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Mandatory electronic prescriptions was the easy bit in NHS paperless plans

Digitisation across primary and secondary providers is the bigger challenge

Analysis Plans for a "fully paperless" National Health Service have been announced and re-announced countless times – most recently they promised we'd be paper-free "within the decade".

But then again, four years ago the NHS was telling us it would happen by 2020, and in 2013 former UK health secretary Jeremy Hunt said it would happen as early as 2018.

I think it's this government ... requiring patients to trust that NHS digital services will never break, because it'll save Matt Hancock a few quid he can spend on AIs...

Over this past weekend, the Department of Health once again claimed that future is a step closer, but this time along with some action: all prescriptions across England will be digitised from next month. However, a completely digital NHS remains a long way off.

The electronic prescription service (EPS) will be rolled out nationally in November, said the department, claiming it would save the NHS £300m by 2021 through increasing efficiencies, reducing the amount of paper processing required and reducing prescribing errors.

As the department itself acknowledged, however, almost 70 per cent of all prescriptions are already being prescribed and dispensed through EPS.

Already in use

In fact, e-prescriptions have been around for some time, noted Dale Peters, an analyst at TechMarketView. "EPS was first announced by the Department of Health in 2003 following earlier pilots. It was delivered as part of the National Programme for IT (NPfIT) and first introduced at a pharmacy in Leeds in 2009.

"EPS survived as NPfIT was dismantled and has been making incremental progress since then. In the three years from 2013 to 2016 it is estimated EPS has saved the NHS £136m."

Currently EPS allows prescribers to send prescriptions electronically to a patient's "nominated" dispenser – usually a pharmacy – removing the need for a paper prescription. Under the next "phase", which has been tested with 60 GP practices and 3,100 pharmacies, all prescriptions, regardless of whether the patient has a nominated dispenser, will be processed electronically.

"Those without a nominated dispenser will still be given a paper copy of their prescription (known as a token), but it will include a bar code that a pharmacy can scan to download the electronic prescription from the NHS Spine," Peters added.

So while primary care minister Jo Churchill might claim this is "another important step towards eventually making all prescriptions paperless", a paper element will still remain.

Dr Neil Bhatia, a Hampshire GP, has also been using it for some time, with the vast majority of his patients already using the service. He's a big fan. "Electronic prescriptions are an absolute godsend for practices, it saves a lot of time and allows you to do them remotely from home or any computer."

However, he notes that not all practices or chemists are geared up for EPS. "The delay is at the other end, chemists may not be downloading the prescriptions effectively, sometimes only once a day... so people will sometimes be waiting a bit longer."

Paper backup

He added: "There wont be an instant cost saving. Its more about the time-saving for GPs... and of course if the system goes down, we will always need paper."

Sam Smith, of campaign group Med Confidential, agrees that contingency plans would need to be put in place. "What happens when the tech in a pharmacy breaks? Can a person go to the other pharmacy across town and get it?"

He remains underwhelmed by the policy. "I think it's this government being willing to pull away the psychological safety net that underpins patients, and requiring patients to trust that NHS digital services will never break, because it'll save Matt Hancock a few quid he can spend on AIs.

"Is it a wrong decision? Probably not. Is it the right decision? Maybe not – but it shows the things this Secretary of State chooses to care about."

According to Bhatia, the NHS is slowly moving in a "paper-light" direction, but he says hospitals are still heavy users.

"Our surgery doesn't hold paper, although we have vast amount of stuff still coming in in paper form, which we no longer store. [Ideally] I'd want every letter from the hospital sent to me electronically, that would save hours in scanning… But the IT required for them to do that is still not there."

In many ways EPS is the "low-hanging fruit" when it comes to digitising the NHS. Connecting primary and secondary care providers is the bigger challenge. Just look at the disastrous NPfIT programme intended to connect 30,000 GPs to 300 hospitals via a central electronic records system. ®

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