back to article Hunt's paperless future: NHS watches £60m vanish down plughole

Health Secretary Jeremy Hunt's grand scheme to make NHS England paperless by 2018 has suffered a significant spending blow after a £60m slice of a tech fund allocated for the system appeared to disappear. Details about the cash shortfall, first spotted by the Health Service Journal (subscription needed), were buried in an NHS …

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Surely the prescription scheme can't be being abandoned, there are already posters about it in pharmacies?

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Coat

Beep...

...sorry, unexpected old bag in the seating area.

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JDX
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Paper prescriptions do seem remarkably antiquated really. Being able to walk into any pharmacy and they can see it would be good, as would your chosen default pharmacy automatically fulfilling your prescription.

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Paper at least has a rudimentary id check system built in (the person presenting the prescription at the pharmacy will usually be the same person that collected it from the surgery). If it's been sent on ahead, watch out for the generalised pick-up scams.

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Here in Holland we have both. The prescriptions from the doctors are sent directly to the pharmacy. I walk in, identify myself with personal information (name, DOB etc (anyone who wants to just pick up my prescription would have to know my details and know exactly when the doctor sent it through) and get my medication which has normally been prepared. Easy and relatively secure.

The paper prescriptions (from Hospitals and other clinics) are much less secure, anyone can present my prescription and pick it up on my behalf. No checks, no nothing (and if they do that it automatically goes to my insurance company and they bill me for medicine I have not had!).

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Paper also has the feature that you can check it, tell the receptionist that the doctor wrote the wrong items again and get it fixed.

My partner has several serious long term medical conditions and uses a number of different tablets, patches and other medical equipment daily. On a regular basis her doctor will get a repeat prescription wrong, often prescribing a medication they have on file that she hasn't taken for a few years or an old dose of the correct medication. At least with the current system you can get it corrected before you leave the surgery. If you don't know till you get to the pharmacy and they scan your barcode then a trip back to the doctor would be needed - usually something she would not be able to manage.

Also how will they cope with me picking up a prescription for her because she's lying in bed doubled over in agony again?

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JDX
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When I pick up a prescription for my wife I walk and say "I'm here for Mrs. JDX". I don't have her prescription or proof of ID other than being asked to confirm her address.

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Anonymous Coward

True enough; however, I would worry if the chemist the 'script was sent to did not have the medication. What then? It's not uncommon to have to 'shop around' for a chemist that has in stock the item you've been prescribed. Hopefully, the original chemist would ring around and then forward it along. You can't rely on hope though.

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>as would your chosen default pharmacy automatically fulfilling your prescription.

Maybe for some people, but not for me. The only item on my prescription that could be described as regular is the diabetes stuff - but even that is subject to variation depending on need.

The other stuff I get on prescription I order when needed. A regular order would either lead to me ending up with a stockpile of unused and out-of-date drugs (bad) or running out (worse!).

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When an electronic prescription is issued via EPS the authoriser (GP/Prescribing Nurse) can optionally print a 'token'; it's not a real prescription, but it has your details and the items issued. So you could check this then if concerned.

The issue you raise with items being wrong already occurs wherever pharmacies already pick up prescriptions on behalf of patient, but you are under no obligation to use EPS, you can continue to have paper prescriptions issued and collect these yourself.

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I can only speak from experience, but when my prescription was changed I was asked.by the pharmacist if I knew it had been changed. Phone.calls ensued and it turns out it had, I just hadn't been told. It was picked up though, and because it was electronic - they check against previous prescriptions on the screen on front of them. It doesn't rely on me knowing the names of my medication.

Not sure if this is the norm or if I just have a great pharmacist, but I was happy with them being able to check...

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Anonymous Coward

Re-orders

To order a repeat prescription at our doctors' you tick the required boxes on the previous prescription's tear-off section - and drop it in a box. Then you collect the prescription a couple of days later. You can also tick the boxes online.

Filling the prescription can then be done by visiting any pharmacy you wish. Does the new system have a central database for the dispenser to access - or does the surgery have to send it to a nominated phamacy?

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Anonymous Coward

Re: Re-orders

Tearing off a section and ticking boxes? How antiquated! The surgery I use has a website where you can login and do these things. I thought that might have been standard by now.

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Re: Re-orders

It should be but it isn't. Mine doesn't either.

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Re: Re-orders

> The surgery I use has a website where you can login and do these things

Which is all very well if you:

a) Have an internet connection

b) are not terrified by the InterWebNetThingy

c) Have a computer.

There are a *lot* of people that come into one of those 3 categories and any system needs to take them into account too.

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Pharmacies are not perfectly stocked all of the time. With the paper prescription, if the first pharmacy I go to doesn't have the item in stock I can always try another a little way down the road which may. How is this going to work if prescriptions are only handled via electronic means? Am I going to be effectively tied to just a single pharmacy, to me that would more than eliminate any potential benefit of doing away with paper prescriptions.

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JDX
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Are you tied to only accessing your email from one PC?

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Pharmacies will never be perfectly stocked all of the time, there's upwards of 3500 commonly prescribed drugs / doses - there's no way that your local pharmacy will have all of them to hand and definitely not the less common ones.

