back to article Mandatory electronic prescriptions was the easy bit in NHS paperless plans

Plans for a "fully paperless" National Health Service have been announced and re-announced countless times – most recently they promised we'd be paper-free "within the decade". But then again, four years ago the NHS was telling us it would happen by 2020, and in 2013 former UK health secretary Jeremy Hunt said it would happen …

  1. monty75

    Paperlessless

    I've been getting electronic prescriptions for a couple of years now. When I go the pharmacy they print it out for me to complete the form on the back. All this has achieved is to move the paper from GP to pharmacy. I mean, it's quicker and less effort for me but it's not paperless.

    1. Benson's Cycle

      Re: Paperlessless

      I don't. I book online, I collect, no paper.

      1. Anonymous Coward
        Anonymous Coward

        Re: Paperlessless

        Me too. But if you need to make any sort of claim (for example in England free prescriptions etc...) then they still print and use it to get the required boxes ticked and signature.

        Hopefully though they can look at that too - in theory proof of eligibility should be available digitally anyway - but could at least be stored, with a expiry date for periodic review.

        That said the process to apply for a HC2 which often covers prescription costs, is paper only! (and alot of paper it is too!)

      2. tiggity Silver badge

        Re: Paperlessless

        Hi @Benson's Cycle

        As @monty75 implied

        If you pay for prescriptions you have to sign the paper that comes with the prescription meds (if you don't pay chances are pharmacist has just ticked it for you & yiu did not see te paper, but there is paper involved). Typically the medicines are in a bag (with paper prescription stapled to it) in drawers / on shelves in pharmacy ready for collection, and pharmacist refers to paper script attached to bag of meds when you collect e.g. ID question such as address which is printed on the paper

    2. AMBxx Silver badge
      Joke

      Re: Paperlessless

      After they've printed it out, they probably fax the completed copy back to the GP.

      Only half joking...

      1. Anonymous Coward
        Anonymous Coward

        Re: Paperlessless

        It's so true!

        But at least that's already had it's days numbered:

        https://www.gov.uk/government/news/health-and-social-care-secretary-bans-fax-machines-in-nhs

        April 2020

    3. NIck Hunn

      Re: Paperlessless

      I've also had an electronic repeat prescription set up for the last few years, but in most cases they fail to arrive on time. At which point the pharmacy has to fax (yes, fax!) the surgery to remind them that it's overdue.

  2. Hooky

    EPS went live in 2005 not 2009

    Its funny because there were several Doctors that wanted to issue the first electronic prescription. For the NHS team at the time they really had to find someone else because the poor guy that was most keen was the spitting image of one Harold Shipman. Not a good advert for new ways to get your drugs.

    The surgery that issued the first electronic prescription was in the same building as the pharmacy - yet the patient took it somewhere else.

    The idea of tokens was all built in to that system, as was the concept of pre-authorised repeats allowing 1 token to cover up to 6 months of repeats.

    I find it hard to believe that so much of what we built in has yet to be implemented nearly 15 years later.

    1. Anonymous Coward
      Anonymous Coward

      Re: EPS went live in 2005 not 2009

      Hello, mysterious ex-colleague!

  3. Smooth Newt
    Meh

    £300 million?

    Electronic prescriptions are already very widely used, so we are only talking about some smallish increment. So, some small proportion of prescriptions will now join the rest in being communicated to the pharmacy over the Interwebs instead of by a customer clutching a piece of paper. And this is going to save £300m?

    Must be bloody expensive printer paper.

    1. Lazlo Woodbine Bronze badge

      Re: £300 million?

      The £300m is total efficiency savings, which includes all but eliminating prescribing errors because the pharmacist couldn't read the doctor's writing.

      Some drugs are hideously expensive and if given in error they have to be thrown away when returned, even if the blister pack is unopened.

      There is also the usual ten fold inflation when involving a Government department press release...

      1. Smooth Newt
        Meh

        Re: £300 million?

