Hunt: I'll barcode sick Brits and rip up NHS's paper prescriptions UK Health Secretary Jeremy Hunt wants to tear up the NHS's clumsy system of printed prescriptions - and instead use "unique barcodes" to dish out medication straight to the poorly. Under the proposals to hopefully reduce human error, paperwork listing medicines and drugs will be sent directly from doctors' surgeries to …
GPs surgeries can already send prescriptions direct to pharmacies but whenever my gf uses that service something goes wrong. Like it takes 3 or 4 days for them to get the prescription and get all her medicines in at the pharmacy. Or the GP forgets to add one of her many medications to the prescription requiring another round of phone calls, etc. Or they put the wrong quantity or the wrong type of pill (she finds it very hard to swallow some kinds of pills). It is faster and she is more likely to get the correct medicines if she or I pick up the prescription, check it before leaving the surgery and take it to the pharmacy ourselves.
This might help for people who go to the doctor and get a prescription with one item on it a couple of times a year but for the long term sick with regular large prescriptions it will make their situation worse.
" I meant that he fills it in there and then and lets you leave once he's "committed it to the system" "
That assumes that you are seeing the doctor every time you get a prescription. People on long term or permanent drugs don't usually see the GP every 2 months, instead they just get a repeat prescription from the surgery when they request it and have a check up every year or so
The prescriptions are not written anymore.
They are printed, after consulting the patients details on a database.
So any mistakes in the past would have either been iron-out, or the patient killed. Job already done.
This goes even if you have opted out of the "spread your details to the world via India" system.
the current system is beautify simple.
The pharmacist keeps your old prescription in a brought forward system (a pile of paper in date order).
shortly before the repeat prescription is due he hands it a man with a van who takes it to your doctor.
At the surgery someone is handed a bunch of prescriptions and using their local record system orders a batch of new prescriptions, these are then printed on mass and given to a doctor to sign. Hands up all those who think the doctor reads them before signing.
A few days pass and the man with a van revisits the surgery to pick up the signed prescriptions. Back to the pharmacy and the pharmacist makes up the prescription entering the details in his local label printing/ stock control system. The paper prescription is then sent to the payment authority where it is no doubt entered into another system. the repeat prescription slip is then put back into the carry forward pile ready to go round again.
The really astute Reg readers might think that there is some room to stream line this system.
The current system is also open to abuse. We tried it for 9 months, and during that time we had to go to the doctors 5 times because the prescription "went missing" - The surgery had a record of it being printed and signed, but the pharmacy didn't receive it.
On the othe side of the coin, my multiple drug prescription is also sent electronically to the pharmacy (for the last 2yrs or so). The prescription being picked up my myself in as little as 30mins (no mistakes so far). A few years ago I opted out, but now, after a heart attack, can see the benefits, provided of course the system is designed efficiently
But if a paramedic is called to an unconscious patent outside their home, then they will not be able to access their medical records. This is a serious problem. I recommend that everyone is forced to have this barcode tattooed on their body somewhere that the medical practitioner can see instantly. For instance the left hand or the forehead.
More seriously, I often come out of the doctor's office after my pharmacist of choice (directly opposite the doctor) has closed for the night. So I use the one up the road. Or maybe I'm just about to leave town and have to take the prescription with me. Is the proposal to put the prescription on some central server - which crashes more often than a piece of paper, or am I stuffed until I can get to the pharmacist that the doctor has an agreement with?
By all means put a bar-code on the paper, and put in a step of checking that against the barcode on the medicine bottle. But don't make life harder just because it seems like a good idea.
No it's going to be uploaded to the chip they're going to surgically embed into your left arm, which will of course use the high speed link they surgically embed to copy it to the one in your right leg... who says they don't have a clue about IT, they're beginning to understand the importance of having a good backup.
Electronic Prescriptions Service R3 anyone ?
EPS r2 already allows your prescription to be sent immediately to your pharmacy of choice - and as long as your chemist hasn;t already dispensed awaiting your collection, you can walk to any other pharmacy and collect your drugs from there.
So this new system differs how exactly ?
