9. Tools to optimise repeat prescribing

9.1 NHSE and NHS BSA Oversupply Dashboard
9.2 Increasing and optimising digital functionality of the repeat prescribing system
9.2.1 Increasing utilisation of digital repeat prescription ordering
9.3 System suppliers
9.4 eRD
9.5 Proxy ordering
9.6 Emergency supply requests
9.7 Patient information leaflet

To support practices and PCNs to improve the safety and efficiency in repeat prescribing systems, we are signposting to a range of tools and resources.

9.1 NHSE and NHS BSA Oversupply Dashboard

The NHS Business Services Authority (BSA) is home to all the prescribed and dispensed medicines data for England. Such detailed data allows us to understand the quality and quantity of prescribing in England and in recent years has seen a number of ground-breaking dashboards, for example those looking at the rates and type of polypharmacy in general practice.

NHSE and NHSBSA have recently developed a dashboard highlighting the scale of potential oversupply of medicines for a range of prescribing areas. This can support improvement initiatives, particularly around addressing inconsistencies with repeat prescribing processes, and help to minimise avoidable waste or the risk of harm to patients. Oversupply is when more medication is dispensed than should be typically needed or wanted by the patient.

This work supports recommendation 4 of the National Overprescribing Review, namely to “improve data for feedback to clinicians and commissioners to guide prioritisation and monitor success”.²

The oversupply dashboard is available to all general practices and PCNs in England. The dashboard relates to a targeted number of therapeutic areas – typically those with a straightforward dosage schedule to highlight where cumulative amounts of prescribing are considered excessive for a 12-month period.

At launch, the dashboard will look at:

• Aspirin 75 mg
• Statins (solid oral)
• Glucose monitors/sensors
• Fixed dose inhalers
• Daily laxatives
• Blood glucose testing strips
• Oral nutritional supplements.

This is a list of medicines with a straightforward daily use quantity that could be indicative of an oversupply problem. It helps users to spot egregious amounts, quantities that might not be safe, or amounts that may add up to a lot of wasted medication. This can be used to identify issues relating to specific patients or to identify practices or wider geographies with wider systemic oversupply problems. The specific patient cohorts (e.g., patients on ten or more medicines) also provide an opportunity to prioritise initiatives such as structured medication reviews.

Practices and PCNs can register for ePACT2 on the NHSBSA website to access the oversupply dashboard.

Practices could use this data before and after completing the repeat prescribing toolkit action plan to gauge the effectiveness of any interventions.

9.2 Increasing and optimising digital functionality of the repeat prescribing system

It is recognised that different practices will be at different stages of digital maturity. However, the following principles are suggested to support the digital optimisation of the process.

Repeat medication ordering

1. Use of digital/online* order requests for repeat medicines should be maximised where possible, and variation in methods of accepting order requests should be minimised

*_{Digital/online refers to NHS app, NHS.uk webpage, or third-party online ordering platform that delivers the request directly to the GP practice system.}

Receipt of repeat medicine order requests

2. IT workflows should be configured to allow timely and safe management of repeat medication order requests, with mechanisms in place to identify over ordering

Prescribing repeat medication

3. Risk of duplicate or prescriptions issued too close together should be highlighted within clinical systems to avoid unintentional overprescribing

4. Use of EPS and prescribing IT system functionality should be optimised for prescribing repeatable medicines safely and efficiently.

9.2.1 Increasing utilisation of digital repeat prescription ordering

The number of appointments viewed or managed through the NHS app has more than doubled, from 1.95 million in November 2022 to 4.1 million in November 2023.

There were 10.7 million views of patient records in the app in November 2023, compared with 5.8 million in November 2022. There has been an increase in the number of over 50s signing up for the NHS app, following the introduction of new services, including vaccine bookings.

From 2023 to 2024, the number of digital repeat prescription requests in the NHS app rose by more than 45%, amounting to 3.1 million repeat prescription requests a month. A total of 77.5 million repeat prescription have been ordered through the app since the functionality was first introduced. Repeat ordering through the NHS app saves patients an average of 18 minutes with each online order, and each practice an average of three minutes per order received.

As the NHS app grows in both popularity and functionality, we hope to see increasing utilisation and assurance that digital becomes one of the main routes for repeat prescription ordering. This will bring clarity about the process to most patients and a more consistent approach to managing the influx of repeat order requests for most general practices.

However, we recognise that not all patients are able to use digital tools in this way, therefore additional arrangements will need to be made locally so that patients who cannot yet use the app or other online tools are able to order their prescriptions safely and effectively.

Developments we hope to see in the NHS app in the future include:

• The ability to track prescriptions and repeat prescription requests
• Better pharmacy nomination access
• The ability to track eRD prescriptions – the number of authorisations remaining, for example
• Improved repeat medication ordering journey.

Information for patients about the NHS app can be found on the NHSE website.

Age UK have guidance for older people using the internet, including how to order prescriptions.

9.3 System suppliers

GP clinical system suppliers have a significant role to play in increasing the functionality of repeat prescribing systems and identifying over or under ordering of repeat medication by patients.

System suppliers also have a responsibility that any new functionality aimed at improving repeat prescribing efficiency does not compromise medication safety or increase the risk to patients from authorising medicines to be repeated without the appropriate clinical checks.

9.4 eRD

First introduced in 2009, eRD is a non-compulsory method of dispensing prescriptions electronically. It means that patients who regularly get the same medicine do not need to visit their GP every time they need a repeat prescription. Instead, the prescription can be sent straight to their pharmacist for dispensing.

Using eRD, GPs can issue up to 12 months’ worth of regular prescriptions, which can be stored securely on the NHS database, so they are ready at the pharmacy each time a patient needs them.

eRD was rolled out nationally in April 2019 as part of the GP contract. Within three months, nearly 700,000 patients were using the repeat dispensing process and today, over 1.2 million patients benefit from this service. It is estimated that eRD has helped manage increased pressure of the health service and saved over 90,000 hours of GP practice time – time that can be reinvested in patient care.

Practices can access data from the NHS BSA to identify patients who have taken the same medicines for ten out of the previous 12 months and therefore may be suitable for eRD. This data can be requested from the NHSBSA on the ‘requesting eRD data’ page.

Health Innovation Wessex have published a range of tools and guidance to help practices successfully deploy eRD.

9.5 Proxy ordering

Proxy access was developed to allow someone other than the patient to access and manage parts of their GP online services account. The proxy is given their own online access account (rather than using the patient’s login details). It is usually used by the parents of young children and recognised carers of adults. It can also to support CQC registered care homes and GP practices and pharmacists to work together to allow care home staff to order online repeat medication on behalf of residents.

Proxy ordering guidance can be found on the NHSE website.

9.6 Emergency supply requests

Emergency supply requests for medicine can be requested from NHS 111 or 111 Online where the patient is unable to receive a prescription for their regular repeat medication in a timely manner. NICE Emergency Supply of Medicine guidance should be followed.

Where appropriate, the pharmacist will advise the patient or their representative on the importance of ordering prescriptions in a timely manner from their GP practice and prevent the future need for emergency supplies. If an urgent supply is needed, the pharmacy should check the GP record/National Care Record to ensure that they are not making duplicate supplies to ensure patient safety and reduce waste.

9.7 Patient information leaflet

Further patient information is available in section 5 and the repeat prescription infographic.