        Despite the Government hand-waving about "reducing errors", all the NHS prescriptions I've seen in the last 30 years have been printed on the GP's laser printer, the ability to do this seems to be integrated into the practice's record keeping/appointments/etc IT package.

      2. Anne Hunny Mouse

        Re: £300 million?

        My local CCG made everyone go electronic, the argument being someone would have to approve the request and avoid over ordering of medicine. I doubt this happens much, if at all.

        As said elsewhere, the secure nature of the prescription pad adds to the cost.

        Certain members of society are keen to get their hands on blank pads so they can create their own prescriptions (or sell the pads to others so others can).

        In some areas / clinics the printer trays for prescriptions have locks on to deter thieves.

    2. Doctor Syntax Silver badge

      Re: £300 million?

      "Must be bloody expensive printer paper."

      For what I hope are obvious reasons the base stock is a security print. That means not only specialist printing techniques but also rigorous control, secure disposition of waste etc. Pads are, or were (it's a long time since I've seen one), personalised to the prescriber which also introduced a good deal of maintenance of prescriber data etc. It all adds to costs.

      Nevertheless my previous GP used to use the tractor-fed paper face-down in their office printer, not only wasting money but making a nonsense of the whole security issue.

    3. Warm Braw Silver badge

      Re: £300 million?

      Have just visited the GP and been issued an electronic prescription for one medication and a paper prescription to submit if initial meds don't work. That's actually saving the NHS from either unnecessary dispensing or a second GP intervention. If the new system is inflexible it will end up costing more...

  4. Bob Dunlop
    FAIL

    Three gas guzzling trips coming up

    I've stuck with paper as I swop between four different pharmacies including one 150 miles away depending on where we are shopping this week. So if I still have to go to the med center to get the paper ticket how is this gonna help? Oh yes the system will be more fragile as it'll depend on the pharmacists network being up.

    I still remember writing a letter to my doctor asking then not to upload my personal data to the "Spine" so how's that gonna work ?

    Long ago I had to make just one trip as the med center would dispense pills for me, now it's two trips, how long before it's three gas guzzling trips I wonder. One to pick up the ticket, one to give it to the pharmacist and a third to collect the pills.

    1. Steve Davies 3 Silver badge

      Re: Three gas guzzling trips coming up

      Don't forget paying £2.50/hour to park at the Med Centre on each visit... Well that's what happens at mine.

      They've even cut down the space for pedal cycles in order to get another car in.

    2. Chloe Cresswell

      Re: Three gas guzzling trips coming up

      For myself, getting a repeat prescription is: Drive to GP (2 miles), order prescription. 2-3 days later, drive to GPs to see if it's ready, if so, take it. Then start the round of walking at the weekend to fill it. My record so far is needing to go to 6 pharmacies, because 5 didn't have it. The 6th had 4 weeks out of a 6 week prescription, and 2 weeks later were able to fill the missing 2 weeks with a different medication.

      So I guess I'll be sticking with paper too.

      1. Intractable Potsherd Silver badge

        Re: Three gas guzzling trips coming up

        @Chloe: that sounds awful! It can be done better - the system my GP uses includes in-person, online, and telephone ordering of repeat prescriptions (both 24-hour services). The online and phone options allow for stating whether you want to collect the prescription or have it sent to a particular pharmacy (I assume these are e-prescriptions) to be dispensed and ready for collection two working days after. If there is going to be a delay (some of my wife's medications have had supply problems this year), the pharmacy will call to notify of the delay, and offer to deliver them if necessary.

        1. Chloe Cresswell

          Re: Three gas guzzling trips coming up

          My GP has on their IVR "We do not accept requests for repeat prscriptions over the phone"

          And most of the pharmacies I tried last time it wasn't a case of "call to notify you", it was "We can not get these, we will not accept this prescription for dispensing"

  5. Twanky Bronze badge

    'Electronic' repeats will not automatically fix the processes.