Let me guess, it will also allowed controlled drugs :)
You wont have a choice of pharmacists because your doctor (or semi-autonomous grant holding patient acquisation unit as he is now known) - is signed up to GooglePreScript which has an exclusive contract with
Easypharm, who unfortunately only have branches in London and the Caymens (for tax reasons)
They will deliver the drugs to your home, for a moderate extra fee, and in only 28 days.
I don't understand how this is different from the existing systems that everyone has had repeated hissy fits about then refused to use.
Have a look at The Electronic Prescription Service and Summery Care Record and tell me what the difference is between these and Mr Hunt's plans?
GP systems are from a few providers and are tailored to patient record keeping, pharmacy systems are from other providers and tailored to stock control dispensing and payments. Pharmaceutical manufacturers and wholesalers systems are tailored to bulk stock control and ordering but we can leave them out of this.
I think there probably are savings and safety improvements to be achieved but are they as great as might be expected
At the moment GP writes prescription (most actually select the drug, dosage etc on screen) and the printer churns out the script which the GP signs. Bad handwriting is mostly an issue of the past in prescriptions.
Patient takes script to pharmacy of their choice (the only one open at that time, the one next to the surgery, or the one in the supermarket where they buy their groceries - convenience)
Patient gets medication from pharmacy in exchange for NHS charge and goes off to get better (hopefully)
Pharmacy submits prescription to local NHS organization which then scrutinizes it and if satisfied provides the differential between NHS charge and actual cost of medication to the pharmacy.
If you are regular with a pharmacy then they can cross-reference your latest prescription with previous ones and warn you of any problems. But I suspect most aren't
Any PM who wants to look like a star turn but lacks the Churchillian gravitas to pull it off needs a Jeremy Hunt or two in their cabinet. There's nothing better to reassure the public (and the party for that matter) that there is a bottom to the political barrel if you scrape hard enough, but its definitely not them, and the nation can be confident that the guy (probably) giving the public purse a quick run round the block at Chequers at the weekend is the only thing between them and the abyss.
Churchill got it wrong. The best argument against democracy is a five-minute TV interview with the average cabinet minister.
It isn't your usual world domination sprawling IT metasystem, it is a really easily defined scope, easily implemented and tested. This is exactly the kind of scope that can be delivered effectively and solve an actual specific problem. If whoever manages it rejects all scope-creep and rides the schedule and budget, this is a sensible project.
Right, before it even gets to the engineers there will be the consultants (Accenture etc). That's 95% of the budget gone right there for 'advice' that is basically a mixture of common sense, information any idiot can find via google and indecipherable jargon designed to make it sound like you're really smart. How do I know? Well I have a sibling who worked for Accenture, and yes was briefly involved in that NHS IT system fuckup.
Everyone jokes about lawyers over billing their clients, but consultants take it to an entirely new level, their job description is to bleed you dry.
Please just let me email my repeat prescription requests to my GP's surgery, instead of making me go there one day with a note and two days later to collect the prescription. Then let me take it to whichever pharmacy I feel like on the day. The existing and proposed systems for involving pharmacies in obtaining repeat prescriptions just add to the time and the complication.
Also, I should be able to get my complete medical records by turning up at the surgery with a USB stick and my passport.
My way of doing it would take next to no additional IT. Any proposals from computer-illiterate politicians are likely to be expensive failures.
My surgery has an on-line prescription service, which I don't use. I created an account and logged in for the first time to be greeted with what appeared to be an admin's screen, with the capacity to change the background images and modify the newsfeed, etc.
I logged out again and went back to the telephone method.
I do like the USB medical records idea, at least until they make carrying a medical history USB mandatory.
The French health service has a chip-card (Carte Vitale) which acts as a patient ID card, but doesn't hold any medical records so is pretty useless (fortunately as it turns out).
A few weeks ago I put mine into the machine at the medical insurance office, for some trivial document, and the system displayed a "please wait" screen. Then a Windows XP taskbar unhid itself from the botton of the live touchscreen!
Fully active, pointer followed my finger: start menu -> control panel -> examine system...
I stopped there. Note to self, don't trust that system with anything
I already have an NHS Prescription Card. It has my NHS number on it. I'm exempt from paying because I have Leukaemia. The last Lab gov brought that in a few months before I was diagnosed.
