1. Evaluation EPs Repeat Dispensing Pilot North Manchester
Greater Manchester LPC

2. Introduction
North Manchester Clinical Commissioning Group (CCG) and Greater Manchester Local Pharmaceutical Committee (GM LPC) have been working in collaboration to deliver a Repeat Dispensing Project across North Manchester.
The project intended to support the wider health system through better use of the community pharmacy network using the Electronic Prescription Service as part of Repeat Dispensing.

3. Current Issues
Current prescribing issues were identified that eRD may be able to positively impact and improve
Workload and transaction costs for GP practices
Patient safety – potential risk patients will be without medication
Patient convenience
Professional working relationships and primary care collaboration
Medicines waste

4. Process
All 36 GP practices in North Manchester are included in the pilot, along with the 52 neighbouring pharmacies.
Each GP practice nominates an eRD Champion, ideally their current EPS lead.
eRD Champions and pharmacies attend training sessions to learn more about repeat dispensing using EPS and to ensure integration between GP practices and neighbouring pharmacies.
Each pharmacy nominates their 10 most suitable patients, in line with the standard operating procedure and training documents provided by the Project Lead and the training session they have attended.
The GMLPC Project Lead visits each GP practice and spends 3-4 hours implementing eRD for suitably identified patients. This includes setting up the computer system and training practice staff.

5. KPIs following implementation
100% of community pharmacies actively identifying suitable patients
75% of community pharmacies identify 10 suitable patients
5% of North Manchester patients on eRD
75% of GP practices demonstrate reduction in repeat prescription workload
75% patients feel they can manage their prescriptions better on eRD
75% patients feel community pharmacy is best place to manage repeat medication.

6. Status 27 38 511 811 GP practices visited and live by September 2017.
Pharmacies attended eRD training in February 2017.
511
Patients implemented on eRD by January 2018.
811
Patients nominated for eRD by January 2018

7. Pharmacies There are 52 pharmacies in the North Manchester pilot area.
38 attended the eRD pharmacy training in February.
Furthermore, some pharmacies that did not attend training are engaged and nominating patients.

8. GP Practices
The project lead has visited 27 of the 36 North Manchester GP practices
Face to face in-house training was provided to 97 members of staff (Including GP’s, Practice Managers, Nurses)
This training took 92 hours in total.

9. Patients 844 Patients were selected for eRD
So far 511 patients have been implemented.

10. KPIs following implementation
75% of community pharmacies identify 10 suitable patients - Achieved
811 patients were nominated, this equates to 15 per pharmacy on average.
511 patients have been implemented, this equates to 9.8 per pharmacy on average.
It was difficult to capture the data as Pharmacies submitted patients direct to the GP, some practices reviewed the lists provided by community pharmacies prior to implementation and some were deemed unsuitable. The number of nominated and implemented patients has therefore been captured by GP practice rather than pharmacy.
Anecdotally the project leads reported that many pharmacies nominated patients for eRD prior to or on the day of implementation, and were engaged with the service.

11. KPIs following implementation
5% of North Manchester patients on eRD – in progress
According to data published by NHS Digital 3.5% of patients in Manchester CCG locality were on eRD in March 2018.
It has not been possible to break this down to North Manchester due to the merger of the CGGs and the way the data is presented, we do not have access to data that can be split.

12. Feedback from Patients
Feedback was received from 113 patients.
Demographics
Male: 42% Female: 58%
Age : 2.78% : 32.41% : 30.56% 75 or older: 32.41%
Ethnicity. White: 92.86% Asian: 2.67% Black: 2.68%
Q. Had you heard of repeat dispensing prior to this service? Yes 61.47%

13. Feedback from Patients
KPIs following implementation
75% patients feel they can manage their prescriptions better on eRD - Exceeded
90% of patients said that they feel they can better manage their medication as a result of the service.
75% patients feel community pharmacy is best place to manage repeat medication. - Exceeded
93% of patients said that they feel their community pharmacy was the best place to manage their repeat medication.

14. Feedback from Patients
Positive Outcomes
94% said they are happy with the current process for ordering their repeat prescriptions.
95% said they feel this is a better way of ordering and looking after their medication.
91% said that through this service, they have not received anything they did not order / need.
94% said that during the service they did not run out of any medication which resulted in a call to the out of hours service.
89% said that they felt the service gave them better control of their medication.