    SWMBO and I have both had regular repeat prescriptions for years.

    I used to have a 'nominated pharmacy' and would log in to a web-based service every 28 days to request a repeat from the doctor and then go to the nominated pharmacy to collect my pills (no, not dried frog). I then lost (part of) a batch of pills with some of my luggage while on a business trip and asked the surgery to issue an early repeat prescription which they happily did - but the pharmacy (initially) refused to issue them as 'it wasn't due'. In my book if the doctor says 'issue more pills' the pharmacy should just get on with it. Anyhow, I de-nominated that pharmacy (which was far more difficult than it should have been) and now every 28 days I request a repeat prescription on the web-based service and collect the paper from my doctor's surgery and take it to any pharmacy that's convenient for me. At my annual checks the surgery keeps suggesting 'electronic repeat dispensing' will be far more convenient for me - but it wouldn't be. If they were to be honest and say it would be more efficient for them, I'd seriously consider it.

    SWMBO has encountered a different problem: She was happy requesting repeat prescriptions on the surgery web page at any time of the day or night and picking up her pills from her nominated pharmacy at any time during opening hours in the following few days. She was then asked to go onto electronic repeat dispensing - where a single prescription is issued by the doctor to the pharmacy to cover almost a full year (13 x 28 days) and then she contacts the pharmacy to request a new batch every 28 days. The trouble is, the pharmacy hasn't got web-based ordering so she has to remember to order her next batch of pills during pharmacy opening hours and then visit a few days later to collect them.

    One step forward...

    'Electronic' repeats could be used to improve things - but not if the process is fundamentally flawed.

    1. barry86m

      Re: 'Electronic' repeats will not automatically fix the processes.

      One of the Pharmacists jobs is to make sure the prescription is dispensed legally and without harming the patient. When it appears the patient will have too much of a medication is it their job the question it - and refuse to dispense if necessary.

      Pharmacists very regularly catch errors doctors have made in prescribing medicines; over supply, interactions, wrong medicine for the condition (e.g. methadone vs methylphenidate, amiloride vs amlodipine), wrong dose etc

  6. Will Godfrey Silver badge
    Unhappy

    Mine is half-arsed

    The prescription is handled electronically between the the pharmacy and the surgery, but for renewals, I'm given a repeat form (used to be half of the prescription itself) and have to hand that in to the pharmacy next time. However, the renewal form isn't just a copy of the last one, but freshly (electronically) fetched from the surgery. Now that would be fine but for one problem. Sometimes the repeat from has items missing - not because the treatment has ended, but because someone somewhere failed to tick a box. So then I have to go to the surgery (and wait in a long queue - sometimes in the rain) to fill in a new request.

    I've learned to not throw away the empty packets until I have replacements.

    It then takes at least 3 days to be cleared.

  7. Doctor Syntax Silver badge

    I wonder how a totally electronic system would work for consultations outside the GP's surgery or hospital. I assume there will be a well secured means of sending the prescription from a phone (you may detect a slight snark here) but what if the patient also needs the bar-code token? Does this mean the doctor has to carry a portable bar-code printer or will there be pads of pre-printed tokens to be carried?

  8. Richard Jones 1
    Happy

    Today's Experience

    I saw the local GP surgery today had immediate instructions for a blood test with a paper form printed out. The pills to be collected from the pharmacy of choice in about half an hour, meanwhile have an urgent blood test plus a paperless x-ray ASAP. Arrived at the hospital 25 minutes later where I was the second person in the phlebotomy queue . Five minutes later blood testing was done, then paperless to the x-ray department, gave my details and had an x-ray. I picked up the pills on the way home, so two our of three transactions were paperless and all done within two hours from the get go. It worked well for me.

  9. sclg

    Works for me...

    After a heart attack and triple bypass 23 years ago (IT is stressful!) if been on quite a lot of pills ever since.