This is not an ID card in anyway shape or form but your NHS number can be used to make sure that you get the drugs your doc wants you to have.
In a few months it will be useless anyway because I turn 60 and get them free anyway.
My surgery rigourously insists on the same method; go in two days in advance (taking time off as surgery hours are pretty much office hours), fill in paper form, come back in two days (ditto re hours) to find you prescription hasn't been written. Receptionist asks what it was, pops off to see doctor and gets it done - which could have been done without the waste of everybody's time two days in advance.
Or I can use the new sparkly web 'patient access' system...
Log on to portal (two days in advance) using slightly weird combination of details; select from available repeat prescriptions and submit. Check back in two days to find either 'issued' or - far more likely - a mysterious letter with no explanation, i.e. 'R'. Arrive at surgery on day and get told 'R' means rejected, but the receptionist has no idea why. Receptionist pops off to see doctor and gets it done - again, a little of everybodys time wasted for no gain apart from those who profited from creating a web portal so generally dreadful a 6 year olds class project would have been marked down for incompetence had they produced it.
I can also order via a phone call to my (very good) local pharmacist, who know me and will submit a repeat request via their computer system. Before they had this, someone would walk the 4 yards to the surgery with submissions, return and collect them an hour later, doing this several times a day - "a nice opportunity to stretch my legs" as the pharmacy assistant put it.
A sprinkling of shiny overpriced uk.gov spec tech later, and there's no leg stretching, just finger drumming as she waits for the requests that they were assured would take 10 minutes with the new system to come back; instead of spaced out across the day, they come back in one glut at 5pm irrespective of time ordered. So instead of ring pharmacy in the morning, collect pills today lunchtime, it's tomorrow lunchtime, and the pharmacist spends a bit more of their day twiddling thumbs.
Twenty years ago, doing this all involved very much less of my time ( an hour, usually out of office hours), and I got my prescription on the same day, 3 months at a time. It now takes me a bit of each of two days to get one months supply, takes up more time for both doctors and pharmacists receptionists and involves a whole swathe of presumably offshored cut price 'tech support' to keep it not working very well at all, although some people get a good deal richer at the taxpayers expense.
So as far as I'm concerned, Hunt can FOAD and go back to being government spokesperson and apologist in chief for his corrupt and greedy friends in the media business.
I wonder how much money and how many years they will put into this system before abandoning it as not working?
Meanwhile I have for years been able to order a rail ticket online and designate any one of hundreds of stations to pick it up from - all details individually specified down to my seat reservation.
But then your favourite sponsor would not get a chance to spend several months designing a system that hasn't a snowballs chance in hell of working.
Then spend several years getting it working.
Then dumping it because technology has advanced.
Then back to designing another system....
Etc.
Etc.
Etc.
"We're not going to cancel the opting out that's already happened"
But we're not letting anyone else opt out now.
"There may be a process of recontacting people to explain the new arrangements"
We're going to keep asking if you still want to opt out until you give us the answer we want or you mess up the opt-out form, which we will take as consent.
"Hunt: I'll barcode sick Brits and rip up NHS's paper prescriptions"
You missed the bit about giving our details to his mates in the insurance and pharma industries a là DVLA.
"
You can 'opt out' of all sorts of stuff if you want to. See here for SCR.
As for the Big National Database of everyone registered with the NHS:
"There are a small number of patients who feel that the existence of a database containing their contact details may place them at increased risk and may want to have details within their records restricted and flagged.
It is important for healthcare staff who are approached with requests for a patient's record to be flagged to understand and communicate to patients that flagging a record should not be undertaken lightly, because of the potentially significant impact on the ability of the NHS to deliver joined-up healthcare.
Flagging a record as 'sensitive' will mean that local NHS IT systems will be unable to retrieve your address, telecomms details, registered GP Practice and alternative contacts (such as next of kin) from the PDS. The information will still be held nationally, however.
As a patient, if you require your record flagged you should contact your GP. Similarly, if you wish to have a flag removed from your record this should be done through your GP. Further information for healthcare professionals is available on the NHS CFH nww (N3 connection required) site (N3 connection required)." See the HSCIC's site for more information.
