reducing the administrative burden of prescribing, dispensing and providing pharmacy services is clearly vital, as less time spent on labour-intensive processes means more time for patient care.

That’s why we are extending and enhancing EPS to all eligible prescriptions and into other care settings, initially urgent care, which is being rolled out now – with controlled drugs next on the list.

This means prescribing will be quicker for everyone and there will be fewer errors. The burden and costs of using paper will significantly reduce. Exemption checks will be done digitally, and less NHS money will be lost to fraud.

Maximising the use of data

When we look at the bigger picture, the data we have on medicines use, efficacy and spend, isn’t quite where it needs to be. The NHS doesn’t have enough comparable data about medicines to ensure people get the best health outcomes and best value for money.

Quality, comprehensive data has the potential to do great things for medicines optimisation and improve safety and outcomes for patients. We’ve already seen the huge savings identified in hospitals by NHS Improvement’s Model Hospital work.

But until we have a comprehensive dataset that combines and collates all NHS prescribing, and allows the data to be linked to other datasets, we will never have the whole-system view we really need to make the most of this information.

Introducing a single, consistent set of medicines data which is used by everyone in the NHS will allow the NHS to prescribe in the most effective and efficient way for patients.

Another part of the solution is introducing improvements to hospital pharmacy computer systems, which will ensure the supply of medicines within the NHS is cost-effective and efficient. Electronic prescribing and administration (EPMA) systems will offer further opportunities to collate meaningful data on medicine use.

Clinicians will be better informed about what does and doesn’t work and which medicines provide value for money. Care will be more personalised, because the NHS will know more about what is more effective for a person’s age and condition.

But for all the work we’ve already done – on EPS, NHSmail, SCR and more – there is still much to be done. Pharmacy is being given an ever more important role in making sure the NHS provides the world class care its patients deserve. It requires the digital tools at its disposal to make that happen. We need all pharmacists to be e-pharmacists.

Vishen Ramkisson is senior clinical lead for digital medicines at NHS Digital

9 Comments

Paul Dishman, Pharmaceutical Adviser

As far as I can see EPS has little, if any benefit, for pharmacy. Pharmacists have to buy their own printers and toners, unlike GPs, and spend hours printing out paper prescription tokens, a job previously carried by GP secretarial staff. Lose, lose.

Chemical Mistry, Information Technology

£17.4 billion in 2016-2017 where did it all go, still have doctors printing green fp10 when patients come and shout at the pharmacy because not come EPS, the reason being GP forgot smartcard or locum gp could not be bothered, they that is progress !!!!

*This comment has been edited in line with C+D's community principles.*

Wolverine 001 , Pharmacist Director

How does EPS reduce admin burden when you have to print off 20 weekly scripts!! Just reduces toner and drum costs for the GP!

A.S. Singh, Community pharmacist

EPS is a way of big brother monitoring you. Digital is not always better. Look at your electronic hive system at home. 

patrick black, Marketing Manager

I think I spoke to an e-pharmacist at a nightclub in London many years ago.

A.S. Singh, Community pharmacist

Mr Ramkissen

You are yet another non pharmacist trying to change pharmacy. I wonder how much pharmacy experience you have? I think this proffession is sick and tired of people like you thinking you know about pharmacy because you had a prescription for amoxicillin once.

Do some time at the coal face and you'll find that there a a huge no. of pharmacists who would are digitally pro-active. The problem is the NHS doesn't know or recognise what we do and hence we are not adequately funded. 

All the points you've suggested about using NHS 111,EPS tracker etc I've been doing since at least 2015, I guess you all think we are backwards with technology. Why don't you give us access to medical records? This article is no more than an insult to a hard working under-funded proffession

A B, Community pharmacist

I agree with almost everything you say. However, what would you do with access to full medical records that can't be done using SCR (assuming the patient has one)? It would be handy to look at discharge summaries but you can't dispense off them, you'd still have to refer the patient back to the GP or contact them for any medication changes.

I'd just be interested to hear any scenarios where you would need full access to medical records.

Leon The Apothecary, Student

"pharmacist.exe has stopped working and needs to shutdown."

Adam Hall, Community pharmacist

If NHS Digital wants us all to be "E-pharmacists" then can I suggest they do two things - treat pharmacists like they treated GPs and pay for using the systems (and I don't mean the paltry amount for SCR usage) and don't allow any GP to "opt out" of issuing prescriptions electronically (Hello, Dispensing Doctors!)

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