15. “Happy with the service”
Feedback from Patients
Opportunities
Q. How would you improve the service?
37 open responses
Positive response/no improvement needed: 16
Receive medication quicker/on time: 6
Improve communication between GP and Pharmacy: 5
Improve patient information: 3
Other (general): 8
“Happy with the service”
“None, it’s excellent”

16. Feedback from Patients
Opportunities
Q. Please add any general comments:
46 open responses
Positive response: 28
Issues experienced: 7
Delays experienced: 3
Improve communication between GP and Pharmacy: 1
Improve patient information: 2
Other (general): 5
“Excellent service that is ‘patient focused’ Thank You”
“I am pleased with the way the service is conducted”

17. Feedback from Patients
Opportunities
Reduce Delays
68% of patients said they feel they received their medication with undue delays compared to before joining the service.
16 respondents highlighted in the comments that they had experienced some issues with the service, 9 of which mentioned issues with delays or their medication not being ready on time.
Patient: Ensure repeat prescriptions are ready for me to collect every 28 days (in my case) without fail. No delays, no missing items.

18. Feedback from Patients
Opportunities
Improved communication between pharmacy and patient
78% said that they received adequate information about the service. However 61% said that no one from the pharmacy team checked/contacted them about which medication they needed before dispensing.
In the comments 6 patients recommended an improvement in communication from the pharmacy.
Patient: “Contact before regular delivery to just check supply to cut back on duplicate orders and prevent build up”
50% of patients said this service prevented a build-up of medication at their house.

19. Feedback from Pharmacies and GP Practices
To assist the evaluation of the pilot GMLPC sent a questionnaire to all the GP practices and pharmacies involved.
32 Responses were received from pharmacies and 32 responses were also received from GP practices, this allows for the answers provided to be evaluated comparatively.

20. Feedback from Pharmacies and GP Practices
Q. What is your role?
Pharmacy
GP Practice
Awareness prior to service
93.75% of pharmacies and 68.75% of GP practices were aware of repeat dispensing prior to the service starting.
84.38% of pharmacies and 67.74% of GP practices were aware of electronic repeat dispensing prior to the service.

21. Feedback from Pharmacies and GP Practices
Q. Did your pharmacy/GP practice use repeat dispensing as part of your prescription management?
Pharmacy
GP Practice
Benefits of repeat dispensing
96.88% of pharmacies said that the majority of their team are aware of the benefits of repeat dispensing and 80.00% of GP practices said that the majority of their prescribers are aware of the benefits of repeat dispensing.

22. Feedback from Pharmacies and GP Practices
KPIs following implementation
100% of community pharmacies actively identifying suitable patients - Ongoing
90.63% of pharmacies said they have been able to continually identify patients suitable for electronic repeat dispensing.
70.97% of GP practices said they felt the patients selected by community pharmacies are appropriate for electronic repeat dispensing.

23. Feedback from Pharmacies and GP Practices
KPIs following implementation
75% of GP practices demonstrate reduction in repeat prescription workload – Data not available
The questionnaire asked if electronic repeat dispensing had impacted on the prescription work flow and the time taken to process repeat prescriptions but did not ask if there had been a reduction, so this data is not available. This would need to be edited for future use to ensure it is captured.
45.16% of GP practices said that electronic repeat dispensing had an impact on the prescription workflow and 43.33% said that it had impacted on the time taken to process repeat prescription requests.
In comparison 74.19% of pharmacies said that electronic repeat dispensing had impacted in the prescription workflow and 77.42% said that it had impacted on the time taken to process repeat prescription requests.

24. Feedback from Pharmacies and GP Practices
Positive Outcomes
67.74% of pharmacists said they feel this service has improved their stock control for these patients.
87.10% of pharmacists said they feel they could better manage requests for early prescriptions, for example if the patient is going away on holiday.
70% of pharmacists said this service enabled them to better highlight medication related issues for the patient.
87.5% of pharmacies and 80.65% of GP practices said that the majority of their team/prescribers are aware that unused/not needed items can be cancelled at any time by the practice.

25. Feedback from Pharmacies and GP Practices
Opportunities
Awareness of the EPS tracker
100% of pharmacies said they are aware of the EPS tracker and that they know how to use it, of these 96.88% said that they feel confident using it and 87.5% said that they use it regularly.
In comparison 62.50% of GP practices said that they are aware of the EPS tracker and 54.84% said they know how to use it.
This suggests that there is an opportunity to develop awareness and understanding at GP practices of the EPS tracker.

