The great debate on the value of e-scrips

We've had a Kung Fu moment on GP this week, contemplating a question very similar to the one about a tree falling in a forest making a noise if there is no one around.

Our debate centred around if electronic prescriptions have any value if they are not downloaded. 

Electronic prescribing is one of the major planks of the National Programme for IT and the government's drive for a high-tech, 21st-century electronic NHS.

Proponents of the system will likely boast that more than 9.5 million electronic prescriptions were generated in England during 2006. An amazing number which, you will agree, points to the imminent end of paper prescribing, with related green benefits. Or does it?

The thing is that those millions of scrips are adding up to one very quiet falling tree, because only 1.4 per cent of them were downloaded and barely 1 per cent dispensed.

Part of the problem is that although many GPs had the facility to generate the e-scrips, pharmacies did not have the technology to receive them - rather like inventing Morse code and not sharing the key. By mid-2007, only 42 per cent of pharmacies have the software to deal with these scrips.

So all that 9.5 million figure tells us is that GPs have proved capable of making an extra mouse click in the prescribing process and that is hardly a surprise.

This approach to e-prescribing illustrates much that is wrong with the DoH's grand plans in general. Headline figures serve to promote an agenda - e-scrips, use of choice software, numbers of doctors - without a context to reveal their real worth.

Also the government seems set on measuring the wrong thing. We know how many referrals are made through Choose and Book not what difference it makes to patients' experience of care. We know about the quantities of e-scrips, not whether patients will accept or trust them and whether it will make the prescribing process more efficient.

Unless there is a functional system to test we will never know that answer, and surely that is the only real question to ponder.

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