The concept of the electronic prescription service is that electronic prescriptions can either be sent to a specific pharmacy or the patient can be given a printed identifier which any pharmacy can use to retrieve a prescription. A pharmacy's dispensing and drug management system is required to support this functionality and the messaging is carried by the N3 network (direct or tunnelled), which for those that don't know is the largest private internet there is.

The advantage of sending a prescription to a pharmacy is that the pharmacy can use this to get the prescription ready for you to pick up which reduces your potential wait time It also allows them to smooth out the pharmacy assistants' picking process and to better use their dispensing pharmacist's time because they must double check every prescription before it is handed over.

The electronic prescription is also designed to remove the step where a paper prescription must be confirmed by a pharmacy with the prescribing doctor prior to picking and hand over. This is an obvious check to have in place as a prescription is nothing more than an easily forgable pre-printed slip of paper and this check does add quite a lot of burden to the process.

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Hopefully the pharmacies themselves will invest in getting their stock online so that surgeries will be told they haven't got the stock it, when they expect more in. In a ideal world the GP would be able to assign the prescription to one that has got it in stock.

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Medicines Act 1969

When there are multiple items on a prescription form the law currently requires that they must all be dispensed by the same pharmacy. Clearly this can cause problems when one of the items is out of stock and the patient will be in a different place the next day. It's necessary either to wait until the following day to collect both/all items from somewhere else, going without all the medications in the meantime, or make a return journey to the first pharmacy, which may be inconvenient.

Given that electronic prescriptions can now be sent direct from the doctor who authorises the script to a nominated pharmacy, it seems a bit absurd that the law has not been changed to allow pharmacies to forward the unfulfilled part of a script in the fairly rare circumstances when an item is not in stock and it's not easy for the patient to return to collect this from the same pharmacy which dispensed the other item(s).

The problem is well known to pharmacists and it would not be technically difficult to solve. Presumably all that would be needed on the legal front is a Statutory Instrument to modify the Act. But like much with the computerisation of health, the needs of the patient seem not to be given much attention.

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Re: Medicines Act 1969

As I understand it, this is to dissuade pharmacies from cherry picking the supply of drugs, whether for stocking, financial or other considerations.

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This is what happens

When Ministers design systems

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People have been claiming computers will make offices paperless....

...longer than they have been saying that "this will be the year of linux on the desktop".

Both statements are complete bull pats and always will be.

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paperless office

agree, not gonna happen (until we run out of trees)

and really, who wants it?!

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And everyone thought Idiocracy was a satire. http://en.wikipedia.org/wiki/Idiocracy From "plot": Joe is arrested for not having a bar code tattoo to pay for his doctor's appointment, only just realizing the current year and society's state.

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pharmacyst

If the item is not in stock and the prescription was sent via the Electronic Prescription Service (EPS) then we print off a prescription-like document on a white form (technically an "EPS token" ). This has a barcode on it so the patient can take this EPS token where they want and any pharmacy can then use this barcode to download the prescription onto their computer. Alternatively, we can "return" the prescription electronically and the patient can request ( at their surgery, presumably) that the prescription be sent elsewhere.

BTW, the pharmacy system we have here is called "Nexphase", written with VB6 and using the freetard version of SQL server. Use by Boots and Sainsbury's, amongst others. 1Gb database to store the details of several thousand prescription labels ? It's s-l-o-o-w.

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Re: pharmacyst

I worked on the implementation of EPS release 2 in my previous job for a big pharmaceutical, as I recall one of the issues that was never resolved was if you had a nominated pharmacy, the patient had to go to that pharmacy. If they obtained the paper "EPS token" and took it to a different pharmacy there was an error that popped up advising that the patient wasn't at the correct pharmacy. This was one of the reasons why there was a massive push to lock patients in for repeat business.

With EPSr2, there were plans to extend it out to care homes, controlled drugs used by the 2-4 schedules and online pharmacies such as Pharmacy4U. The system was never perfect and up until recently was a pain if the prescription got lost on its journey (due to the many different exchanges and several companies needed to make it's long journey to the pharmacy). Sadly this happened quite a bit in the beginning and the NHS don't hold ANY SLA agreements in place to reset the prescription if it does get lost.

Nexphase was always a pain, especially as it was NEVER designed for multi-store use. The original purpose was for small 3-4 pc independent pharmacies to use...then when it was picked up and ran with it was CONSTANTLY being patched, upgraded, Hotfixed and plastered/glued/bolted on after being hit with several hammers to do something that resembles what would make sense.

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FAIL

Re: pharmacyst - Used by Sainsbury's

It's perhaps worth noting that Sainsbury's now offer, or rather seem to press on customers using their pharmacy, an 'advice service'. They 'check' that the use of medicines is appropriate.

It looks as though the unwary will be encouraged to sign a consent form which, as far as I could see, would give them permission to discuss details of a prescription with the customer's GP. There wasn't any obvious limitation, so it's hard not to imagine that they may be intending to use this as implied consent to access medical records at any future date.

Despite offering advice, the pharmacy where I had gone could not provide information about interactions between two medicines, failed to access the manufacturer's data, and provided incorrect information about the appropriate timing of taking one of the medicines and eating

It looks as though they are using or perhaps working with the NHS promotion of the electronic prescription service to increase their share of this lucrative market, making it seem both normal for people to wish to share their medical information and convenient. I won't be signing up.

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Happy

"integrated digital care"

I think someone needs to pull their finger out

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