26. Feedback from Pharmacies and GP Practices
Opportunities
Making use of Information in MURs
83.87% of pharmacies said that the majority of their team are aware that not dispensed items are flagged up on the Patient Medication Record % said they feel their local practice(s) use this information as part of their medication reviews with patients.
In comparison 41.94% of GP practices said that the majority of their prescribers are aware that not dispensed items are flagged up on the Patient Medication Record % said their clinicians use this information as part of their medication reviews with patients.

27. Feedback from Pharmacies and GP Practices
General comments
Pharmacist:
Positive impact – particularly for dosette patients
It’s a good service
GP:
Only small amounts of patients on repeat dispensing not enough to have any impact.
Good
Our practice hasn’t really embraced electronic repeat dispensing mainly due to lack of training and the length of time changing each item.
Need more training. Struggling with updating repeat prescriptions.

28. Feedback from Pharmacies and Patients
Opportunities
Improved communication between GP and pharmacy
Only 56.25% of pharmacies said they felt repeat electronic dispensing has reduced the number of phone calls made to local GP practices.
Pharmacist: “Although EPS repeat dispensing has reduced Admin…it has increased queries for us…some items missing…having to phone surgery.”
6 patients also added comments suggesting that communication between the pharmacy and GP could be improved.
Patient: “Medical centre and pharmacy don’t seem to communicate in a manner that is beneficial to the patient”

29. KPIs following implementation
Conclusion
100% of community pharmacies actively identifying suitable patients – In progress
75% of community pharmacies identify 10 suitable patients – Target achieved
5% of North Manchester patients on eRD – In progress
75% of GP practices demonstrate reduction in repeat prescription workload – Data not available
75% patients feel they can manage their prescriptions better on eRD – Target exceeded
75% patients feel community pharmacy is best place to manage repeat medication – Target exceeded

30. Financial Overview The project has kept within it’s budget of £17958.
The table below sets out the spending during the 5 different phases of the project.

31. Financial Overview
The table below displays how the budget has been spent throughout the project.

32. Conclusion
The project has been successful and provided a platform for supporting further implementation. The project has shown improved communication and better patient perception for their repeat management. Some scoping work to understand barriers of implementation, impact on waste reduction and ensuring a seamless service between practices and pharmacies would be beneficial. This would support development of further training/ implementation support which could be beneficial to the pilot area and facilitate the project being rolled out to other areas. 

33. Pharmacies Trading Name Address of Contractor 1
Postcode
Telephone number
Asda Pharmacy
Asda Sport City, Alan Turing Way
Bradford
Manchester
M11 4BD
North City Shopping Centre
Harpurhey
M9 4DJ
x 319
Blackley Village Pharmacy
Unit 5, 73 Old Market Street
Blackley
M9 8DX
Boots
11-13 Piccadilly
City Centre
M1 1LY
32 Market Street
M1 1PL
Unit 5, Piccadilly Station
M1 2BN
3A The Circus
Portland Street
M1 4RL
Collegiate Medical Centre
407 Cheetham Hill Road, Cheetham
M8 0DA
103 Crumpsall Lane
Crumpsall
M8 5SR
Manchester Fort Retail Park, Cheetham Hill Road
Cheetham
M8 8EP
65 Victoria Avenue
M9 0RD
Cameolord Pharmacy
16 Oxford Street
M1 5AE
Cheetham Hill Internet Pharmacy
460B Cheetham Hill Road
Cheetham Hill
M8 9JW
Cohens Chemist
861A Ashton New Road
Clayton
M11 4PA
22 Swan Street
Ancoats
M4 5JQ
Breightmet Health Centre
Collyhurst
M40 7QH
407 Queens Road
M40 8RL
287 Cheetham Hill Road
M8 0SN
244 Cheetham Hill Road
M8 8UP
102 Church Lane
M9 4NH
664 Rochdale Road
M9 5TT
55 Victoria Avenue
M9 6RA
D & K Chemist
380 Moston Lane
Moston
M40 9LX
DocPharma Pharmacy
1st Floor, 84 North Street
M8 8RA
Drugs 4U Pharmacy
1st Floor, 311a Moston Lane
M40 9NL
Haven Chemist
6 Medway Walk
Miles Platting
M40 7HS