    For at least the last 10 years my practice has used pharmact2u. I never go to the surgery but when I need the repeat prescriptions I just go online, login and select from my 'list'. They arrive in the post 3 or 4 days later.

    Truly paperless and they have never let me down. (Yet!!)

    1. This post has been deleted by its author

    2. Anonymous Coward
      Anonymous Coward

      Re: Works for me...

      Seems odd that your Practice is "using Pharmacy2U" as it's nothing to do with the practice, it's up to the patient to nominate a pharmacy that suits them.

      It's worth doing some reading up on their business practices, might make you think twice (fined for selling patient data, misleading advertising, branded "unsafe and ineffective" by the CQC, etc), personally I wouldn't let them anywhere near my prescriptions or healthcare. There's a lot to be said about a good high street pharmacist with time to speak to and understand patient needs, much of which can't be said about a faceless online warehouse pushing out high volumes at the lowest possible cost per unit. Amazon will be next, and that'll be the end of the local high street pharmacy.

  10. Da Weezil

    God help us when this hits Wales. My GP used to use the "my surgery" website service that just worked fine, the log in page would populate from my password vault and everything was good - even my dyslexic sister could cope with it.

    The they inflicted (My Health On-line) emisweb.co.uk mess on us. despite several attempts to anchor my log in to the log in facility the site defaulks to https://www.myhealthonline-emisweb.wales.nhs.uk/Account/Login?ReturnUrl=%2f with a 3 field table for you to REGISTER with, use requires an id code issued by your GP surgery to make your initial registration, on this page is a tick box for "I have a username" that then modifies the log in box to a 2 field table for just username and password.

    In my view the "register" page should only be seen when using the site for the first time - after that you should be able to land directly on the page with the correct 2 field table to log in without having to click through from the "wrong" table (it doesnt remember the choice from previous visits). When I raised this with the Twonks in Cardiff i was told this was how it had been delivered by the people who built the site and we would just have to live with it. Totally unbelieveable.

    So like all things the come out of Cardiff Bay and its satellites, Im expecting it to be as bad as anything else.

    1. John Arthur
      Happy

      Like Da Weezil I am in Wales and suffer from the myhealthonline system for repeat prescriptions. I have found that if you grit your teeth and get past the first page for registration so that you have the page with only two boxes for username and password you can then bookmark that page and come straight back to it next time. If you have a password manager you can get it to fill in the boxes too!

      Hope that the team who designed it does not read El Reg or they will doubtless bugger it up.

    2. whileI'mhere

      I've been through both of those systems with my GP. (Shudder)

      Now they are using Patient Access software and it does seem to be a great improvement, so far.

  11. Captain Mainwaring

    Just amazed

    Just amazed that 2 decades into the 21st century, my GP still prints out referal letters and sends them by post to the local hospital just 3 miles away. Even more amazed that the results of any tests or consultations are similarly printed out and returned by the same method back to my GP surgery. Can anyone enlighten me as to why the above transactions can't be done by email, or some other secure messaging system? It surely can't be a technical IT issue that prevents it.

    1. Anonymous Coward
      Anonymous Coward

      Re: Just amazed

      "Can anyone enlighten me as to why the above transactions can't be done by email, or some other secure messaging system? "

      Because £10Billion was not enough for getting such things done.

      1. Mike 137 Silver badge

        Re: Just amazed

        "email, or some other secure messaging system". Email is a secure messaging system? Since when, particularly for those on "free email"? And I dispute the security of any government portal on principle, on the basis of historic fact. It seems that despite medical and health information being classified as sensitive by European data protection legislation, everyone is determined to spread it across the planet without a care. Healthcare becomes health-negligence.

  12. Duncan Macdonald Silver badge

    Pharmacy out of stock of a medicine ?

    With paper prescriptions - if a pharmacy was out of stock of a medicine, you could take the prescription to another pharmacy with no problem. With the "paperless" system it is awkward at the least to use another pharmacy and sometimes impossible without going back to the doctor.

