Dr Neil Paul offers advice for PCNs thinking about developing a Prescription Ordering Direct (POD) service to realise benefits such as cost savings and a reduction in medicine waste
Increasingly, PCNs and groups of practices are looking to identify working at scale opportunities. It can only increase efficiency. A practice manager in our PCN recently observed how ridiculous it is that all seven PMs in our network duplicate work that could be done just once.
The current philosophy in my PCN is to keep practices separate but collaborate to deliver the DES contract, while also investigating possibilities for working at scale.
Indeed, we already share some work, employing two PCN-level clinical pharmacists to carry out high level tasks across all practices. This includes reviewing and reporting on all MHRA alerts and then feeding back information to practices and clinicians.
We are looking at other ways to work together. One interesting option is developing what is called a pharmacy POD (prescription ordering direct) service, to share the management of repeat and acute prescribing requests. A POD enables patients of participating practices to call a central dedicated number and speak to a trained advisor, or use an online form, when needing to order a repeat prescription. In other words, it’s the creation of a scaled-up team of people who process some or all the prescriptions on behalf of multiple practices.
The size and expertise of the team brings numerous benefits. First, despite the computerisation of prescriptions, there remains huge variation between practices in quality and methodology. Some practices handle all requests within 24 hours, some take three days or more. At request stage, some also put a huge amount of work into ensuring safety, quality and cost saving, while others issue the prescription and carry out medication reviews whenever they can later. With a single team handling prescriptions, PODs should improve standardisation and reduce variation between practices, thereby also cutting down on medicine waste.
Not only that, PODs have the potential to save money, increase profits and reduce the bureaucratic burden on managers and clinicians, including GPs. In addition, they could reduce staff turnover by improving training, and lead to a cut in the number of calls made to practices, alleviating pressure on reception staff.
Several areas around the country have PODs in place already, such as in parts of Kent, the West Midlands, Sussex, and Norfolk. Existing services have tended to be set up in areas where practices are happy to work together but aren’t merging. Having a strong vision and engagement are key to their success, not to mention the time and headspace to manage an implementation team.
With the advent of PCNs and Additional Roles Reimbursement Scheme (ARRS) funding, I’m a little surprised PODs aren’t proving more popular though there are some hurdles to jump.
If your PCN is considering adopting this model, the following tips might help:
ARRS funding for pharmacists and pharmacy technicians means much of the staffing costs for a POD could effectively already be covered, although money will have to be found for management costs. It might be reasonable to use any relevant PCN funding, such as DES funds or other pots such as the primary care development funding.
Remember that when employing staff, you need to be mindful of VAT liability. Seek advice from your accountants.
Ultimately, if you are going to create a new service, you need to be sure it’s an improvement on whatever it is replacing. Decide on the main aims and objectives. For example, are you aiming to increase efficiency, or profitability, or raise the quality and robustness of prescribing methods? Do you want the POD to include structured medication reviews or medicines use reviews? Will the service replace practices’ own systems or will it be an add-on?
Some PODs offer limited and specific services, such as only handling repeat requests from nursing homes, requests from patients that are housebound, frail or elderly, or arranging prescriptions for hospital discharges. Going small to begin with might be an easier way to get the service off the ground.
If you have PCN-level pharmacists working on behalf of all your practices, there may be an obvious opportunity to discuss how to expand and grow their service.
Fully explain what the POD scheme is all about and how it will benefit practices, while also listening to their concerns and suggestions. Look at what each practice does now and learn from the best. After all, you rely on their support and funding. You don’t need all to practices to engage with this. The service can involve two or three practices at first. If it’s a success, others will likely want to join.
Should practices lend their ARRS staff or should they resource it with funds, so staff can be employed centrally? What are the different types of roles required? For example, think about creating a project management role for the POD, since practice managers are already busy.
Also make sure that practices contribute fairly in terms of both funding and sharing the workload for setting up and running the service.
If a team member needs help or advice from a GP/clinician, do they need to call on the patient’s registered GP, the on-call GP, or the last GP that saw them? All practices may have different systems, so you need to agree on processes that work for all.
Locally, we use EMIS but I don’t think it works that well at enterprise level. Ideally staff would need access to all patients from all practices.
You may need a new site for the team if there is insufficient space at a single practice. Alternatively, if you use a distributed model, you will have to think through carefully how that will work and how it will be managed.
Is your PCN DES agreement robust enough for dealing with issues that arise from launching this new service? Consider setting up a Memorandum of Understanding that covers all the decisions involved. Also, tie in periods for practices might be needed to prevent one or more being able to pull out at any time, bringing the service to a halt.
A POD is a positive move but you may need to allay fears about prescriptions services becoming delocalised, or that it’s part of a takeover from the private sector.
Perhaps it’s all these questions and points that have stopped more networks developing PODs. Yet despite the issues, none of which are unsurmountable, I remain convinced they could be a very effective option for some practices and patients.
Dr Neil Paul is a GP partner in Cheshire and Clinical Director of SMASH (Sandbach, Middlewich, Alsager, Scholar Green and Haslington) PCN
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