Derek wanless' report on the future of the NHS gave IT a huge shot in the arm in April when the ex Nat West chief executive recommended that the government double its spending on NHS computer systems to over £2 billion a year.
Investing such huge sums of money on integrating NHS systems would lay "the basis for the delivery of significant quality improvements and cost savings over the next 20 years".
Key to this aim is electronic prescribing. Lord Hunt first set-out the government's vision of the "Pharmacy of the Future" in September 2000, whereby GPs would email pharmacists directly.
The National Plan set a deadline for the introduction of e-prescription by 2004. In March 2001 the government selected three consortia to take the e-prescribing pilot to the next stage: "TransScript" - comprising Syntegra and Gehe UK (AAH/Lloyds Pharmacy and PharMed); "Pharmacy2U" - Pharmacy2U, North-West Co-operative, Health Global Worldwide, Viacode Security and Hadley Healthcare; and "SchlumbergerSema" - SchlumbergerSema, Boots the Chemist, National Cooperative Chemists, Cable and Wireless and Microsoft.
The consortia each make use of a different combination of electronic messaging, digital signatures and the bar-coding of prescriptions [see box]. There is also variation in whether the patient nominates a pharmacy where they will collect their drugs or alternatively have them delivered directly to their homes.
The success of each of these pilots is currently being evaluated. It is by no means set that the government will approve just one. If there are proven advantages to more than one consortia the government could endorse them all whilst leaving it to the NHS at a local level which one to choose. This compromise would have the added advantage of central control of standards with a degree of local choice.
"Too many medicines are wasted and far too many people suffer avoidable side-effects and complications," Lord Hunt said.
This view was endorsed by a report by the All Party Pharmacy Group - chaired by Howard Stoate MP - in January which said e-prescribing "has the potential to deliver great benefits".
Indeed there are many issues connected with the 600 million prescriptions issued a year by GPs in England. Patient safety is of course one: e-prescribing would mean pharmacists no longer having to decipher illegible scripts.
Prescription fraud is currently estimated to cost the government £100 million a year. And though the evasion of prescription charges by patients constitutes one part of this, pharmacists substituting a more expensive drug with a cheaper alternative is one of the most common forms of prescription fraud.
Additionally - although possibly to the doctor's chagrin - the government would also have a method by which it could control the NHS formulary and, when there is an alternative drug, enforce the substitution of the cheaper generic version. Doctors may not welcome this degree of interference with their clinical judgement but it is one way the NHS could save a great deal of money.
E-prescribing would also combat other types of fraud such as GPs and pharmacists conspiring to process bogus prescriptions and the theft of medical scripts by those abusing prescribed medications.
There are many potential benefits from the introduction of e-prescribing. However the APPG report said that it was essential that e-prescribing should not be regarded as a process "by which paper prescription is simply replaced by an electronic version. It is a means to an end, that end being the introduction of electronic patient records."