34. Pharmacies Trading Name Address of Contractor 1
Postcode
Telephone number
Higher Crumpsall Pharmacy
248 Middelton Road
Higher Crumpsall
Manchester
M8 4WA
K'S Chemist
Ancoats Primary Care Centre
Old Mill Street, Ancoats
M4 6EB
Lloyds pharmacy
109 North Road
Clayton
M11 4NE
Wellfield Medical Centre
Crescent Road, Crumpsall
M8 9JT
Unit 1, Burgess House
North City Shopping Centre, Harpurhey
M9 4DH
Manchester Pharmacy
Unit 4, Hoyle Ind Estate
Hoyle Street
M12 6HG
Mediward Ltd
227 Hill Lane
Blackley
M9 6RG
Newchem Pharmacy
55 Old Church Street
Newton Heath
M40 2JN
Peak Pharmacy
Unit 11, Lime Square Ashton Old Road
Higher Openshaw
M11 1DA
Pharmaco
Stanley Street
M11 1LE
Rowlands Pharmacy
400 Alan Turing Way
Beswick
M11 3BE
4 Windcroft Close
M11 3SN
Lloyds Pharmacy In Sainsburys
170 Heaton Park Road West
Higher Blackley
M9 0QS
Superdrug Stores
7 - 9 Piccadilly
City Centre
M1 1LY
Tesco In-Store Pharmacy
Cheetham Hill Road
Cheetham
M8 5DP
Victoria Avenue East
M9 6HP
Tims & Parker Pharmacy
Moston Lane East
New Moston
M40 3GP
Valentine Medical Centre
2 Smethurst Street, Blackley
M9 8PP
Well
Droylsden Road
M40 1NT
9 Old Church Street
M40 2JL
Victoria Avenue
M9 0RB
Whitemoss Pharmacy
247 Charlestown Road
M9 7BD
Wilkinson Pharmacy
384 Hollinwood Avenue
M40 0JD
203 Lightbowne Road
Moston
M40 9DD
321 Moston Lane
M40 9NL
Wise Pharmacy
376 Cheetham Hill Road
Cheetham Hill
M8 9LS

35. GP Practices Practice Address Date visited Number of staff trained?
THE AVENUE MEDICAL CENTRE THE AVENUE MEDICAL CENTRE, VICTORIA AVENUE, BLACKLEY, MANCHESTER, M9 6BA
THE NEVILLE FAMILY CENTRE THE NEVILLE FAMILY CENTRE, 25 OLD MARKET ST,BLACKLEY, MANCHESTER, M9 8DX
4/7/717 5
CHARLESTOWN MD CHARLESTOWN MD, CHARLESTOWN RD, BLACKLEY, MANCHESTER, M9 7ED
ST GEORGE'S MEDICAL CENTRE ST.GEORGES DRIVE MED CTR, ST.GEORGES DRIVE, MOSTON, MANCHESTER, M40 5HP
11/07/2017 1
WHITLEY ROAD MEDICAL CENTRE WHITLEY ROAD MEDICAL CTR, 1 WHITLEY ROAD, COLLYHURST, MANCHESTER, M40 7QH
18/07/2017 4
SIMPSON MEDICAL PRACTICE SIMPSON MEDICAL PRACTICE, 361 MOSTON LANE, MOSTON, MANCHESTER, M40 9NB
MP VICTORIA MILL VICTORIA MILL HEALTH CTR, 10 LOWER VICKERS STREET, MANCHESTER, LANCASHIRE, M40 7LH 6
FLORENCE HOUSE MEDICAL PRACTICE HGR OPENSHAW PCC, 1344 ASHTON OLD ROAD, MANCHESTER, M11 1JG
25/07/2017
LIME SQUARE MEDICAL CENTRE LIME SQUARE, ASHTON OLD ROAD, OPENSHAW, MANCHESTER, M11 1DA
THE SINGH MEDICAL PRACTICE THE SINGH MEDICAL PRACT, 1 CHURCH LANE,HARPURHEY, MANCHESTER, LANCASHIRE, M9 4BE
DROYLSDEN RD FAMILY PRACTICE 125 DROYLSDEN ROAD, NEWTON HEATH, MANCHESTER, M40 1NT
01/08/2017 3
HAZELDENE MEDICAL CENTRE HAZELDENE MEDICAL CENTRE, 97 MOSTON LANE EAST, NEW MOSTON, MANCHESTER, M40 3HD
PARK VIEW MEDICAL CENTRE PARK VIEW MEDICAL CENTRE, 66 DELAUNAYS ROAD, CRUMPSALL, MANCHESTER, M8 4RF
29/08/2017
CITY HEALTH CENTRE CITY HEALTH CENTRE, 2ND FL, 32 MARKET ST, MANCHESTER, LANCASHIRE, M1 1PL
CONRAN MEDICAL CENTRE CONRAN MEDICAL CENTRE, 77 CHURCH LANE, HARPURHEY, MANCHESTER, M9 5BH
26/09/2017

