The electronic repeat dispensing (eRD) Quality Improvement fellowship was the first part of a NHS England/Wessex Pharmacy Local Professional Network Project that I undertook in a GP practice to help increase the uptake of eRD with limited resources (e.g little GP/nurse time and no practice pharmacist). The project culminated in a poster presentation, pragmatically highlighting how the findings can be transferred to any other GP practice. As most practices do not have a practice pharmacist, it was important to keep my clinical contribution to a minimal, so as to truly make this project transferable and sustainable without a practice pharmacist.
In reality the outcomes were dwarfed in comparison to what was achieved when I used my clinical skills during face to face patient consultations; as what was discovered in the last 8 weeks of the project.
It is the unique value of the practice pharmacist to be able to gain patient consent, screen for clinical and mental coherent suitability, as well as counsel on the process involved for eRD. This should be done during (and can complement) a clinical medication review. This makes the whole eRD recruitment process manageable, increases patient understanding, reduces patient drop out from service, and reduces incidence of technical issues (which can actually put the practice staff off from further implementation).
In addition the GP practice pharmacist can play a pivotal role in aligning the needs of both pharmacy and GP practices.
A periodic (monthly or bimonthly) campaign to switch clinical groups of patient to eRD should be promoted within the practice and the community pharmacies.
For example, during one month I focused only on patients taking oral anticoagulants (i.e warfarin or DOACs). This campaign was explained to the local pharmacies. The community pharmacy team could identify eRD suitable patients on anticoagulation to the surgery. MURs were targeted at these patients – this helped understand patient compliance, determine eRD suitability and prepare patients (and the practice pharmacist) for a more focused clinical medication review, and where appropriate, an eRD switch.
For visible operational efficiency to be seen by any practice, at least 20-25% of long term repeat prescriptions should be switched to eRD to make the whole process meaningful. Of course, in theory up to 80% of repeat prescriptions could be switch to eRD. To achieve this level of uptake within a reasonable time scale, without technical issues, and meaningful engagement with community pharmacy, it is unreasonable to assume this can be achieved at scale without the practice pharmacist.
eRD is high on the agenda for many stakeholders, at local and national level. Yet modest success is being achieved. I believe with the pragmatic guidance in eRD implementation, GP practice pharmacists can add a significant, tangible and immediately realisable, dimension to their value to the primary care arena.
For consultancy advice/assistance on eRD implementation please get in touch with Jaggy Khela on jaggykhela@gmail.com.
