When I started in general practice we’d already made the switch to an electronic patient record. We still pulled the paper notes before each surgery—even though the chances of finding a relevant previous entry and being able to read the handwriting were slim—and laboratory results arrived on slips of paper to be stuck in the notes. These were soon replaced by electronic messages, which arrived more quickly and were less likely to be lost. The last element to go paperless was prescribing: even seven years ago I was still signing stacks of paper prescriptions, ready to be collected by the patient or the pharmacy.
Although we can still print and sign prescriptions, the vast majority are sent electronically to the patient’s designated pharmacy (which can be anywhere in England) or simply to the NHS Spine, whence they can be retrieved by any pharmacy at the patient’s request. This has reduced our workload: I don’t get cramp in my hand from signing so many repeat prescriptions, and the whole system is secure, as each prescription is trackable from generation to dispensing. It’s more convenient for patients and is greener, with less patient travel required and less paper consumed.
The mystery to GPs is why hospitals have been so slow to follow our example. From our perspective, it would save a lot of work if our colleagues in hospital outpatients could just prescribe the medicine they think is needed and send it to the patient’s community pharmacy, rather than writing to us with a request to prescribe it on their behalf. As well as making us grumble about being treated like “community house officers,” it’s inconvenient and time consuming for the patient, as they have to liaise with the GP to get their medicine.
Pharmacy is a pinch point at our local hospital, and discharges are delayed while patients wait for their medicine to be ready. Sometimes they can’t wait and have to go home without it, which then generates the need for an urgent prescription from the GP. These problems, and more, would be solved by bringing electronic prescribing to hospitals. It might also help community pharmacies, which need the extra business to remain viable, while benefiting the hospital pharmacy, which is clearly overworked.
There may be initial disquiet about whose budget a prescription is set against, but in any given area the integrated care system is ultimately responsible for both primary and secondary care spending, so this should be easy to solve. There will inevitably be technical issues with software, smartcards, and interoperability with other systems in the hospital. However, the transition costs will be rapidly eclipsed by improvements in service, efficiency, and patient flow.
In November 2020 the Department of Health and Social Care issued a press release stating, “The NHS is on course to eliminate paper prescribing in hospitals and achieve the NHS Long Term Plan commitment to introduce digital prescribing across the entire NHS by 2024.”1 By November 2023 only six hospital trusts had started along this path,2 so the plan is way behind schedule.
Electronic prescribing will reduce friction and improve efficiency across the NHS. It really should be a priority in 2025.