    1. Chloe Cresswell

      Re: Pharmacy out of stock of a medicine ?

      My record in the past year has been needing to go to 6 pharmacies to fill a 6 week prescription. The 6th had 4 weeks worth and were willing to let me take that.

  13. G R Goslin

    The Lord save us...

    .. from these endless 'economies'. If it's like practically all Government initiatives the savings of £300 million, pale into insignificance against all the ancillary costs which are ignored, The hardware, the software, the maintenance, the cock-ups, the hand-outs, the support.

    it's odd the way things go. A while back I researched costs of 1914 against 2014, in real terms, taking into account all the 'improvements' with modern technologies, manufacture, transport, etc. In 2914, in modern day terms, a pint of beer would have cost you around £1. Now. with all the savings that modernisation has brought, the cost is approaching £4. Much was the same with postage. The stamp on your letter now costs more than double what it did in 1914. And in 1914 you got two posts a day, and one on Sunday.

    1. Anonymous Coward
      Anonymous Coward

      Re: The Lord save us...

      I think you're applying some crazy mental gynastics here. The price increase of a pint in the last 100 years is due to inflation of the economy, and I certainly wouldn't use it as an excuse to not implement a paperless system for the NHS...

      1. G R Goslin

        Re: The Lord save us...

        Not so. From the Governments own data, the one pound coin, presently has about the same value as the threepenny bit of the early 1900's. Then, again from the Governments own figures, beer was about two pence (d) a pint. So, allowing for inflation, the beer, now should be just under a pound a pint. That is not mental gymnastics, simply mental arithmetic.

  14. Colonel Mad

    Tosh

    We have System Online from TPP, it's rubbish and confusing for older, less IT savvy patients, the Phone and tablet interface is the worst piece of software I have ever used.

  15. Boris the Cockroach Silver badge
    FAIL

    i dont

    use the 'e-prescription' thing as I've seen the endless faffing about as the pharmacy tries to download the thing... then it doesn't , then it does but only for 1/2 the items.

    Plus the fact you have to 'nominate' a pharmacy... which is fine if you use the same one all the time, however in the case of the pharmacies around here, tend to be good or f'ing useless.......... so you can spend lots of time finding out the f'ing useless ones, then goto a good one and have to wait for an hr because so many people use the good one.

    'But the pharmacies can clearly read the prescription' comes the bleat... strangely , my doc has been printing out the things and just signing the bottom for ages....

    Oh well, looking forward to my next round of drugs..... which due to a routing error have to be picked up in Thurso...

  16. a_mu

    It takes 3 days to get a perscription

    Let me illuminate how this new system works,

    Our local pharmacy has now gone over to direct prescriptions to pharmacy electronically

    It means one can no longer come from doctor to get prescription down road

    as the electronic form goes off to a central system, where the prescription is for security checked and filled,

    that is then posted by courier to the pharmacy,

    who get delivery once per day

    So you see Drs Monday, prescription is sent off, it gets filled Tuesday, and sent, it gets to you pharmacy Wednesday, late.

    If you want a prescription same day now, you ask for a paper one you can take to the local tesco ,

    1. JohnnyP

      Re: It takes 3 days to get a perscription

      If you're referring to the NHS EPS system, you're talking utter tosh, this is categorically not how any of it works.

  17. M7S
    Meh

    Ambulance crews often prefer paper prescriptions

    As when dealing with patients who may not be totally au fait with what they take, or why (other than “the doctor told me to”) there’s half a chance of working out underlying health conditions from the medication lists*, which may help determine what they need right now.

    As always with medical care, it’s not the only criteria to use.

    *repackaging tablets into dosset boxes is a good idea, particularly for those with memory or organisational issues, but often there’s little or no useful indication of the contents

  18. Mike 137 Silver badge

    A guarantee of patient privacy

    "Electronic prescriptions are an absolute godsend for practices, it saves a lot of time and allows you to do them remotely from home or any computer."

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