DGT0005

Written evidence submitted by Pharmacy2U

Summary

• Established in 1999, Pharmacy2U is the UK’s first and largest digital pharmacy. We dispense repeat prescriptions from our centralised, automated dispensing facilities direct to people’s homes, liaising with their GP

• This submission focuses on the role of digital transformation in the pharmacy sector and the savings that digital services, such as ours, can deliver for the NHS, whilst improving convenience and outcomes for our customers

• Our digital pharmacy service dispenses over 1,000,000 NHS prescription items per month, which is comparable to around 150 bricks-and-mortar pharmacies. Our at-scale, automated model is around 15-20% cheaper to the NHS than the average High Street pharmacy, meaning the NHS pays us less per item dispensed

• Wider benefits of our industry-leading technology include: reduced dispensing error rates, increased medicines adherences and reduced medication wastage. Due to the efficiencies that can be delivered, the current Community Pharmacy Contractual Framework supports greater use of automated technology in the sector, such as ours, to allow frontline pharmacists to focus on patient-facing clinical services

• However, digital transformation to support this shift in the pharmacy sector has been slow and relies on agitators, such as us, to work within contractual and legislative constraints that historically favour premise-based models of care – such as legislation that governs hub-and-spoke models and outdated financial mechanisms

• The COVID-19 pandemic exposed the shortcomings in digital capabilities within the sector, for example, interoperability between different parts of the health system and poor user experience within the NHS App. As a result, shielding and self-isolating patients have often needed to rely on friends and family or NHS volunteers to pick-up their repeat medication, or indeed the capacity of small, independent pharmacists to undertake deliveries at an extremely challenging time for the sector.
   

• Now is the time to take action to support pharmacies to increase their digital capabilities, including the use of automated, digital pharmacy services such as Pharmacy2U. To achieve this, we are calling on Government to:

• Establish greater flexibilities to develop hub-and-spoke models for dispensing repeat prescriptions
• Agree a fairer system for pharmacy reimbursement
• Ensure the NHS App is as effective as possible for pharmacy
• Facilitate improved operability between GP and pharmacy IT systems

Introduction

We welcome the opportunity to provide evidence to the Public Accounts Committee’s inquiry into Digital transformation in the NHS. This submission focuses on the role of digital transformation in the pharmacy sector and covers the following topics:

• Overview of Pharmacy2U’s business model
• Digital transformation in the context of COVID-19
• The efficiencies digital transformation can deliver for the NHS
• Recommendations for action

Whilst the National Audit Office’s report on Digital transformation in the NHS focused largely on secondary care and digital capabilities of the hospital sector,[i] this submission shines a light on the efficiencies that can be achieved from digital transformation in the pharmacy sector.

Overview of Pharmacy2U’s business model

Pharmacy2U is the UK’s largest digital-only pharmacy. We liaise directly with GPs to deliver NHS prescriptions straight to people’s homes, from our automated dispensing facilities. We operate at scale, dispensing over 1,000,000 NHS prescription items per month (comparable to over 150 bricks-and-mortar pharmacies), providing a huge convenience to patients who rely on timely and regular access to repeat prescriptions. Our ambition is to transform the pharmacy sector, bringing greater convenience and access to the 29 million people who rely on repeat prescriptions every day, whilst delivering value-for-money for the NHS.

Digital transformation in the context of COVID-19

During the pandemic, Pharmacy2U has been quick to respond to increasing demand. In the first week of lockdown, week commencing 23 March 2020, we saw 32,639 new patients register with our services, 23% of who were over 70 years old. This was an increase of 395% compared to the same week in 2019, when 11% of new patients were over 70. Throughout this peak, the number of new patients that joined has remained significantly higher than in previous years, with at least 15,000 new patients registering each week.

To meet this demand, we have been able to substantially and rapidly scale up our operations. During the peak of the pandemic, we dispensed 236,339 items in one week, compared to 128,774 in the same week in 2019. The ongoing pandemic has been a challenging time for traditional High Street pharmacies. Community pharmacy is on the frontline of the pandemic response, affected by staff sickness, medicines price increases, and stock shortages.[ii] The rapid increase of demand for our own service indicates that patients have been unwilling to visit pharmacies in person for routine medicine collections.

Digital transformation within the pharmacy sector has lagged behind that of other healthcare settings. Both the benefits of digital transformation and the shortcomings in the pharmacy sector’s current capabilities have been exposed as a result of the COVID-19 pandemic. We hope the Public Accounts Committee will take into account the role of digital, including digital pharmacies, in transforming the sector at this crucial time of recovery.

