How to develop a prescription ordering direct service   

Dr Neil Paul offers advice for PCNs thinking about developing a pharmacy prescription ordering direct (POD) service to save costs and reduce medicines waste 

Increasingly, PCNs and groups of practices are looking to identify opportunities to work at scale and increase efficiency. 

One interesting option is a pharmacy prescription ordering direct (POD) 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 adviser, or use an online form, when needing to order a repeat prescription. In other words, it’s a team of people who process some or all of the prescriptions on behalf of multiple practices.  

The size and expertise of the team bring numerous benefits. First, there is huge variation between the way practices handle prescription requests. Some handle them all within 24 hours, some take three days or more. At request stage, some 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. PODs are a single team handling prescriptions, which should improve standardisation and reduce variation between practices, also cutting down on medicines waste.  

PODs can also save money, increase profits and reduce the bureaucratic burden on managers and GPs. They can reduce staff turnover by improving training, and ease pressure on reception staff because fewer calls will be made to practices. 

Several areas around the country already have PODs, such as Kent, the West Midlands, Sussex and Norfolk. If your PCN is considering adopting this model, the following tips might help. 

1 Think about funding 
Additional Roles Reimbursement Scheme (ARRS) funding for pharmacists and pharmacy technicians could cover much of the staffing costs for a POD, 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 like primary care development funding. 

Remember that when employing staff, you need to be mindful of VAT liability. Seek advice from your accountant.  

2 Define your purpose 
Decide on the main aims and objectives. 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 and medicines use reviews? 

3 Consider starting small 
Some PODs offer specific services only, such as repeat requests from nursing homes or requests from patients that are housebound, frail or elderly.

4 Alternatively, do you already have a prototype POD in place? 
If you have PCN-level pharmacists working on behalf of all your practices, there may be an opportunity to discuss how to expand and grow their service. 

5 Engage with practices
Explain how the scheme will benefit them. Look at what each practice does now and learn from the best. You don’t need all practices to engage with this. The service can involve just two or three at first.

6 Assess what workforce is needed to run the POD 
Should practices lend their ARRS staff or should they resource it with funds, so staff can be employed centrally? Think about creating a project management role for the POD since practice managers are already busy.  

7 Agree how the POD team can access support 
If a team member needs help from a GP or other clinician, do they need to call on the patient’s registered GP, the on-call GP, or the last GP that saw them? You need to agree on processes that work for all. 

8 Think about data sharing and IT 
Ideally, staff need access to all patients from all practices. 

9 Decide on a location for the service 
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 consider how that will be managed. 

10 Check agreements 
Can your PCN DES agreement cover this new service? Set up a memorandum of understanding for all the decisions. Include tie-in periods, to prevent a practice pulling out and halting the service. 

11 Communicate with the public 
You may need to allay patients’ fears, for instance that the scheme is part of a takeover from the private sector. 

Dr Neil Paul is a GP partner in Cheshire and clinical director of Sandbach, Middlewich, Alsager, Scholar Green and Haslington (SMASH) PCN

To access a longer version of this article, visit pulse-intelligence.co.uk