I've had a kidney transplant and am currently on medication that will have to be given to me indefinitely. For me personally a better system would be to register a pharmacy with the clinic. The clinic can then tell them what medication I'm on and repeat that if it ever changes. I can then go direct to the pharmacy for a refill, and when I do so the clinic is notified. No need to get a response from the clinic that way and things are sorted out more quickly.
As for 'paperless' and 'reducing errors' perhaps it's escaped Hunt's notice, but all prescriptions seem to be entered on a PC anyway and then printed out for the GP to sign. How exactly is merely stopping the printing going to stop the errors?
you can kind of do that already. Just ring the pharmacey and tell them what you need and they go get it from the Doc's. The other way round will not work at the moment as in most cases (not yours) Doctors will want to have the final rubber stamp.
For example i have monthly ones that have controlled and uncontrolled medications (the uncontrolled is OTC in lower quantities) and have had for the last 4 years. Every single month a doctor has to look at my script and ok it. i have a feeling they give it a quick glance to check the date range and thats it. Imagine how much time could be saved if they could set it to auto-approve (unless its out of a range i.e too soon)
Except that this medication is prescribed by the consultant at the hospital, not the clinic. It also adds at least 2-3 days to the process of getting a refill not to mention take up the time unnecessarily of the doctors involved.
I've had entire items missing from my prescriptions in the past - even important anti-rejection drugs that I continue take on a daily basis, so I don't think repeatedly asking doctors for a prescription is a good thing, since it introduces the extra chances for errors to be made (especially since the requests often have to go through receptionists that have little if any knowledge of the medication being organised)..
So long as I can still take the prescription to the chemist of MY choice, not my doctor's.
I don't, as a rule, visit the doctor's unless something is green or falling off, so I haven't had a prescription for myself in over a decade. But when I pick up other people's, I've often found that their doctors have sent it straight to a pharmacy that's inconvenient for everyone and it's a fight to get it back and use it in the one you want.
And why would I do that? Take the Boots pharmacy, for example, that took the prescription for my girlfriend's Pill, fulfilled only half of it and then said we could get the other half "next time" because he had run out. And then refused to fill the full amount or give us the prescription back.
Sorry, but we ordered a month's worth for a reason - we were going on holiday and needed a month's worth. I had to have an ALMIGHTY row to get the prescription filled fully or returned to me so I could take it somewhere that could fulfill it. And in the past I've had no end of problems where the doctor sends the prescription to the local supermarket pharmacy or whatever that closes at some ridiculously early hour and thus stops me collecting it in a timely fashion at my convenience again.
Honestly got so annoyed that I made the girlfriend change doctor, change pharmacy and insist on getting a paper prescription each time rather than have it "sent on for you".
I don't care about the IT. Just give ME the barcode to take where I want. And stop pharmacies from being able to hold your prescriptions to ransom.
I remember seeing a news report years ago about the large amount of money the NHS was wasting because of people fraudulently ticking the "I don't pay for my prescriptions" box on the back of the slip. Apparently it was only rarely checked that the patient was eligible for this examption. Maybe this measure is really, at least in part, about mimimising that sort of fraud?
IIRC the reason for the charge was a nominal sum to cover the pharmacists cost of handling the prescription. Since this new computer system will reduce the cost dramatically (all computerised systems do ) the fee can be abolished.
Alternatively anybody who doesn't have to pay can prove that by registering a 90quid e-passport in the new system on every visit
The charge was introduced in 1952 to cover part of the drug costs.
(I note rationing was still in force in '52)
In some cases, the prescription charge is more than the actual drug cost eg a week course with a common antibiotic, in some cases the charge is less than cost eg a contraceptive hormone implant, and in some cases a lot less eg hormone implant for prostate cancer treatment.
"Maybe this measure is really, at least in part, about mimimising that sort of fraud?"
I don't see how it would help as my GP doesn't know if I have an exemption or pre-payment certificate. It will still be down to the pharmacy to determine entitlement.
The easiest way to cut fraud would be to abolish prescription charges altogether. It penalises the long-term sick, it doesn't usually cover the cost of the medication or if it does, your GP will advise you to buy it over the counter.
