Electronic Repeat Dispensing (eRD)
General Practice is facing unprecedented demand from patients and a shortage of GPs. Effective Electronic Repeat Dispensing (eRD) would save 45 minutes a day of GP time.
eRD is also specifically mentioned in the new GP contract (January 2019):
Primary Care Networks will be encouraged to be ‘digital first’ and improving access (page 34 Section 5.10 (iii)
‘All practices will be offering and promoting electronic ordering of repeat prescriptions and using electronic repeat dispensing for all patients for whom it is clinically appropriate, as a default from April 2019.’
- In England each year over 1 billion prescription items are dispensed. 77% of these are repeat medicines.
- This is 410 million repeat prescriptions - equivalent to an average of 200 per GP per week. (3)
- The average number of prescription items per person per year is now 19.
- DH showed in 2002 that if 80% of all repeats were issued as Repeat Dispensing, 2.7 million GP hours would be saved.
- For Wessex, this means if we prescribed 80% of all repeat medicines as electronic Repeat Dispensing, then we could save 108,000 GP hours which is around 61 whole time equivalent GPs.
eRD is when a person who has a stable long term condition is prescribed up to 12 months of their medicines. These prescriptions are stored electronically and drawn down one at a time by the community pharmacist. The patient does not have to request prescriptions from the GP during this period. When the penultimate prescription is dispensed by the pharmacy, the patient is asked to see their GP for review and a new prescription.
The Wessex area has been slower than other areas in England in adopting this service (which has been part of the national Community Pharmacy Contractual Framework since 2005). Wessex as a whole has an average level of repeat dispensing of 8.89% which is below the national average of 12.69% and significantly below the highest CCGs in England which are above 45% (NHS BSA Dec 2016).
Areas that have implemented repeat dispensing well have also been able to demonstrate a reduction in medicines wastage. Studies in Manchester showed that for every 1,000 prescriptions moved from repeat prescribing to repeat dispensing, savings of £550 were realised. These occur when the pharmacist checks with the patient if medicines are still needed or causing problems.
Wessex AHSN is working to support CCGs, GP practices and pharmacies to help realise the potential of repeat dispensing in the following ways: Strategic oversight of projects:
Wessex AHSN can advise GP Practices on the key components that need to be in place to successfully increase the uptake of eRD.We have also identified key partners to support implementation of eRD including the Commissioning Support Unit, NHS Digital and the Hampshire and Isle of Wight Local Pharmaceutical Committee.
Support to train practices with low levels of EPS and eRD: The NHS Digital EPS Implementation team and local Commissioning Support Unit can support the set-up phase in specified practices with additional support from the CCG. GP Clinical System Providers are able to provide training to Practices who are not familiar at all with generating electronic repeat dispensing prescriptions.
Working alongside the CCG, Wessex AHSN can support practices and pharmacies at implementation stage. This is vital to the success of the project and could cover:
Measurement and evaluation:
- Identifying suitable patients to move to eRD
- Communicating the change to patients
- Meetings between local GP practices and local pharmacies to ensure good communication channels
Analysis of data to capture the efficiencies at general practice level will help those practices resisting the change to see the benefits. Wessex AHSN is working with local CCGs to ensure that we have comparative before and after data which we hope will support the development of a persuasive argument for those practices and CCG's yet to see the benefits.
Patient-facing communications: We are working with our patient representatives to ensure that patient communication is done well and that patients understand the benefits for them (as well as the wider benefits of freeing up GP capacity).
Are you a GP or Pharmacist who is curious about eRD and how it can save time? Then watch our GPs and Pharmacists explain it.
NHS Business Services Authority has also produced a useful guide to Electronic Repeat Dispensing (eRD) below: