NHS e-prescription service goes TITSUP: Problems since Monday The NHS electronic prescription service (EPS) has barely been working since Monday, and is still suffering a Total Inability To Support Usual Performance in many parts of England, thanks to problems with system supplier Cegedim. The EPS allows General Practitioners to send patients' prescriptions electronically to a pharmacy, …
I just had my prescription filled electronically. I was told it would reduce the use of paper. That is not true. When I got my meds from the chemist, they had printed out my repeat order form on six pieces of paper. It used to all fit on one when the doctor did the printing. It did save me a trip to the surgery and the chemist had my order all bagged up and waiting for me.
> The electronic system now also requires me to sign the form at the pharmacy. Not sure why.
It is supposedly to indicate that you have received the prescribed items.
The member of staff who gives them to me just does a squiggle on the form, ever since I found out from Patient Advice and Liaison Service (PALS) a few years ago that my signature is not required, and thus refused to sign it.
Gotta be a rebel in your old age!
Brad Pitt is famous. People who have never seen his films (there must be one somewhere - humor me) still know his name because Angelina Jolie. Cegedim is only famous to the circle of people who they invoice, and in this case, I think their "fame" is directly proportional to the amount they invoice.
It will soon become another sort of fame if these cock-ups continue.
When it got introduced at my local GPs practice last year, they were inundated with calls from patients where their prescription had been sent to the wrong pharmacy. Mine had been sent to Boots in Birmingham (used to use that store but stopped using it a few years back), someone else's got sent to Oswestry even though they had not lived there for over 15 years. It was a utter mess.
Recently I was told I couldn't have a repeat prescription as I hadn't had the doctor review my condition in the last 8 months. This restriction was only made known after several increasingly frantic discussions with the pharmacy as to why my recent online renewal had not yet reached them.
Apparently there has been a change in the handling of long term medication prescriptions. My doctor had agreed that my long term condition was so stable that we didn't need to waste NHS resources. So an annual check-up was all that was needed - unless my own monitoring raised any concern.
Eventually the surgery were able to give me a prescription by booking an appointment with my doctor at his earliest free date - some weeks hence. When I saw the doctor I was again down to my last day's pills. He decided the only efficient way round the 8 month review problem was to get him to do a "phone consultation" with me after 6 months. Basically - "Hi Doc - thanks for ringing - everything's ok - bye!"
So I managed to get my new set of pills. However when I came to request my next prescription the online system would only let me make the request 7 days before the pills were finished. The pharmacy said that the lead time on the request getting to them was now three days rather than two. So it only needs an intervening Bank Holiday weekend to cut things very fine.
Reminds me of the old adage - "Every solution breeds a new calamity". What was supposed to save the NHS money is in fact costing them more in my case.
Talk to the surgery not the pharmacy. The pharmacy kindly offer to call for your repeats so they can interact with you and sell you a toothbrush or somesuch, and in some minority of pharmacy chains so they can demand a repeat of everything on your prescriptions list rather than of the things you want or need.
"Talk to the surgery not the pharmacy."
I eventually did after it was obvious that the online prescription had apparently disappeared into thin air. The surgery apologised but said it was down to new government rules that they had to follow - presumably enforced by the new computer system.
The new rules are apparently to stop the prescribing of drugs to patients who no longer need them. All my pills are precautionary - and I'm on them for the rest of my life as long as my body tolerates them. Not taking my pills would increase the risk of an expensive hospital intervention.
I am bi-polar. After many MANY years of going through various combinations of meds, I finally have a tiny dose of a common AD that works miracles for me. I work 100% of nights, but every 28 days I have to get up at (what is effectively the middle of the night for me!) and toddle around to the nurse to have "An Interview" regarding my AD prescription. This is bad enough, but I get asked the same f**king idiot questions each month, and given "Advice on Weaning" me off the ADs despite them being totally aware of what happens when I do - All is great at first, then after a few weeks, 'The Crazies' start. Small at first, but then getting ever larger...
After 50+ f**cking years you would have thought they'd have got my condition written down/understood by now? All this shit started about two years ago after some poor sod killed themselves through not being monitored while on ADs (lawsuit mentioned). I get it, I really do - It's 10% saving my arse, 90% saving theirs! My specialist has informed the GP that this monitoring is a waste of resources and money (even said it is his responsibility), but I still have to go - "Cos Paperwork...!"
And when I do re-order the meds, like you say - I get screwed-up by bank holidays/system failures (and general incompetence as happened today!!!!!!!!!!).
I love my local GP and staff, but the ever-increasing amount of BS they have to go through on a daily basis is ruining the system for pretty much everyone who relies on it. It makes their lives a living hell too.
IF you Brits think YOU have it hard, then please come over to the other side of the pond, and get a 'truly "Murican experience". Wait until you have to deal with INSURANCE COMPANIES and their rules and restrictions!!!
