A repeat ordering project in Warrington improved patient safety, reduced medicines waste and saved money.
Background
The increasing cost of drugs and amount of medicines waste within the NHS due to over-ordering of medicines, stockpiling and unused medicines was raised by our CCG clients. MLCSU Medicines Management and Optimisation (MMO) team were asked to look at options to support reductions in medicines waste.
We determined that this could be tackled if everyone involved with issuing repeat medication worked together. If patients ordered their own repeat prescription directly from the GP practice rather than a third party ordering on their behalf it was suggested that we may be able to improve safety and reduce medicines-related waste.
Action
The MMO team led and implemented a phased pilot project initially with seven GP practices increasing to 12 practices after six months. Patients were empowered to only order items that were needed on their repeat prescription directly from the GP practice. This removed the third party ordering via pharmacies for the majority of patients.
Individual arrangements were agreed for a small number of patients at each practice who were identified as needing help with ordering their medication. We supported each practice and provided training for all staff, developing and sharing an information pack to support processes to be completed before the ‘go live’ date. We worked collaboratively with Warrington CCG communications team, the Local Pharmaceutical Committee (LPC) leads and community pharmacies to communicate the changes required to implement the new system to the general public via posters, leaflets and newspapers.
Each practice went live on a planned date, enabling the MMO team to be present in each practice to support practice staff with any queries. We were able to assist both the practice and the patients with queries in a bespoke manner, resulting in a more successful implementation.
Impact
The repeat ordering project started in March 2017 and currently has 12 live practices. The most current data available shows a reduction in spend on medicines resulting from a significant reduction in the number of items issued, which correlates with associated improvements in patient safety and quality.
The average numbers of items prescribed on a monthly basis, in each practice, after the implementation of the pilot were significantly reduced compared to the period prior to implementation. In total 18,028 fewer scripts were issued each month across the pilot practices whilst non-pilot practices issued 5,112 fewer scripts.
Item growth within the pilot practices was reduced, with an average for the participating practices of -2.7% April to August 2017 (when compared to April to August 2016) against the items growth at non-pilot practices of -0.6%.
This represents an estimated cost saving of £108,365 based on Warrington CCG average actual cost per item (April 2016 – March 2017) = £8.39 multiplied by difference in item variance between pilot and non-pilot practices.
The project team were very supportive to the practice in preparing for and following the ‘go live’ date. We did meet some initial resistance from our patients because they felt we were inconveniencing them by asking them to order directly via the practice but by taking the time to explain the long-term benefits for everyone, their initial concerns were overcome. The other added benefit is the increased usage of our online services not only for ordering repeat medication but booking appointments, accessing test results, updating personal information etc.
Andrea Catterall, Practice Manager, Padgate Medical Centre
We have found the new process far better. We are getting our repeat prescriptions done in a more timely manner as the staff spend less time querying prescriptions with the pharmacies and logging all the faxed requests and we get far less phone calls from the pharmacies with their queries. More and more patients are signing up for online services and ordering their medication online which is so much more efficient and we then have a record of medication ordered if there are any queries.
Valerie Hinds, Practice Manager, Westbrook Medical Centre
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