A constructivist approach? using formative evaluation to inform the electronic prescription service implementation in primary care, England.

As part of the National Programme for IT (NPfIT) in England, the Electronic Prescription Service (EPS) is being implemented in two releases. The first release placed barcodes on prescriptions and is widely implemented. Release two (EPS2), the electronic transmission of prescriptions between GP, pharmacy and the reimbursement body, has just started implementation. On the NPfIT agenda, community pharmacies have been predicted to benefit from changes in work practice following the full EPS implementation. The study focused on how the advanced EPS (EPS2) might alter dispensing work practice in community pharmacies on issues such as workflow and workload; and the bearing of these issues on improvement in quality of service and safety. This paper demonstrates how findings of the pre-implementation study were used to provide formative feedback to the implementers. A mixed ethnographical method that combined non- participant observations, shadowing and interviews, before and after implementation, was used to qualitatively study eight community pharmacies across three early adopter Primary Care Trusts (PCTs) in England. Key implementation issues were fed-back to the PCTs as part of the EPS2 rolling-out process. Staff access to dispensing terminals needs to be improved if electronic dispensing is to be encouraged. Also, as a safety issue, pharmacists are planning to print off electronic prescriptions (tokens) and dispense from them. Although safer, this could increase workload. The EPS2 could positively alter work practice by improving certain demanding aspects of dispensing whilst reducing human errors. For example, the high demand of customers handing in prescriptions and waiting for them to be dispensed could be reduced through automation. Also, the extreme variation in workload during various times of the day could be evened out to improve workflow and provide a better service; however, in order for this to be fully realized, technical issues such as number of staff per dispensing station and dispensing from tokens would need to be addressed.