Right now, I am fighting with an insurance carrier over some lab tests which they will not pay for, because two words (medically necessary) were NOT on the lab order form at the time the blood was drawn. When someone is on blood thinners (to prevent blood clots and stroke), monitoring their clotting time is essential. But tell that to the idiots at the insurance company. Dumb fucks, all.
</rant>
I am a GP. We have used the system for 3+ years and it is much better for REGULAR prescriptions than paper. We get many less queries about missing ones than we used to.
If anything goes wrong it is a nightmare to sort out because the structure of the program is so rigid.
The Dept of Stealth and Total Obscurity believes that everyone collects their prescriptions every 28 days. No-one ever looses tablets or has them taken by the hospital or has any need to vary their timings because of holidays. They insist that we and pharmacies print paper copies of SOME prescriptions. Basically it is a partial and transitional system
Given all that I electronically signed 166 prescriptions this morning. I could not have handled them on paper.
Some chemists handle it badly. So do some GP practices. Overall it is hugely helpful. But it remains a pig to use!
Well EPS (and previously paper as well though hardly ever used) does have that functionality. They call it Repeat Dispensing and allows the GP to sign a 'master' prescription with multiple issues (GP's choice as to how many) that then repeat against a set schedule (again GP's choice).
The big advantage in EPS over the paper version is that the GP can electronically cancel those remaining issues whenever they want.
"If anything goes wrong it is a nightmare to sort out because the structure of the program is so rigid."
Disclaimer: I know nothing about large IT systems
Would this be a failure to discuss failure modes or ways of varying operating circumstances at the planning stage? I've noticed that when planning processes involving people (not IT based, and small scale and short duration) there is a tendency to assume that everything will be like it is most of the time and a reluctance to plan for something taking longer than it should, or for edge cases.
Coat: Mine's the one with the first prescription I have needed this side of the millennium and that was on paper (not recurring one hopes, just a skin infection)
@Tashritu - you have my sympathy. The system also doesn't seem to cope well with people like me who occasionally forget to take their tablets, such that every now and then, why no, I don't need this particular months prescription, thank you, as I've still got about a month's supply in hand (from about a year's worth of being a ditz and occasionally forgetting to take my tablets). Rather than be overjoyed at my only needing 11 months supply of tablets to last a year, the system seems to get its knickers in a twist about once a year, requiring me to have a word with the pharmacy about it, and about every other year, my GP as well.
Perhaps the much bigger issue is that of Summary Care Records and pharmacies being allowed access to them.
A complete and utter farce which is currently rolling out, ripe for abuse (guidance is that each pharmacy COMPANY should have a a responsible person, and a person responsible for the responsible person, who would clearly be unable to check all of the SCR access requests so should just "pick a few and see if they seem ok") and so poorly implemented as to be of very limited clinical use.
But that would require actual investigative reporting...
I was put on Statins by some doctor when i went into hospital for a heart related issue.
The government has made it the law (effectively) that ANY heart related problem MUST be due to bad lifestyle and high cholesterol. Therefore statins (anti-cholesterol drugs) are prescribed almost routinely.
In my case, i had (and still have) unusually low cholesterol. I was in hospital for a few days but it took about 3 months to get a doctor, any doctor to take me off that medication ... because another doctor put me on it, so they should be the one to take me off, not my responsibility (liability) etc.. finally I told my GP to call the various hospital doctors and tell them whats what. She did fortunately.
I am now out of the UK and buy prescription drugs over the counter (there are no prescriptions here). However, if i come back to the UK i could not get a prescription anymore without going back into the full system and registering with a GP, don't know how long that would take, as GPs refer heart stuff to hospital consultants who's next appointment is 4 - 6 month from now.
My medicine is available in the UK from three manufacturers. Despite claims that they are "the same", everyone who has the experience knows they are all different. There are also frequent stock issues with one or other make not being available from some or all) pharmacies.
Whilst this is the case, I want paper prescriptions I can take round pharmacies and get the last packet from the back of the shelf, if necessary.
My GP practice is in a health centre with two other practices and an out patient minor surgery unit and a pharmacy. It great. Except I still have to queue to get my printed prescription from the receptionist then walk about 15' the pharmacist to hand it over then sit and wait 10-15 minutes while it's filled. It's the perfect situation to cut out the middle man and print off the prescriptions directly to pharmacists printer. But rules.
A Practice in Yorkshire used light pens to sign the prescription on screen, and have it print out, signed.
Pharmacists not at their (dispensing) Practice sought a ruling against this, that it didn't comply with the Medicines Act requirement to sign the prescription before dispensing.
Basically this was an effort to reduce the convenience and make life as difficult as possible for dispensing doctors.
Actually they prevailed and the practice stopped.