"it doesn't usually cover the cost of the medication"
The vast majority of drugs prescribed cost less than £7.85.
A course of Amoxycillin costs less than a pound.
A Salbutamol inhaler (now generic) costs £2.30.
28-days supply of Paracetamol/Codeine [500/30] (the maximum a UK doctor can prescribe for an NHS patient) costs, again, less than a quid.
The cost of those above for a private patient would be much higher than the prescription charge, and that would not include the consultation/prescription charge !
A lot of medication is not available for purchase without prescription !
3 downvotes, but you don't worry about this shit when it's Google, or Tesco or Amazon or Apple.
All of whom will quite happily tell you to naff off if you want to control how they use your info such that it becomes harder for them to deliver their services.
Organisations need to use your info and need to disseminate it across the organisation, anything else is inefficient and pissing money against the wall.
My objection is not the amount of sharing between GP/hospital, but who is given access to the central database.
And, of course, where that database is.
At the present the proposal is it is not just medical providers that have access to that data but sundry others such as local taxation, DfWP, DVLA. Some 500,000 plus public servants. Then there is the already-happening proposal to let various others have access to "anonymised" data. By various they mean anyone with a wallet no doubt.
Makes me wonder how many govt ministers have shares in the IT companies that will try and bring this into existence - besides Alien 3 beat you to it, Jezzwald - make it easy and tattoo bar-codes on everyone's head, I'm betting in your case, they'll spell HUNT wrong....
Bar codes are so 80s.
What it translates to is lots more money from healthcare software providers for all the pharmacists that need to upgrade the systems which interact with the NHS system at a huge cost (or pay massive sums of money -even larger sums of money) to get their own past the QA processes needed for interacting with the NHS system.
A silent way to further milk the healthcare system of money, only deferring the costs to pharmacies (many smaller ones which will then end up closing)
Unless you missed the news: The NATIONAL health service has left the building. With the passage of the Health and Care reform act it, effectively, was killed.
Now the health dept has no control on funding, or over foundation trust hospitals (except setting standards)
Control has now passed to the GP commissioning groups (circle health, virgin health, capita et-al)
Doctors now send patients to private clinics for a large variety of things.
"you'll need about 12 sessions of physio, you get 5 on the health service and the others will be £50.00 each session. Don't slam the door on your way out. Goodbye"
The latest idea is a patient gets a set amount, and uses it to buy their treatment.
Obviously nothing can go wrong with that.
"I'm sorry sir/madam/ms you have consumed your entire budget. How are you going to pay the additional £25000.00"
"Or a doctor is prescribing the wrong drugs, because they don’t know what drugs their patient is already on."
Ehh??? My doctor sure knows what I'm on - he has one of these telebox things with a keyboard, and it tells him.
Mind you, if Government ministers have doctors who prescribe stuff without knowing what else these people are on, then that explains an awful lot of the last three years' idiocy.
My missus is a Pharmacist, and has worked in community and primary care. At least 30% of prescriptions they receive from doctors contain errors, from wrong doses (sometimes dangerously high, sometimes so low as to be a waste of time), to drugs contraindicating or duplicating the effect of existing ones, to some that have been withdrawn for safety reasons.
The whole system of doctors prescribing is the issue. Pharmacists are the experts on drugs, they spend years studying them, and continually have to prove that they are up to date and knowledgeable. Surely the doctor should be the one identifying the illness / sickness, and then passing that information on to the pharmacist, who will have the more detailed and up to date knowledge on drug regimes?
P.S. I know the article is about PC and hospitals, but anyone who goes to Boots / supermarket pharmacies and expects good service needs their head checking.
AC/DC for fear of missus finding out of me taking her name in vain.
But the doctor knows what drugs you have a reaction to, if any.
And, quite frankly, handing your illness details and medical history to a pharmacist is a data step too far.
and complete details would be needed, because one drug for an illness may not be practical if the patient has another ailment that may be exacerbated by a new drug. Or maybe you don't read those nice, and quite lengthy, A4 pages of detail that comes within the medication ?
"And, quite frankly, handing your illness details and medical history to a pharmacist is a data step too far."
