Over the last year I have written articles about pharmacy workflow, dispensing processes and efficiency. I have explained how new technology can help pharmacy businesses become fully digital, completely paperless and more safe. I have discussed how Titan innovations such as artificial intelligence and barcode technology can help free up pharmacist time away from checking prescriptions.

Having an efficient process to deal with prescriptions once they arrive is one thing, but what about the bit that happens before the prescription even gets to the pharmacy. 

In my career as a pharmacist, repeat prescription and order management has often presented me with the greatest challenge. It is by far the most time consuming, unrewarding and chaotic process that exists to this day. 

I sometimes envy normal retail businesses and their order and supply process. If you are an Amazon customer, you select what you want, add to basket, make your payment and then track your order as it reaches your door.

In pharmacy however, a simple transaction like this is just not possible. For a start there are four parties to achieve essentially the same outcome. A patient places the order, a doctor has to authorise it, the pharmacy dispenses it and then the NHS makes the payment. What could possibly go wrong?

The fact is, many patients are simply not able to manage their repeat orders. They have enough problems just trying to take the medication we supply. Those on MDS packs, care home residents or receiving home delivery, usually need help with their repeat orders to the surgery.

Repeat Order Challenges

Many CCGs have banned pharmacists ordering repeats on behalf of patients presumably because they think that pharmacists will order everything unnecessarily and create waste. Instead, patients are encouraged to use Patient Ordering Direct (POD) or other surgery ordering systems.

For the few pharmacies that are allowed to order for their patients and need to provide this service to support their patients, they are left to manage this best they can using fairly primitive processes on their PMRs or internal IT systems.

Regardless of who places the order, the issues that arise are always the same;

• Not all items that are requested get issued
• Items that were not requested get issued
• Doses are changed randomly without any communication
• Doses are printed “as directed” without any clear directions
• Quantities are not aligned with any particular cycle
• The 5 days it’s taken to get the prescription means you now have 5 minutes to dispense and deliver
• Patient runs out before the prescription arrives and you have to make a loan

If you have never come across any of the above issues then you have never worked in community pharmacy.

Sadly, pharmacists are often left having to pick up the pieces, deal with anomalies and ensure there is continuity of supply for their patients, often at their own expense. Sure, we could just supply what is on the prescription but that’s not what we do. Our instinct is to help the patient however best we can even though we are an easy target for when it goes wrong. Heaven forbid the surgery could ever be blamed for a mistake.

Technology Solutions Pros and Cons

In recent years, an increasing number of digital apps have emerged to help patients order their medication. These apps use a technology called IM1 which forms a connection between the patient and their surgery allowing them to view and order their drugs directly.

The NHS App launched a few years ago provides the ability for patients to view their records and order their medication. A great tool for those patients that use it but unfortunately with zero pharmacy integration.

Companies such as Boots, Echo and Pharmacy2u are using their apps to help smooth out the ordering and supply journey. The patient remains in control of their supply process whilst the pharmacy can see the orders placed and help track the progress. Obviously this is great for their respective businesses and gives them a competitive advantage over community pharmacies.

Healthera, Avicenna, Numark and other suppliers have launched apps to help the ordering process for patients with their local pharmacy. These apps offer levels of convenience for ordering and an experience which aims to compete with the online suppliers. Patients can order their items and nominate their pharmacy, a choice usually limited to only those signed up to the service.

Whilst these emerging apps do provide a solution for community pharmacies to compete, they don’t necessarily solve all the complexities of order management. Integration with PMRs is either non-existent or limited at best. We must also recognise that ordering via apps is not for everyone. Not all patients are proficient with this technology. The signing up process can be convoluted involving NHS LogIns and Linkage Keys. Let’s not forget that most of the patients we are talking about are elderly and in need of care.

The Future of Order Management

Although technology solutions have come a long way to improve the process of ordering, we need to go much further to create efficiencies in managing prescriptions. Patient ordering apps must become fully integrated with PMR systems and the end to end dispensing workflow. 

Pharmacy systems should know what has been ordered so they can reconcile the prescription upon arrival. An electronic system of communication must exist between the pharmacist, patient and their doctor to resolve queries. Issues such as dose discrepancies, new drugs or missing drugs need to be rectified in real-time.

We need to consider more flexible solutions for elderly patients and those who are unable to use apps or online systems. There is no reason why pharmacists should not be allowed to manage repeat prescriptions for these patients, especially with consent of carers and family members.

Whether we like it or not, helping patients order their prescriptions is something that has become part and parcel of the pharmacist's role and is as crucial as the dispensing function itself. Like everything else, we need to embrace the role with technology, improve the process and free up pharmacists time. Our time can then be better spent on supporting patients with how they take their drugs and not just how they get hold of them.