The efficiencies digital transformation can deliver for the NHS

Our model is designed to inject efficiencies into the pharmacy sector of the kind seen more widely in the retail sector. We dispense our medicines at scale from two centralised and highly automated dispensing facilities and send them direct to our customers through the post. Our industry-leading technology can reduce dispensing error rates, increase medicines adherence and minimise medication wastage.

We also help to take the burden of repeat dispensing away from bricks-and-mortar pharmacies and are more cost-effective to the NHS: repeat prescriptions dispensed by Pharmacy2U are 15-20% cheaper to the NHS than the average pharmacy.

Key efficiencies

• Since 2014, our calculations reveal that the NHS has paid us £9m less per year than they would have paid the average bricks-and-mortar pharmacy to dispense prescriptions. If distance-selling pharmacies dispensed 50% of all prescription items, this would release annual savings to the NHS of around £200m
• Error rates present a significant and growing challenge to the pharmacy sector – the National Pharmacy Association (NPA) reported a 32% increase in the number of patient safety incidents reported during 2019 compared to 2018.[iii] Pharmacy2U’s AI-led dispensing technology dispenses one item every two seconds at an industry-leading clinical accuracy rate of 99.98%
• We have a growing evidence base suggesting that our service supports increased medicines adherence, with automated prompts reminding customers to reorder their prescriptions, ensuring their access to medicines is not disrupted
• Our processes reduce medication wastage and the associated costs, as we only reorder repeat medication when our customer requests it. It has been estimated that the level of waste of medicines in England is approximately £300m per year[iv]
• Through our AI technology, we can utilise big data and knowledge of our customers’ needs to proactively provide our customers with personalised health advice and specific preventative tests (such as tests that measure kidney function in patients with diabetes). This is underpinned by full patient consent and adherence to NHS data security standards, and provides a more efficient and holistic service to the customer whilst reducing the administrative burden on their GP

Recommendations for action

In order to maximise the opportunities for digital transformation in the pharmacy sector, we recommend that the Government takes the following steps:

1. Establish greater flexibilities to develop hub-and-spoke models for dispensing repeat prescriptions. In line with commitments made alongside the Medicines and Medical Devices Bill, which is being debated in the House of Lords this autumn, legislative reform would allow larger services like Pharmacy2U to work in partnership with smaller, independent pharmacies to drive efficiencies through at scale automated dispensing. This would improve patients’ access to clinical services in their community pharmacy, whilst supporting the longer-term sustainability of the sector. With hindsight, this legislative change would have been beneficial in supporting the sector respond to COVID-19 and ensure that people who have been shielding or self-isolating can continue to access their repeat medication

2. Agree a fairer system for pharmacy reimbursement. A system of reimbursement which is fair to different types of pharmacy operators should be considered. At present, outdated financial mechanisms, such as the ‘clawback’, favour premise-based services over large-scale, digital pharmacies. We welcomed the commitment in the Community Pharmacy Contractual Framework to abolish establishment fees and review existing funding mechanisms. However, progress has been very slow on reforming these systems and must be accelerated to ensure impact within the timeframe of the current Contractual Framework

3. Ensure the NHS App is as effective as possible. Whilst we welcome recent changes to the NHS App which allow patients to nominate an online-only pharmacy, we are concerned that the current list of online, or ‘distance-selling’, pharmacies from which patients can nominate will be confusing given many of these pharmacies cannot delivery nationally and at scale – which may also undermine confidence in the service that digital pharmacies can provide. In order to improve accessibility, a fair and understandable list of national-level digital pharmacies should be developed, in which patients can have full confidence

4. Facilitate improved interoperability between GP and pharmacy IT systems. The IT systems that GPs use are not interoperable with pharmacy systems, meaning that digital pharmacy services must create bespoke solutions that allow their systems to interface with each different operator. Where systems cannot be developed, GPs must be chased manually for prescriptions. Despite the March 2020 deadline for phasing out fax machines across the NHS, we still need to fax prescription requests to around 50% of GP surgeries, with a further 5% requiring a physical letter to be sent. This creates both avoidable delays for patients and increased burden on an already busy workforce. Mandating better digital integration would facilitate more efficient collaboration between different parts of the health and care system

Contact details

If you would like to discuss any of the issues raised in this briefing in more detail, please contact pharmacy2U@incisivehealth.com.
 

September 2020