How we’re moving towards electronic prescriptions in Wales

Working with Digital Health and Care Wales (DHCW) to improve the way medicine is prescribed and dispensed, here’s what we’ve learnt from visiting pharmacies and GP practices and speaking to people who need medicine

21 November 2022

We recently posted about how we’re working with Digital Health and Care Wales on two parts of the Digital Medicines Transformation Portfolio (DMTP). One of the pieces of work we’re supporting with is ‘primary care’-related and involves the two organisations working together to improve the way medicine is prescribed and dispensed in GP practices, and in pharmacies in Wales. 

Right now, a significant amount of the process is paper-based, but it will soon be moving towards a technology known as the electronic prescription service (EPS). This work is a key part of the DMTP which aims to make the prescribing, dispensing and administration of medicines everywhere in Wales easier, safer, more efficient and effective. 

The benefits of implementing an EPS include: 

This would be: 

• more efficient – it would avoid having to wait for a doctor to sign a paper prescription and then having to wait for it to reach a pharmacist at another location   
• more secure – it would mean a group of authorised people could access prescription information at the point they need it, rather than having to rely on papers being sent, filed and stored safely each time they’re used 
• improve safety and accountability – having a digital audit trail would show what has been prescribed and dispensed, by who and when 

Much of our work over the past 11 weeks has been around getting an understanding of our ‘users’ through research. These are the sets of people who are directly involved in prescribing, dispensing or administering medicines, or receiving medicines. 

Early on, our research told us that roles within organisations vary, and what one technician does in one practice or pharmacy might be very different to what someone with the same role title does in another. 

We needed a clear and consistent way to understand the people and the activities involved. 

We looked to Rochelle Gold’s post that defines what teams mean when they talk about ‘users’ at NHS Digital. In short, it’s “everyone who uses a product or service from end-to-end, front to back” but in helping to pin this down, she lists the specific groups of people. 

We did the same for this piece of work by the Digital Medicines Transformation Portfolio. Our ‘end users’ are people who:   

• need medicine  
• collect medicine  
• help other people with their medicine  

And for this piece of work, important users are people who:   

• prescribe medicine  
• move and store medicine  
• dispense medicine  
• administer medicine  
• manage medicine  
• create and send communications during the process (for example, a discharge notification)    
• oversee discharge  
• work as clinical professionals and managers with and around others (stakeholders)  
• support others in process or admin  
• develop policy, guidance and processes (stakeholders)  

How users can help

We’ve been speaking to the people we’ve identified as our users, and we’ve been observing them in real-life scenarios that involve their work with prescriptions.  

We call this ‘user research’. It’s essential we do it so we can better understand what currently works for our users and what is challenging.  

Discovering this helps us identify what each set of users need. This means that we’re in a better position to make sure that technology and change supports them, for the reality they work in. Doing this will deliver better outcomes and value for money.  

The importance of context  

Rather than look at prescribing for the whole of primary care, we’ve been asked to focus on 3 areas of opportunity that are to do with: 

1. GP practices that also dispense medicines

2. practices and pharmacies in and around the border between England and Wales, since there may be opportunities to improve how the processes currently work in this context 

3. how pharmacies select items to be dispensed and how that might be better supported 

Within each of these areas, there are many differences between the users (despite often having the same title role), and between the organisations involved. For example, the challenges are likely to be different:  

• in chain pharmacies to those in independent ones  
• in rural locations to those in urban ones  
• if the user feels more comfortable using paper to using modern technology  
• if the user has reliable and fast internet access  

We must consider the context to get an accurate overview of where more support is needed.  

Important themes so far  

To start to build up a picture of what might need to change, and what the opportunities are for improvement, we’ve been visiting pharmacies and GP practices. We have spoken to people who work in each setting and have also been speaking to people who need medicine. 

We’ve already understood how important it is that:  

• people can get the medicines they need, when they need it, from wherever is convenient. A ‘convenient’ location may change, for example, if someone is working in England for the day, or if they’re on holiday, or if they need to get medicine on a particular day when they’re away from home.
• pharmacists know a lot about the volume and types of prescription that will be coming to them in advance, so they can manage their time and the requests efficiently. This might mean ways to help them avoid people arriving in a pharmacy expecting to pick up something that hasn’t yet been dispensed, or fielding questions from people chasing items that haven’t yet been prescribed.  
• doctors move away from time-consuming, manual prescribing processes to free up time to care.  

Some of these points can be addressed by the programme enabling EPS for GP practices and pharmacists to implement. Others are much more to do with the process and procedure that people choose to adopt.  

We’re still learning 

We’ll need to learn much more about what’s needed to bring about the changes, how to help people make the most of opportunities and to reduce the time, effort and learning curves as we go.  

We’ll be doing user research with people who are already using digital medicine technology in England, as well as those that aren’t yet in Wales. That way we can understand: 

• what changes will need to be made 
• what needs to be implemented 
• what it looks like when it’s been in place for a few years 

We’ll talk more about our research findings and what they show soon.