Best Practice Guidance: Ordering Medication Using Proxy Access

A vast number of repeat prescriptions are generated for care home residents each month, with many residents taking 4 or more medicines. Many current ordering processes are complex and convoluted involving the care home, community pharmacy and GP practice. Some areas have noted that this has led to delays in medication being available to residents in care homes, over ordering and wasted medication. This, in turn, then leads to safeguarding concerns.

Given the volume of prescriptions and the fact that care home residents can be more vulnerable to the adverse effects of medicines, leading to ill health and hospital admissions, it is important that good procedures are in place to prevent error and harm. Since 2002 GP practices have been able to offer online access to their patients so they can access their patient record, book appointments, and order their medication. Proxy access refers to access to online services by somebody acting on behalf of the service user and with the service users’ consent.

Benefits to proxy ordering

Care home:

  • Improves access to ordering for the care home staff which can be day or night.
  • Reduces time on the phone or on hold, for example for chasing medicines orders.
  • Can message the GP practice, e.g. to ask for medication to bring in line with the medication cycle.
  • Allows more time to care for patients/residents.
  • Allows prescriptions to be tracked through the system.
  • Straight forward system to use and easy for staff to be trained.

GP Practice/POD:

  • Reduces the amount of time it takes admin staff to enter each prescription onto the Computer system.
  • Reduces the amount of medicines queries and so frees up time.
  • The GP practice will be notified by the care home if: patient is in hospital. patient moved to another care setting or patient has died

Covid-19 related benefits:

  • Risk of transmission is reduced as contact is not required due to use of digital processes.
  • Allows prompt information transfer.
  • Frees up staff allowing more time for organisations to spend with patients on patient care.

The solution is not complicated but does require the completion of the following paperwork as it is essential that resident/patient privacy is respected and protected:

  • Data sharing agreement between the care home and GP practice
  • Patient consent form to allow electronic ordering
  • Proxy ordering request form for care home staff

Guidance produced by NHS England has been reviewed and agreed by Lancashire and South Cumbria Proxy Ordering Group as part of the Integrating NHS Pharmacy and Medicines Optimisation (IPMO) programme. A recording of a recent webinar along with the slides can be found on the Lancashire and South Cumbria Medicines Management Group (LSCMMG) website. On this website you will also find the local process, forms, guides and FAQs to support best practice for CQC registered care homes, GP practices and pharmacists to work together to allow care home staff to order online repeat medication on behalf of residents.

Please note, the email address for support for care homes with NHS email has been corrected in the slides to be england.dsptnorth@nhs.net.

Staff have already been identified and are ready to roll out and offer support to implement proxy ordering of care home patient’s medication across West Lancashire. If you have any further questions, please look at the NHSX FAQs before contacting the MOCH Team if you wish to discuss further.

** Before proxy access for care home staff can be set up, the care home must have a secure email system and preferably the NHSmail system. Further information is available in another guide Data Security Protection Toolkit (DSPT) and NHSmail guidance.

Last updated on 30 December 2020 at 10:45 by Samantha Russell