Why we’re running a prescriptions discovery

Mapping our prescriptions service in Well Renfrew store

We’ve been looking at our prescriptions service.

There’s nothing new about that — as an organisation we do it all the time. It’s the main part of our business and we’re always reviewing different aspects of it to make improvements.

The service has evolved over time. Some of this has been driven by changes in NHS regulations and technology. Other changes have been led by us, most notably our investment in automated, hub-and-spoke dispensing.

So, we’ve decided to run a discovery to answer three fundamental questions about the future of our prescriptions service:

• How can we meet the raised expectations of our customers? The customer experience of getting a prescription from their GP and getting it from their pharmacy hasn’t changed much since the advent of the Internet and the smartphone. It’s still a bit of a hassle. Our assumption is that our customers will — increasingly — expect the same kind of service they get in other areas of their lives: on-demand services that work like magic, hiding the complexity that lies beneath.
• How can we increase the number of items we dispense each year? Pharmacy funding has been cut by the government, so growing our market share is important to us as a business.
• How can we reduce the burden on store staff? Anyone who has seen behind the scenes in one of our stores will recognise this. Our assumption is that there is lots we can do to simplify processes and give better tools to store staff, so they can focus on serving customers.

Our prescriptions service, explained

When we say ‘our prescriptions service’, what we are really talking about is:

• One-off (‘acute’) NHS prescriptions: where patients bring in a paper prescription from their NHS prescriber (usually a GP) and we dispense it for them in store.
• Private prescriptions: as above, but dispensing non-NHS prescriptions. The standard NHS prescription charge and exemptions don’t apply to private prescriptions.
• NHS repeat prescriptions: where patients request a refill of their regular medicines through their GP so that we can dispense it for them in store.
• Managed NHS repeat prescriptions: as above, but we request refills on behalf of the patient with their GP.
• Repeat dispensing: where a GP prescribes a course of medication for us to dispense to a patient at regular intervals.

This is a simplified summary of a complex set of services. There’s lots of other things going on in the background to support this:

• NHS Electronic Prescription Service (EPS): IT infrastructure run by NHS Digital that connects GP (‘prescribing’) systems to pharmacy (‘dispensing’) systems. This has reduced the number of paper prescriptions we deal with, but because EPS only currently works for patients with a nominated pharmacy we still see plenty of paper prescriptions, too.
• Payments and exemptions: we take the standard £8.60 per prescription for customers who pay for their prescriptions, and check exemptions for people eligible for free prescriptions.
• Reimbursement: our stores submit claims to the NHS Business Services Authority to get reimbursed as set out in the Drug Tariff.
• Healthcare Service Centre: our fulfilment centre in Stoke, from where we make sure all our stores are fully stocked with medicines. We’ve started to centralise and automate some of the dispensing process here.
• Home delivery: we run a network of vans that deliver medicines to customers from our stores.
• Well Careplus: we supply around 500 care homes with prescription medicines, with ordering via our Well Pad tablet computers.

One of our delivery vans in Bristol

We deliver all this across our 780 stores, with regional variations in England, Wales and Scotland.

We also provide loads of other services from our stores, from flu jabs to medicines use reviews. We’ve not looked in depth at these other services as part of this discovery — we’ve focused on our core prescriptions service in stores.

You wouldn’t design it like this

Any service that has evolved over a long time accumulates layers of process and technology. Often people will remark you wouldn’t design it like this today.

But we don’t have the luxury of tearing it up and starting again. Millions of people rely on us for things they really can’t do without: their medicines. Therefore, as a business we are quite rightly very operationally focused. We can’t just stop dispensing medicines while we redesign our prescriptions service.

Despite this, we needed to find a way to take a step back from the day-to-day to figure out how to improve prescriptions.

So we decided to give ourselves a focused period of 8 weeks to find out what was going on in our prescriptions service and set a plan to improve it.

Telling us what we already know

There’s at least as many reasons not to embark on an initiative like this as there are in favour of it.

Some people think the current state is just the way things are — no point trying to fix it.

Others have a more optimistic view of change, but just don’t see the point in running an exercise like this. We already know what the issues are, this will just tell us what we already know.

But we knew there was value in this. Even if it told us what we already knew, it would give us — for the first time in a single place — a clear understanding of how the service works and how to improve it.

Seeing things from a different perspective

Talking with colleagues at Well Stalybridge

We start with discovery get a deep understanding of the problems we’re trying to address. During discovery we:

• understand the needs of our customers, services they use and processes they go through
• map the current end-to-end service
• identify pain points and strategies to remove them
• identify opportunities to deliver a better service for customers

It’s really useful when developing digital products — discovery helps us challenge assumptions and validate whether we’re building the right thing.

The real value for us in running our prescriptions discovery has been to see things from a different perspective. This may sound obvious, but this is often really difficult, especially for experts who are so familiar with a particular service.

For this discovery phase we partnered with Common Good, a Manchester-based design studio with experience in healthcare and retail.

By bringing together a multi-disciplinary team, we’ve been able to look at our prescriptions service through a few different lenses:

• The customer lens: by getting out of the building to speak with real customers, we start to understand their experience better (and how to improve it).
• The design lens: using design methods like service mapping and the double diamond, we are able to break down a complex problem (like improving prescriptions) into understandable and addressable chunks.
• The technology lens: with specialists in the team, we are able to figure out quickly whether there are new technologies we can leverage. As Richard Pope wrote, ‘you can’t build what you can’t think of in the first place’.

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This is a big piece of work, but a really important and exciting one for Well.

We’ll be writing more on this blog shortly about what we found through our research on prescriptions and what we’re doing as a result.

Dan Sheldon
Head of Well Digital