8 Min In Analysis
It’s time to delve deeper into health discussions. Broaden your understanding of a range of pharmacy news and topics through in-depth analysis and insight.
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Digital health records offer many benefits, including improved patient care, more accuracy and clarity of medical records, and increased efficiency. They also allow patients to access their health records through the NHS app and other online services.
But while these benefits are clear, agreeing the governance and getting the set-up in place to facilitate the shift from current systems is a muddier process.
Earlier this year, the Tony Blair Institute (TBI) published a report called A New National Purpose: Harnessing Data for Health, in which it advocated for a National Data Trust to support economic growth. It also proposed a digital health record to drive improvements to health and care, and make sure the NHS is ready for the AI era.
According to the TBI, each person’s digital health record would be the “single source of truth” for their health and care data, and be “the fundamental building block” to opening up a new way of delivering healthcare in the future. Currently, patient health records sit in silos across hospitals, GP practices and pharmacies.
Dr Nick Thayer, head of policy at the Company Chemists’ Association, which was interviewed for the TBI report, backs the idea. “A digital health record would ensure that health and care data is harnessed to ensure that patients are seen by the right person, at the right time, and in the right place,” he says, stressing that any such record must include all parts of a patient’s journey and care.
“Community pharmacy care, and the data that supports that, is critical to a successful patient record as this would allow pharmacy teams appropriate access to wider NHS records, whilst ensuring the care they provide is available across the health system,” he says.
“The report rightly states that a digital health record could be key to expanding the Pharmacy First scheme, but it also offers a way to draw upon community pharmacies to deliver even more first-line preventative care such as screening, vaccinations, management of long-term conditions and acute care.”
Disjointed
However, the current state of care records, and community pharmacy’s access to them, is somewhat disjointed.
The Summary Care Record application portal (SCRa) was replaced by the National Care Records Service (NCRS) in September 2023. The NCRS allows pharmacists to view previous summary care records, access documents and find National Record Locator information. NHS England says it is working to make sure that all community pharmacies can view summary care records, but at the time of writing it had not answered requests for clarification regarding if and when pharmacists could write into these records.
More promising progress in read-write access to records is the GP Connect Update Record facility – one of the enhancements to connect community pharmacy and general practice announced in the NHS England delivery plan for recovering access to primary care in May 2023.
The Update Record system allows registered community pharmacy professionals to send Pharmacy First, blood pressure check and contraception service consultation summaries, including details of medicines supplied, directly into general practice workflows for filing.
It began with a small number of GP practices and community pharmacies in January 2024, before IT suppliers began to roll it out across all practices at the start of April. There was, however, a blip in July, when GPs realised that the option to turn off Update Record while they got used to the new system was only temporary, leading to their representative bodies encouraging them not to use it.
After reassessing the situation, NHSE confirmed that the ability for a practice to opt out of Update Record would continue to be an option. However, many GPs are now not engaging with GP Connect as part of their ongoing collective action.
Nonetheless, figures from NHSE show that as of July, more than 5,660 community pharmacies had sent 110,000 consultation summaries to GP practices using Update Record, with suggestions of a future expansion of the system to include updates for urgent medicine supplies. The system currently operates with pharmacy PMRs from Positive Solutions, Sonar Informatics, EMIS Health and Cegedim Rx.
More pharmacies access London Care Record
Several pharmacies in South East London have joined pharmacies in North East London ICS and South West London ICS in being given access to the London Care Record, based on a product called the Health Information Exchange (HIE) from Cerner UK.
A central OneLondon Health Information Exchange is connected to a series of local HIEs, enabling a “single and secure” view of patient data to be accessed and shared by primary, secondary and community care providers across London and surrounding areas. Data includes a patient’s contact details, medication and test results, and appointment and referrals information. Community pharmacies currently have access to the information but cannot share it.
Heading to the BaRS
Last month, Cegedim Rx also became one of the first pharmacy IT suppliers to go live with NHSE’s Booking and Referral Standard (BaRS), which facilitates digital patient journeys and processes for patients, healthcare workers and carers.
