The two remaining operational pilots for electronic transfer of prescriptions ETP are to be ended by the Department of Health (DoH), without a clear plan of how ETP will be taken forward. More than 5,000 patients who had been benefiting from the service will now have to switch back to physically collecting their prescriptions.
ETP avoids the need for patients to make return visits to their GP – especially those with chronic conditions such as arthritis who need on-going repeat prescriptions.
Daniel Lee, managing director of Pharmacy2U, told E-Health Insider the news the pilots would be ended came in a phone call from the DoH on June 30, the final day of the trial: “We’re obviously very disappointed after putting in two and a half years of effort and investing millions of pounds.” He added: “We had always been lead to believe that the intention was to move from pilots to national implementation.”
Chris Brooker, managing director of Transcript Ltd, also received a call at the eleventh hour from the DoH. He told E-Health Insider: “All we’ve heard is that they are thinking of stopping the pilots at the end of June and that they want to move to a national roll-out.”
According to the 2001 NHS IT policy document, ‘Delivering 21st Century IT Support’, the pilots would be rolled out nationally. However, this approach appears to have collided with the centralising rationale behind the NPfIT.
Three privately funded ETP pilots, run by Transcript, Pharmacy2U and Flexiscript, were set up in 2001 to test different models of delivering ETP. Commissioned by the policy arm of the DoH, they pre-dated the National Programme for IT (NPfIT) in the NHS and had been run outside its aegis.
Originally due to complete in December 2002 they were extended by the DoH until the end of June 2003. The Flexiscript pilot lead by Schlumberger-Sema suspended live transactions in April this year.
As previously reported by E-health Insider the future direction of ETP and the ETP pilots had become increasingly uncertain in recent months. This uncertainty was confirmed by NHS IT Director General Richard Granger last week in his speech at the NHS Confederation’s annual conference in Glasgow, when he said progress on ETP would occur “Once we get clarity on the policy position around that.”
However, a July 1 letter from health minister Rosie Winterton to the three pilots confirms the closure of the pilots and states that the NPfIT will now take ETP forward. The letter reconfirms national targets – 50% national electronic prescriptions by 2005 with full implementation by 2006/7.
The first official confirmation that the NPfIT will take on ETP came in a June 23 written answer to a parliamentary question by health minister John Hutton, who stated: “The national programme is reviewing the evaluation reports from the pilots, with a view to putting together a range of options for delivering a robust national model to deliver ETP. The national programme will shortly be making an announcement on how this work will be taken forward.”
Mr Brooker said that although there had been talk of a ‘National Prescription Service’, no details had been made available. “As people running the pilots we’ve not been able to get a look at the Integrated Care Records Services (ICRS) specification or any national ETP specification.”
He also questioned how well the centre understood the practicalities of ETP, pointing out that the DoH’s official evaluations of the pilots had yet to be published and that despite repeated invitations there had been “No visits to any of the pilots from anyone from the National Programme or anyone from the DoH.”
Any national ETP solution, either delivered as part of ICRS or by a National Application Service Provider (NASP), remains some way off. The ICRS Output Based Specification (OBS) strongly suggests that a national solution will be delivered through a NASP. "It is assumed that this [ETP]… will be rolled out using the same model as described for eBooking".
Mr Lee pointed out that this will be of little comfort to the 120 GPs and 5,000 patients in the Pharmacy2U pilot currently enjoying the benefits of ETP who will not have an alternative to migrate to when the current pilot ends. “The feedback from the GPs is that they are up in arms and deeply disappointed,” Mr Lee told E-Health Insider.
This was echoed by Mr Brooker who asked: “Are we going to have to go back to GPs and say to them ‘go back to writing scripts’?”
Northampton GP and former president of the NHS Alliance, Dr Andrew Willis who has been trialing the Pharmacy2U system at his Northampton practice, added, "ETP is working. It seems perverse at a time when the Government says it is putting patients first, for it to be considering pulling a system which is demonstrably working for thousands of patients."
Mike Sobanja, chief executive of the NHS Alliance, commented: "We know ETP is a big hit with patients. Whatever ministers decide, they need to bear in mind the impact of cutting the service on the thousands of satisfied patients already enjoying the convenience of ETP.”
Dr Julian Harrison, ETP project manager for Pharmacy2U called on the Government not to cut “a flagship for NHS IT reforms”, with a replacement potentially years away. “Either the Government should push the button on a ready-to-implement national ETP plan or it should keep the existing pilots running to allow on-going testing until a national plan is ready to roll out."
Mr Lee concluded that the shift in national policy on ETP without prior warning should provide a salutary warning for all companies contemplating investment decisions based on stated government policy on NHS IT. “All companies should think twice about raising capital to invest when the Government changes its mind.”
Just as E-Health Insider went to press the national programme issued the following statement: “"The NPfIT is grateful to the three consortia, Flexiscript, Transcript and Pharmacy2U who have been running the ETP pilots. Their work has demonstrated that prescriptions can be transmitted electronically and in a safe and secure manner. During the close down we will work with the pilots to ensure patients and healthcare professionals are notified and have time to make alternative arrangements. We now need to translate the lessons learnt from these pilots into a sustainable and national service.”