This article is about hospitals and Primary care. Weirdly enough, a hospital pharmacist will have both those exact things.
"because one drug for an illness may not be practical if the patient has another ailment that may be exacerbated by a new drug"
10 points, which is what contraindications and interactions are (see my previous post), and who are the experts on those? Oh yes that's right - Pharmacists. When it comes to drugs I'd trust a Pharmacist over a Doctor any day.
Horses for courses, I wouldn't expect a pharmacist to do a surgical consult, I wouldn't expect a surgeon to be writing prescriptions. Instead I'd much prefer to have the best, most knowledgeable person for the job doing it.
me get this straight.
Your doc can send the chemist an e.copy of your medication for you to pick up, also, in the event of a medical emergency, the hospital can type your number in and see what medication(if any) you are already taking.
So what he's talking about is a system exactly like the one the out of hours service uses to send a prescription to your local chemist. coupled with an IT system that lets the GP or the hospital see what each other has prescribed to the patient.
Why not add in the ability for the GP or hospital to see patient notes and test results and we get a system rather like the one my doc and local hospital already uses to see what the patient has been treated with.
In fact, Take the plastic coated bar code tag that I've got to carry in my wallet and scan it into a NHS terminal and you get to see who I am, how much heart surgery I've had and what medication /latest test results are.
I wonder if the health minister actually knows what goes on in his department?
If you've changed a graphics card once you are strictly speaking overqualified for the role and would be considered dangerously likely to accidentally achieve an outcome, so I'd remove that off my CV if I were you. Replace it with a moderately smart but not actually threateningly professional-looking suit, perpetually brown nose and Prince2 qualifications (available circa 500 quid off Groupon). It's what all the govt-related IT types are wearing these days.
Mine's the one with the Prince2 cert in the pocket.
... even if the implementation would turn it into a complete disaster.
I used to be a BloodRunner, and a common shout was to transport patient notes from one hostpital to another. Usually when Granny had been discharged from one of the "Cottage Hospitals", then had a relapse and was then taken to the ED of the main Hospital.
Valuable time could (potentially) be saved if said notes were accessible online.
But it was store and forward as it needs to be. The US VA separately has it working in their many hospitals and the WorldVista project has been making a product with support of an open source version of it for some years
In the UK VistA is well known by enough people to put in a Free system known to work over a population in millions.
I suspect something else had been sold though.
I guess the minister has never talked to someone who works in a warehouse [warehouse I said............!]
A place where misread bar codes are the bane of existence and invariably lead to delivery issues,which is fine with a case of dried plums but not so good for a dose of mis-prescribed medicine and whos to take the blame for getting it wrong?
I belong to the largest HMO in the US, Kaiser Permanente, that has, with its various branches, about nine million members. A couple of years ago, Kaiser developed an integrated record keeping, prescription ordering, etc., etc. system that has been working well for some time. When I see my doctor, he updates my record on line, places an order for any prescriptions, orders any tests or lab work needed, all while I'm in the examining room. By the time I walk over to the pharmacy, my prescription is ready. I can go to the lab without carrying any paperwork for the ordered tests, and the info is in the computer. I haven't heard any of the staff complaining about problems with the computer system, and the only complain I have is when I need to renew a prescription, and do it on line, it takes up to ten days for the prescription to be mailed from a central mega-pharmacy. But that was the case before they had the computer system for everything...
That's a WINE glass... since El Reg refuses to provide a real one.
then any IT System designed by the NHS will always be a complete disaster.
The system used by your HMO would never have worked if designed for/by the NHS as there'd be so many people insisting on their input it would become just another bloated waste of tax payers money.
I live on the Berkshire/Hampshire Border - so my wife, who is often ill, is often treated at, or taken by ambulance to, North Hants (Basingstoke) Hospital, just 15 miles away, much closer at easier to get to than Royal Berks in Reading.
However, details of my wife's medications don't cross county borders between (Hampshire) hospital and (Berkshire) GP surgery, so if either the consultant at the hospital or the GP changes my wife's medications *WE* need to remember this because both bits of the NHS seem to be working in isolation.
That's the kind of stuff that needs fixing (before a miss-match in drugs kills somebody)...
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