A while later a government consulted the Law Society on whether legislation was needed to substitute electronic signatures of whatever sort for written ones on paper wherever other laws said "signed".
The response they received may have surprised them - it was "no" and "signature in English law is the making of a mark, with the intent of signature, and "in writing": "If you can read it, it is in writing".
But GP prescribing systems are nowadays largely specified by Pharmacists, financial types, and people who think emailing Word documents is electronic management of data.
So don't look for that convenience to return really soon.
from the (Cegedim) servers.
Or as some people put it the trouble is at the Pharmacy end. (Clearly, it isn't).
The System does not either report back that the prescription has (not) been downloaded, to its originator, nor apparently is there a way for it to say "I can't send this on, here it is back flagged for automatically printing, signing (although logically that is redundant), and having conveyed to the Pharmacy.
My father's Prescription ( ongoing Repeat Prescription )
HAS to be Old Fashioned ( like him) PAPER
It Cannot Be Done By email / Fax / electronically as it contains Proscribed Drugs ( other laws say prescription MUST BY DELIVERED BY PERSON ).
This suits me as the person. as the one responsible for managing my Fathers medication regime at home
Some of his meds are increased/decreased as his health determins
I Adjust his repeat prescription as needed
Between the MD Practice and his Designated Pharmacy they made so many fuck up blaming each other that in the end i insisted i would collect his Prescription in person so i could review it in situ to ensure what i requested was Supplied
THANKS MR GOV your Electronic system is a gladly appreciated FAIL ( my personal Opinion )
Fail Icon explained above and its a wuckin FRENCH COCK UP SYSTEM
9/10ths of the problem with clinical systems in the NHS is that they have absolutely no clue about requirements gathering. They genuinely don't understand that the primary stakeholder is the patient. Everything from EPS to primary care systems to hospital systems, they're all designed around the clinician or pharmacist and their needs rather than the needs of the people that these people are hired to serve.
It's a common fault that happens in every industry but is not so blatantly obvious as in the health industry where the overwhelming ego of senior clinicians and pharmacists means it has to be all about them.
That might be partly because it is almost infinitely easier to get the opinions of the clinical staff than it is to get the opinions of patients. I'd also take issue with the 9/10ths estimate, since (echoing a previous comment) there does also appear to be a significant problem with "assuming that all will go well, all the time".
here does also appear to be a significant problem with "assuming that all will go well, all the time".
That's a standard beginners' programming error; writing the straight-through case without bothering to think about all the ways it could fail.
The issue, as ever, is that they've put too many crap coders onto the job; any experienced hands looking to complete the job will be ignored (usually dismissed as "being negative").
And it's not going to change, becuase those with the power to change have become accustomed to doing everything open-loop, and experience insufficient pain when it all goes wrong...
Vic.
There's two types of requirements gathering: Bodge job and done properly. The latter is sadly out of fashion these days. Any time you hear "easier" when it comes to requirements gathering you know that it's a bodge job.
There are plenty of patient focus or representative groups that could be used as a start in any requirements gathering. Even gathering a pathway for the common patient needs in an EPS, or those of their carer, in a system would help.
Absolutely correct as regards the egos of pharmacists. I've been a pharmacist for 35 years and prefer to avoid fellow professionals. The humour and irony that I read in El Reg is totally lacking amongst this collection of health service workers. But it's partly due to the ignorance of the public who mistake pharmaceuticals for miracles, thus boosting the status of those involved in handling these items of often dubious value.
I can believe it. My father, who was dying, had his prescription changed by the pharmacist. They substituted co codamol for paracetamol as my father was also on Morphine. I only found this out when I got back to his home. I went back down and questioned this. They said my father's Dr. whose surgery was connected to the pharmacy had changed the prescription which had been written by the Douglas Macmillan hospice. However, a quick visit to the surgery revealed that the Dr. was not in practice that day and had not changed any prescription. The nurse from the hospice soon put them in their place, I've never seen an adult look so scared and ashamed after the admonishment the nurse gave them.
"They substituted co codamol for paracetamol as my father was also on Morphine."
If you are using substituted for in exactly the wrong sense - IE that a patient who was receiving codeine (you know co-codamol is a mixture of Paracetamol and Codeine, right?) and Morphine was instead given Paracetamol and Morphine it makes excellent sense.
Codeine is inactive. In 97% of the population it is metabolised, incompletely, to produce a little Morphine.
A bit like waving a fan at someone standing in a gale - not a lot of point.
You may be confused about who writes prescriptions, as opposed to asking someone else to write one. Or not.
'Hello and welcome to the EPS Release 2 demo.'
'Electronic Prescription Service (EPS) → Statistics and progress.'
'Electronic Prescription Service Authorisation: Operating Guidance 2013/14.'
'The evaluation of the Electronic Prescription Service in primary care.'
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