ETP progress
From Mr A. J. Burr, MRPharmS
It is amazing how far we have come in the last 10 years because many in the profession sought to discourage the introduction of electronic prescription transfer by the venture capital funded company Practice Resource Systems Ltd in the mid 1990s.
Some will recall that in the initial phase, opposition focused on a transactional model for prescription charges, which the company subsequently dropped but the model for prescription drawdown from a central source was widely regarded as fair and equitable because the electronic prescription was not directed to a particular pharmacy.
At the time, the National Pharmaceutical Association and others sought to delay the innovation because they believed it threatened the heart of community practice. But 10 years on, we are likely to see the introduction of nomination for electronic prescription transfer, by which the message is sent directly from the GP to the patient’s nominated pharmacy, despite Release 1 seeking to use a barcoded prescription to trigger draw down from the central spine.
Moreover, the website myrepeats.com has recently received approval from the National Pharmacy Association, despite the fact that the terms and conditions for pharmacies signing up for the service clearly states, under fees 5.1.2: “A fee of 20p per each prescription item ordered from you by a registered user via the website.” Who would have thought progress would have been so swift?
Andrew J. Burr
Sutton Coldfield, West Midlands
ETP Release 2 is becoming a nightmare
From Mr P. V. McAuley, MRPharmS
Bob Dunkley should be thanked for discussing the challenges of electronic transmission of prescriptions. It was a timely article because the Pharmaceutical Services Negotiating Committee, National Pharmacy Association and NHS Connecting for Health jointly published the leaflet “Electronic prescription service — practical advice”, which all pharmacies received recently.I have been critical of ETP in the past and remain critical. I cannot see any advantages in using ETP (Release 1 or Release 2) for community pharmacy. My experience to date, although not as extensive as Mr Dunkley’s, shows that for every single item that is downloaded, the quantities, drug and patient instructions have to be selected or retyped. Nothing can be transferred from the patient medical record history. This takes so much additional time. It may be a function of my PMR and labelling system but I cannot see the functionality changing with Release 2.
There are also issues with the Connecting for Health central spine. On 14 October, when the system failed to download a prescription, I was informed by my system helpdesk that the whole spine was down and to try again tomorrow. What will happen when Release 2 is fully functional and the system crashes? What do we say to every patient in those circumstances? Emergency dispensing for all?
Those unlucky pharmacists who will be trialling ETP Release 2 must rigorously evaluate the system and ensure that their comments for improvement are implemented. But I would like to ask pharmacists who trialled Release 1, whether they have seen their suggestions for improvement implemented when it was rolled out?
Mr Dunkley says in his final sentence “Dream on”, but I am concerned that we are heading for a nasty nightmare.
Peter McAuleySwindon, Wiltshire
ETP in the hands of the wrong generation
From Mr J. Scott
Reflecting on the Broad spectrum article about the challenges of electronic transmission of prescriptions, it appears to me that ETP is only capable of gathering negative media.
I am a pharmacy student at Keele University and take a keen interest in following where my future profession is going. One of these future prospects is ETP but everything I read in the PJ leads me to believe it is a failing system.
To me, it seems innovative and a logical progression but I think it is failing because it has fallen on the wrong generation. I am sure there are many doctors and pharmacists willing to embrace information technology as it evolves and improves patient service, but there are also many who do not.
As long as these reluctant individuals exist, ETP will not function or create a more efficient service with better compliance with doctor instructions. I hope ETP does not get written off as a failure. It just needs the upcoming generation of IT-friendly professionals to prove its potential.
James ScottStoke on Trent
ETP
Thank you Mr Scott for taking the trouble to reply about my Broad Spectrum article. You are quite correct - too many people of my generation (I'm 58) are frightened of IT, and ETP would be better served if it was introduced to the up=coming generation of pharmacists who are more IT literate.
Unfortunately, your argument falls in my case, as I am extremely computer literate, having run web sites for a number of organisations as well as manning a help desk for IT at Rotary International, and it was from my degree of expertise that I wrote the article.
Regards
Bob Dunkley
ETP
There have been a number of articles about ETP in different journals, eg PJ, C&D, Pharmacy Magazine.
There has been numerous comments that if you don't like ETP & make complaints about it, then you are a luddite and against change.
Like Bob Dunkley, whose excellent article started this debate, I am also quite computer literate having had a PC for 25 years (starting with one of the old Spectrums) and have considerable expertise in designing and validating a number of computer systems. What I see and experience in ETP release 1 (which is supposed to be a working system, not a Beta version), then I can only envisage problems with Release 2, the release of which goes back by the day - not a promising sign.
My major comment is - who has designed these systems, have they been pharmacists at the bench? I hardly think so.
Regards, Peter Mcauley
ETP
Thanks Peter for your reply, I dispair as I go round the various pharmacies on locum duties. The system at the moment is set up for people to practice - what you do is not going to the PPA, you don;t get punished financially for dispensing your ETP Rxs. The Connecting for Health People have set the system this way so that we can all get some practice in before it REALLY goes live, and that button we press makes all the difference between getting paid and losing out!!
But do the people involved take this on board - they do not. We have two main blocks towards being fully competant when Release 2 becomes live and pressing that button means money:
1) Pharmacists will NOT use their smart cards - at this stage of the procedings it is a God given opportunity to practice, to get a feel for the system, to get it sorted out with your IT supplier so that your system is working at it's best, and practice practice practice - there is no money involved, you can make all the mistakes you want and you will not be penalised. Hopefully you can learn from what went wrong.
2) GPs will NOT use bar coding on their scripts. Some places that I go to, all scripts are bar -coded, in other places they are not. If you are in an area where they use the bar codes, seize the opportunity, but if not then approach your GPs and tell them that when the system goes live, then there are going to be patients of theirs who will be not be getting their medicine - all because they have not bothered with the new system.
I want this system to succeed - I really do, but each stakeholder is dependent on the other - if pharmacists will not practice, and GPs will not use bar codes, then it will fall. From what I read, there will be no "honeymoon" period, when it goes live - come that Monday morning, and scripts are generated electronically, that's it!!
If nothing else comes of these exchanges on the letters pages, I would like ALL pharmacists to grasp the concept that the patient coming through their front door with a script in their "hot little hand" is going to be a thing of the past, and that Electronic Transmission of Prescriptions is the way of the future.
You might have thought that the Shipman case made radical changes to the Controlled Drugs Regulations, but that is set at nought compared with ETP.
Regards
Bob Dunkley