Deemed by NHSE to be a “crucial part of digital transformation policy across the NHS,” BaRS is said to allow information to be shared “quickly and safely”. The aim is that it will eventually be available in all care settings, says NHSE.
Tracey Robertson, product and technology director for Cegedim Rx, said: “We’re thrilled to see BaRS being implemented by pharmacy and GP IT suppliers. This NHS pathway for patient referrals from GP directly to pharmacy is another significant step for Pharmacy First – not just in delivering improved interoperability but also, as BaRS is a standardised messaging framework which is open to assured IT suppliers, pharmacies now have greater freedom to choose the right technology solution for them.”
PMR upgrades
With increasing access in mind, do pharmacists now need full clinical management systems, rather than traditional PMRs with added functionality?
Steve Russell, chief commercial officer at Positive Solutions, says: “Our view is that PMR systems – at least the good ones – are already doing much more than just labelling boxes of medication. Their functionality increasingly mirrors that of clinical management systems and will only become more so as we prepare for the arrival of independent prescribing for all.”
Phil Galt, a former superintendent pharmacist and now managing director of Cegedim Rx, agrees that core technologies such as PMR systems are no longer “one trick ponies”.
He says: “They are now capable of delivering far more – not only in the dispensing process but also in helping pharmacy teams manage their businesses more effectively by leveraging machine learning and real-time data, serving up foresight vital for business decision-making.”
Santosh Sahu, founder and chief executive of tech platform Charac, believes it is “paramount” that pharmacists are able to collaborate with GPs to share patient information – for example, by feeding clinical examinations and consultations into the NHS spine and patients’ GP records.
“This will allow pharmacists to access the tools to push and pull patient information when they require it,” he says. “Otherwise, the UK healthcare system risks becoming more disjointed than ever with huge clinical risk.”
Hub and spoke ‘affordable and accessible’ for all
A new report has revealed a range of evidence-based benefits for hub and spoke dispensing – despite the promised legislative changes being delayed yet again.
The Centred Solutions ROI Report 2024 says hub and spoke is now “affordable and accessible for all pharmacies”. Switching to the model can deliver an 81 per cent reduction in payroll costs per item, it adds. Hub and spoke can also take at least 50 per cent of total dispensing volumes (70-80 per cent of repeat dispensing) out of branch, while the average pharmacy will reduce stock in store by an average of 50 per cent in a year, says the report.
Centred Solutions has been providing pharmacy hub and spoke solutions for more than three years. “This has put us in a unique position to evaluate the effectiveness of hub and spoke models in different environments,” says sales and marketing director Louise Laban. “For pharmacies who have the appetite for it, hub and spoke has the potential to be a hugely profitable venture, despite the ongoing funding challenges.”
Using a “conservative” estimation model, and taking capital expenditure and operating expenditure costs (excluding transport) into account, the report gives examples of the profits that can be made. For example, it says that a group of five pharmacies each dispensing 8,000 items could make an average profit of £909,000 over five years from clinical service provision; a group of ten 8,000-item pharmacies could make an average profit of £2.1m over five years from services; and a group of 20 pharmacies could make an average profit of £4.9m over five years from services.
“Obviously, every pharmacy is different,” says Laban. “However, we have developed a tool that will allow us to provide more specific data based on a particular pharmacy’s demographics.”
Continuity of service
Proactive owners have been tooling up their PMR systems to meet digital needs for some time – often pairing them with robots to streamline the dispensing process and free up staff time to deliver face-to-face patient interventions. As systems suppliers step up to meet these demands, however, there have been glitches in service and support levels that have left some pharmacies feeling stranded with malfunctioning kit.
In September, for instance, the liquidation and subsequent takeover of Scottish automated prescription collection unit brand MedPoint by Spain-based multinational Farmadosis SL left a number of customers waiting for units they had paid for which were yet to arrive. A spokesperson for the company confirmed that it had contacted all affected customers and was proposing “tailored solutions for every case, trying to reach a beneficial agreement for all involved”.