36. GP Practices Practice Address Date visited Number of staff trained?
BEACON MEDICAL CENTRE BEACON MEDICAL CENTRE, 156 VICTORIA AVE,BLACKLEY, MANCHESTER, M9 0FN
04/04/2017 4
DAM HEAD MEDICAL CENTRE DAM HEAD MEDICAL CENTRE, 1020 ROCHDALE RD,BLACKLEY, MANCHESTER, M9 7HD 3
JOLLY MEDICAL CENTRE THE JOLLY MEDICAL CENTRE, 72 CRESCENT RD, CRUMPSALL, MANCHESTER, M8 9NT
25/04/2017 5
CHEETHAM HILL PRIMARY CARE CENTRE CHEETHAM HILL PCC, 244 CHEETHAM HILL RD, MANCHESTER, M8 8UP
QUEENS MEDICAL CENTRE CHEETHAM HILL PCC, 244 CHEETHAM HILL ROAD, CHEETHAM HILL, MANCHESTER, M8 8AU
BROOKDALE SURGERY BROOKDALE SURGERY, 202 DROYLSDEN ROAD, NEWTON HEATH,MANCHESTER, M40 1NZ
02/05/2017
NEWTON HEATH MEDICAL CENTRE NEWTON HEATH HEALTH CTRE, 2 OLD CHURCH STREET, NEWTON HEATH, MANCHESTER, M40 2JF 6
FERNCLOUGH SURGERY UNIT 1, TAVISTOCK SQUARE, HARPURHEY, MANCHESTER, LANCASHIRE, M9 5RD
WILLOWBANK SURGERY 1 WILLOWBANK, CHURCH LANE, MANCHESTER, M9 4WH
ARTANE MEDICAL CENTRE ARTANE MEDICAL CENTRE, 1 MIDDLETON ROAD, HIGHER CRUMPSALL, MANCHESTER, M8 5DT
16/05/2017
WELLFIELD MEDICAL CENTRE WELLFIELD MEDICAL CENTRE, 53 CRESCENT RD, CRUMPSALL, MANCHESTER, M8 9JT
CORNERSTONE FAMILY PRACTICE CORNERSTONE CENTRE, GRAHAM STREET, BESWICK, MANCHESTER, M11 3AA
23/05/2017
FIVE OAKS FAMILY PRACTICE FIVE OAKS FAMILY PRACTICE, 47 GRAHAM STREET, BESWICK, MANCHESTER, M11 3BB
NEW COLLEGIATE MEDICAL CENTRE NEW COLLEGIATE MED.CENTRE, 407 CHEETHAM HILL ROAD, CHEETHAM, MANCHESTER, M8 0DA
30/05/2017 1
ALEESHAN MEDICAL CENTRE 3 SHIRLEY ROAD, CHEETHAM HILL, MANCHESTER, M8 0WB 2
DR MOKASHI CLAYTON HEALTH CENTRE, 89 NORTH ROAD, CLAYTON, MANCHESTER, LANCASHIRE, M11 4EJ
EASTLANDS MEDICAL CENTRE CLAYTON HEALTH CENTRE, 89 NORTH ROAD, CLAYTON, MANCHESTER, LANCASHIRE, M11 4EJ
06/06/2017
THE MAZHARI & KHAN PRACTICE CLAYTON HEALTH CENTRE, 89 NORTH ROAD, CLAYTON, MANCHESTER, LANCASHIRE, M11 4EJ
ANCOATS URBAN VILLAGE MEDICAL PRACTICE ANCOATS PRIMARY CARE CTRE, OLD MILL STREET,ANCOATS, MANCHESTER, M4 6EE
13/06/2017
NEW ISLINGTON MEDICAL CENTRE ANCOATS PRIMARY CARE CTRE, OLD MILL STREET,ANCOATS, MANCHESTER, M4 6EE
VALENTINE MEDICAL CENTRE VALENTINE MEDICAL CENTRE, 2 SMETHURST ST, BLACKLEY, MANCHESTER, GREATER MANCHESTER, M9 8PP
20/06/2017