With estimates exceeding £300 million wasted every year in the NHS on unused or partially used medicine, Diar Fattah, associate director of medicines optimisation at Dartford, Gravesham and Swanley (DGS) CCG, believes savings and efficiency opportunities around medicines wastage are ripe for the taking.
Wastage is a problem that presents itself in a number of guises in the NHS, and one associated with high costs. One component of this is medicines wastage, caused by patient non-adherence, inappropriate repeat dispensing, and over ordering. This is reportedly costing healthcare £300 million every year.
One of the key priorities for the medicines optimisation team at DGS is to ensure we deliver the best health outcomes for our patients within our financial envelope. With 77 per cent of medicines used in our community generated by repeat medication, an issue of this size cannot be addressed by our CCG alone, it requires collaboration from community pharmacies, GPs and also patients.
Introducing a prescription ordering direct scheme
The repeat prescriptions process is complex, costly, and laborious for everyone; a challenge that our CCG is committed to overcoming. To address these issues, last year we implemented a prescription ordering direct (POD) scheme; a dedicated telephone repeat prescription ordering service, across a limited number of GP surgeries.
The POD facilitates a conversation with the patient before processing the repeat order to ensure the request is appropriate and to highlight inefficiencies. Early success of our scheme highlighted that we reduced prescribing costs by £650,000 in year one, while in rest the country the costs seemed to be increasing.
At this time our team was receiving between 2,000 and 3,000 calls per week. One way to expand this was to recruit more call handlers which of course would be costly which we wanted to avoid, particularly as the biggest cost of the POD service is staff wages.
As coverage grew, so too did our desire to scale the initiative, and the medicines optimisation team explored innovative methods to further expand the POD service by introducing technology. This also meant it was not necessary to recruit as many staff.
Taking POD to the next level
Expanding our scheme, we launched the first ever app-based POD scheme in the UK. This allows patients to request repeat medication via a free smartphone app called Healthera; selected because it is the only patient app accredited on the NHS Apps Library, which facilitates repeat prescribing across a network of pharmacies around the country. Intended to replace the traditional method of ordering through a pharmacy or GP within our CCG, patients can order directly to the POD and track their prescriptions 24/7 via the NHS-approved app on their smartphones or tablets.
Effectively moving to a POD schem has simplified the prescription ordering process. Quality-wise it ensures patients are ordering the correct amounts which avoids medication getting into the wrong hands or being stockpiled, as any concerns are flagged within our team. Feedback has been incredibly positive, and this is reflected in the speed of adoption among patients. More than 5,000 patients have registered on the app, making 1,500 prescription requests every week, and with that figure on track to increase rapidly, there are substantial benefits to yield: patients no longer need to wait on the phone; it eases the intensive workload at peak times as we are able to review app requests in down time; and the ratio of patients covered to staff has increased from 80,000 to 140,000.
Having a POD service in place has reduced the workload for our 16 participating GP surgeries, saving them prescribing costs and allowing practice staff to focus on patient care rather than the time-intensive admin duties related to processing repeat prescriptions. Subsequently it has opened our Healthera mobile-based repeat prescription ordering service to more than 140,000 patients registered with these surgeries. Additionally, we strive to empower pharmacies to play a more active role in patient health care and as such supporting our local community pharmacies is very important. The app reinforces this by enabling patients to order their medication from any of the 60+ pharmacies across the DGS CCG region, including national chains and independent pharmacies. Furthermore, the community pharmacies now have an opportunity to offer patients Amazon-like order tracking, a brand presence, and medication adherence support with Healthera’s pharmacy platform. These peripheral benefits incentivise pharmacies to fully support the CCG POD scheme.
Spreading the word
In DGS CCG alone we estimate approximately £3 million worth of medicines are wasted every year. By boosting our traditional POD approach and pioneering new patient-facing technology we have secured improvements from a quality and an economic perspective; improved efficiencies of the service and improved patient care. The number of CCGs with POD schemes in place is relatively low, approximately eight across the country, most of which have shown promising results, and are looking for ways to scale up savings without increasing costs. At DGS CCG our approach has proved favourable at a local level - shouldn’t we encourage CCGs on a national level to introduce similar schemes in a bid to tackle medicines wastage?
Diar Fattah is associate director of medicines optimisation at Dartford, Gravesham and Swanley CCG. Follow him on Twitter @diar_fattah and the CCG @NHSDGSCCG
For more on their POD, visit Dartford, Gravesham and Swanley CCG’s website.