DDN Oct_2022 Octoober 2022 - Page 8



Are we a step closer to electronic prescriptions for substance misuse services in England ? Linda Geddes and Dr Georges Petitjean reflect on their experience of prescribing OST electronically
HISTORY OF THE ELECTRONIC PRESCRIPTION SERVICE The notion of digitalising the prescription service was first conceived in 2003 as part of the bigger National Programme for Information Technology ( NPfIT ). Although the initial project had a budget of £ 6.2bn , it failed to deliver changes and subsequently did not improve services or patient care as expected . The mantle to digitalise the service has gone through various iterations over the years – Connecting for Health , Health and Social Care Information Centre ( HSCIC ) and finally NHS Digital . In July 2019 a new unit , NHSX , was created as a working collaboration between the Department of Health and Social Care ( DHSC ), NHS England , NHS Improvement and industry . NHSX is rolling out an electronic prescription service ( EPS ) via phased software releases .
The principle of an EPS system is that an electronic prescription is generated and is sent to the NHS spine ( a secure NHS database ) where it can be retrieved by the pharmacy team . One of the main
benefits is that the electronic prescription can be tracked throughout the system and therefore cannot be lost .
According to the online version of the NHS long term plan , EPS has been successfully implemented across primary care and is now used in 93 per cent of England ’ s 7,300 GP practices , with more than 67 per cent of their prescriptions delivered via EPS .
OUR EXPERIENCE OF EPS AT INCLUSION In 2021 following collaboration with NHS digital and Cleo Systems ( a subsidiary of IC24 ) the Midlands Partnership NHS Foundation Trust ( MPFT ) was chosen to be a ‘ first of type ’ pilot site for testing the EPS in secondary care . Inclusion approached the MPFT programme manager and sought approval to be included in the pilot . Our Telford substance misuse services ( SMS ) site was chosen for the Inclusion pilot as it was a small enough team to ensure that control mechanisms could be implemented and maintained . It was also the closest service to the trust , so support
from the programme manager could be assured . Preliminary work started for the trust at the end of 2021 and initial testing began at the start of 2022 .
We were aware from the outset that the platform would not enable us to electronically send prescriptions requiring instalment dispensing ( FP10MDAs ), packaged doses or supervised consumption . That limited our ability to use the system for the majority of our work . As this was a stand-alone system which did not interface with our current clinical system , we had to have an additional process to ensure the clinical system was updated . We identified a cohort of stable service users who were on weekly pick-up of their opioid substitution therapy ( OST ). To maintain control and to allow us to work collaboratively with pharmacy we limited our pilot to one main provider . Although service users are not always directly involved in how their prescription gets to the pharmacy we wanted to ensure they were asked if they wanted to be included in the pilot . The Cleo Solo EPS has the ability to send the
service user an SMS message with the address of the pharmacy and a Google Maps link pinpointing its location . We wanted to test this functionality as it would be beneficial in the future if we had to send a prescription to an alternative pharmacy ( such as what we ’ re seeing with short-notice pharmacy closures ).
As you would expect with any new system there were stops and re-starts as issues were identified and resolved by the system supplier . As we knew it would be difficult for us to react quickly should the pilot be halted we planned to start our prescribing at least one week after the other trust sites .
On 4 April 2022 we sent through seven electronic prescriptions to the nominated pharmacy . Unfortunately after a few hours a message came through from NHS Digital to tell us to stop . Their reason for this was based on safety – unlike the EPS system employed in primary care the Cleo Solo EPS did not have the functionality to post-date prescriptions . The EPS clinicians metamorworks / iStock