Other pharmacists have taken to social media to air their grievances about equipment from pharmacy technology suppliers. Graham Phillips, owner of Letchworth Pharmacy in Hertfordshire, wrote on LinkedIn about his Omnicell robot: “I’m a huge believer in pharmacy automation but… the robot failed on day one and has continued to fail ever since. We’ve logged literally hundreds of faults. It is clearly not fit for purpose.”
Commenting on Phillips’ post, Mike Hutchison from Denny Pharmacy in Falkirk wrote: “We bought one of their PS24 collection points six months ago; great when it works but breaks down as often as it works….”
In response, Edward Platt, senior commercial director of Omnicell’s UK community pharmacy division, and its UK & Ireland hospital division, told Pharmacy Magazine: “In line with every leading technology manufacturer, we receive service requests across all our international markets and product lines, and we have a maximum two-day resolution in place for all urgent cases.
“Since November 2023, our figures show that for all service requests received, on average we have successfully resolved those issues classed as urgent in 1.9 days and for those classed as severe in just over 2 days. As part of our service commitment and agreement, our engineers and technicians have been working closely with the team at Letchworth Pharmacy to resolve their issue, and we are confident their technology solutions are working effectively and meeting all industry standards.
“We are also currently working closely with Denny Pharmacy to resolve their issue. Effective two-way, honest customer relations are very important to us. We urge any customers to contact us if they have any issues or questions.”
“A digital health record could be key to expanding the Pharmacy First scheme”
Managing expectations
Technical hardware can, of course, go wrong from time to time, but in community pharmacy, issues can have a serious knock-on effect on workflows and patient care. So what customer service and duty of care standards should pharmacy owners expect from technology suppliers? Platt says that effective communication and a collaborative partnership between provider and pharmacist are “crucial” for the smooth adoption of any new technology.
"A brief period of familiarisation is necessary for any new technology, and adjustments may be needed to meet specific customer requirements,” he says. “Understanding a pharmacy’s workflow is essential for tailoring systems to daily operations, and ongoing education and training are vital due to the evolving nature of technology.”
Mark Pedder, commercial director at HubRx, a hub and spoke centralised automated dispensing facility for independent pharmacies, says service level agreements are vital and transparency is key. “When a customer invests in any new technology or, in our case, being part of an automated dispensing hub, they need to see in black and white what their investment provides,” he says.
“That is not just what will be delivered and within what timeframe, but also the support it is backed up with. Customers should trust and feel reassured that the smooth running of a facility or system is the supplier’s problem and not theirs; that the supplier has considered every angle; and that beyond the innovation is a team of experts, in-house engineers and a strong support structure, and the technology is made and installed by specialists.”
Amrik Tahim is director of automation solutions provider Avonnex, which focuses on dispensing robots. His advice to contractors considering investing in automation is to “look beyond the marketing hype”.
“There are lots of automation companies out there, but it is important not to simply take it for granted when they tell you what their kit can do,” he says. “It is a lot of money you are spending, so we always encourage our customers to go and see the technology in action at a current user’s pharmacy – without us – and also to come to our showroom and test it themselves. It is not just a box you are buying; it is the service afterwards. If it breaks down, and it may well break down because it is a machine, it is all about the service. In a pharmacy, you’ve got patients waiting, so you need to know that you can get things fixed fast.”
PMR training for locums
Users of Locate a Locum’s digital learning platform, Locate Learning, can now access bespoke training for Cegedim Rx’s Pharmacy Manager PMR.
Cegedim launched Locate Learning in 2021 in partnership with Pharmacy Magazine publisher Communications International Group. “We asked our members which system they wanted to receive more training on,” explains Locate a Locum senior growth marketer Olivia McKearney. “Overwhelmingly, they said Pharmacy Manager was the PMR they encountered most while working a locum shift.”
The new training covers the main Pharmacy Manager tasks and functions pharmacists need to know about during a locum shift – from logging on to searching for a patient, checking a prescription and how to claim. Additional resources include user guides and video tutorials.
Those who complete the Pharmacy Manager training programme will receive a certificate and have a skill update added to their Locate a Locum profile for potential employers to see.
Analysis
In Analysis
It’s time to delve deeper into health discussions. Broaden your understanding of a range of pharmacy news and topics through in-depth analysis and insight.