Case study summary
Trent Vale Medical Practice in Stoke-on-Trent was struggling with the huge demand managing repeat prescriptions was having on its practice team’s time. The practice, which comprises of four whole time equivalent GPs serving a patient population of over 9000, used the Productive General Practice (PGP) Quick Start programme delivered by NHS England’s Sustainable Improvement team, to design a more efficient process. The programme is part of the support available through the General Practice Forward View.
Use the Efficient Processes module from PGP Quick Start to redesign the repeat prescriptions process.
Identifying the issues
From the outset the practice was keen to involve all staff in the project and brought the whole team together including GPs, secretaries and reception, as well as staff not directly involved in repeat prescriptions such as nurse practitioners and data administrators, who could provide an objective view. Using the process mapping tool, the team first mapped out the current steps for managing repeat prescriptions, from when they first arrived in the practice to how they were processed and issued. This highlighted some significant issues.
- The practice was receiving repeat prescriptions from patients and other healthcare professionals in a number of different ways e.g. by phone, fax, in person and online, which was making the process complex and time consuming. Faxes received by district nurses were difficult to read and pharmacy sent a list of requests rather than individual ones.
- The sheer volume of urgent requests was overwhelming for GPs. They were dealt in a different way with patients either waiting for the prescription, which disturbed the GPs between patients, or patients returned to the practice after 4.00pm. This added more steps and confusion to the process.
- Issuing repeat prescriptions was used as a trigger for calling patients in for a review, which made the process long winded and complicated. Furthermore, patients often forgot their review date and did not attend which wasted GP time.
- GPs received early requests on a daily basis from reception, which would be sent back as only patients going on holiday can have this. As this was not checked with patients beforehand reception would have to inform the patient and re-send the request to the GP at the appropriate time. This resulted in double the workload for both GPs and reception.
- The practice was dealing with some requests that should have been dealt with by other healthcare professionals. For example, district nurses can issue their own prescriptions so should be doing this rather than requesting from other parties.
The team found that the time it took to work to the 48 hour practice policy of turnaround for prescriptions regardless of the volumes, was significant.
A new process fit for purpose
The team recognised it needed to work differently. The process mapping flagged many issues and highlighted that a lot of what the team was doing accommodated others rather than the practice itself. As a result the team came up with the following changes to be made.
- A precedent was set that requests made over the phone would no longer be taken. As an alternative patients would be given the options to order online and direct from their pharmacy, they could also use their repeat prescription slip/slips provided by the surgery however, these would have to be posted in the collection boxes in the surgery.
- Receiving faxes would not be acceptable. Instead an electronic order form was set up for district nurses and an online system for nursing homes and pharmacies.
- Urgent prescriptions were only processed if there was an exception e.g. a fault in the original prescription issued where an item had been missed, certain medications such as contraception. Otherwise patients could go to their pharmacy, who by using their discretion, are able to dispense up to two weeks supply of medications where patients can show that they are normally taking the medication.
- GPs only deal with advance requests if there is a valid reason otherwise reception automatically reject.
- The patient’s birthday would be used as a trigger for managing reviews rather than the repeat prescription.
The above changes were communicated as widely as possible. Patients were encouraged to use the online service at every opportunity, posters displayed in the practice, information uploaded on the practice’s website and Facebook page, and available from receptionists. The new patient pack was also updated.
- 337* hours of GP time a year has been released. The GPs are using this released time for patient consultations and reviews, allowing them to spend more time with patients.
- Released 160** hours of admin time a year that is now used to undertake daily tasks which have helped to remove any back-logs of work and keep staff consistently up-to-date with all tasks. The team had also undertaken some duties that were previously undertaken by other members of practice staff i.e. new patient registrations.
- The practice team is sharing the work it has done and the learning with other practices in its locality.
* Time based on approximately 6.4 hours per week collectively released for 4 whole time equivalent GPs.
** Time based on approximately 3 hours per week collectively released for 4 whole time equivalent members of the reception team.
- Encourage ideas from those who will directly be involved in the changes made, this will help secure their buy-in and make the changes happen.
- Get input from everyone even those who are not directly involved in the process, this will give you an objective view.
- Commit to your project and put the time aside you need to do the work.
When we looked at our repeat prescription process we realised just how much time was being wasted and how complex the process had become. A lot of what we were doing was to accommodate others rather than the best way to work for the practice team. PGP Quick Start gave us the tools and support to design a simpler and streamlined process that is fit for purpose and allows us to work more efficiently as a team.
Van Der Linden Harald, GP, Trent Vale Medical Practice
If you would like to find out more about how you can access the Productive General Practice Quick Start programme, visit our ‘Releasing time for care’ web page.