New report explores the use of Electronic Repeat Dispensing in the South West of England
The South West Academic Health Science Network (South West AHSN) has released a new report exploring the use and uptake of Electronic Repeat Dispensing (eRD) across the South West.
The report sets out findings and a set of recommendations from activities delivered by the South West AHSN to understand Electronic Repeat Dispensing and increase its usage in the region (Cornwall, Devon, Somerset).
The eRD report forms part of the South West AHSN’s Technology-enabled Workforce programme, which seeks to optimise digital interactions to improve patient outcomes and workforce benefits.
It is designed to be of use and interest to those involved in delivering and supporting uptake of eRD, including those based in:
- GP surgeries
- Primary care networks (PCNs)
- Integrated Care Boards, Local Pharmaceutical Committees, and others.
What is Electronic Repeat Dispensing?
Electronic repeat dispensing (eRD) was introduced in 2009 as a non-compulsory method of dispensing repeat prescriptions electronically (NHSBSA, 2020). eRD allows the prescriber to authorise and issue a batch of prescriptions for up to 12 months, with just one digital signature from a clinician, until the patient needs to be reviewed. Once eRD is set up, the patient’s nominated pharmacy automatically receives the issues at intervals specified by the prescriber.
Increasing eRD in the South West – what did we do?
After identifying a gap in knowledge and literature on eRD uptake, usage, and experience, the South West AHSN carried out an evaluation to understand eRD usage in the region, covering the period from January 2020 – May 2022. Working alongside our commissioned training delivery partner – DAMN Partnerships – the South West AHSN also carried out the evaluation of a training programme, aimed at increasing eRD usage in primary care settings across the South West. Finally, the South West AHSN carried out a research and evaluation piece to identify barriers and enabling factors to implementing and scaling eRD usage across the South West.
DAMN Partnerships supported one primary care network (PCN) from each county (Cornwall, Devon, and Somerset) through a 12-week programme using a quality improvement (QI)-focused methodology. The programme consisted of six sessions across approximately 12 weeks. DAMN Partnerships worked with the PCN, GP practices, and community pharmacy individually and together.
The report found that whilst the benefits of eRD uptake have been well-documented, uptake in the South West remains relatively slow. Some of the key findings were:
eRD usage across the South West
- eRD usage in the South West has increased since the COVID-19 pandemic. This increase was largely driven by rapid changes in the regulatory environment and by disruption and transformation of ways of accessing health and care services.
- National suspension of patient consent processes from April 2020 onwards led to substantial increase in eRD usage across the region. Thereafter, eRD usage increased more gradually from September 2020 to May 2022.
- Between January 2020 and May 2022, the percentage of EPS (Electronic Prescription Service) items that were eRD items increased slightly, at less than 2%, in all three counties.
- In the same period, the number of eRD items grew from a low base by between 13% and 99% in each of the three counties.
Impact in sites that received QI-based eRD training
- The training programme delivered had a clear positive impact on eRD usage at each of the three PCNs.
- The programme led to improved collaborations and shared knowledge of processes between GPs and pharmacy teamstogether
- A total of 86 staff were trained to support increased eRD uptake across the three PCNs between September 2021 and February 2022.
- Analyses over the 6-month period showed statistically significant eRD usage increases of up to 4.8% of all EPS items. In the same period in the South West, there were no statistically significant increases.
- The number of eRD items in each PCN grew significantly, by between 71% and 417%.
- A total of 12.6 hours was saved per month across the three PCNs, based on an additional 2,835 eRD items being processed with a saving of 16 seconds/item.
Barriers and enablers to implementing and scaling eRD usage in the South West
The below headline findings capture learning from both the evaluation of the delivered training programme and the wider research piece that brought together knowledge from frontline staff and other stakeholders across Cornwall, Devon, and Somerset:
- Overall awareness of eRD in community pharmacy and GP are core to successfully implementing eRD.
- Good relationships between community pharmacy and GPs are core to working together and trusting new ways of working, communicating, and learning. Collaborative training for both groups together supported the development of these relationships.
- Previous negative experiences influence how motivated staff are to adopt and use eRD.
- An external training programme free of charge was a motivator for PCNs that received it to prioritise increasing their eRD usage.
- Making eRD a priority was key to successful eRD implementation at all levels in the system.
- Support and buy-in from other organisations including the Local Pharmaceutical Committee (LPC) and Clinical Commissioning Group (CCG) was key to ensuring shared purpose and opportunity within the system.
- Access to and use of prescribing data to monitor progress and time-saving were seen as important to ongoing use, improvement and embedding of the innovation.
- Passionate lead representatives – ‘eRD champions’ – at each site were recognised by the trainers as being a key part to the success of the training programme.
The report makes the following recommendations, for both frontline staff prescribing and fulfilling eRD items, and those who support them to increase their uptake:
- Learn from the past and understand how it may influence implementors’ motivation to take up new, similar interventions.
- Cultivate the policy and leadership environment which are key to shaping initial opportunity.
- Create communication and engagement plans to ensure there is consistent overarching knowledge shared between key stakeholders about the intervention and up-to-date benefits.
- Ensure appropriate training is given to upskill and improve knowledge, and ensure time is built in to learn while adopting.
- Understand cross-system working and the importance of actively bringing in teams across the system, and building strong relationships between them, using tools such as process mapping.
- Implement with sustainability in mind. Understand what staff need to continue improving past initial adoption.
The benefits of eRD have been well documented but uptake in the South West remains slow. The rescinding of patient ‘opt-in’ consent resulted in a rapid increase in eRD delivery, followed by a more gradual implementation. Good practice exists in the region and an abundance of resources listed in this report are available to support PCNs and community pharmacies to deliver more prescription items using eRD. However, availability of resources alone has not been sufficient to see significant increases in eRD in the South West.
Our findings found that the delivery of a strategically supported and focussed eRD training programme, bringing together GPs and community pharmacy, can lead to improved collaboration and to significant increase in eRD usage over a short period of time, with the potential for ongoing growth of eRD usage. Further, the continued review of eRD data, prioritisation of eRD by PCNs and system stakeholders, ‘eRD champions’, and the engagement of community pharmacy providers are recommended ways of making sustainable change and boosting effective adoption of this technology.
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