A service evaluation of NHS prescription ordering direct in Staffordshire and Stoke-on-Trent Integrated Care Board

Repeat prescribing generates substantial workload within general practice and can contribute to avoidable medicines waste across the NHS. Prescription ordering direct (POD) services aim to centralise repeat prescription ordering processes and support patients to take greater control of their medicines ordering.

NHS Midlands and Lancashire Commissioning Support Unit (NHSML) implemented a POD service across six GP practices within Staffordshire and Stoke-on-Trent Integrated Care Board (ICB) between February 2024 and February 2026. The service was introduced using a phased rollout model and provided repeat prescription ordering through a dedicated telephone line and online webform, using trained call handlers within an NHSML call centre led by the medicines management team. It operated with structured governance arrangements to improve medicines optimisation and reduce unnecessary prescribing.

Evaluation examined operational activity, patient satisfaction, workforce impact and prescribing outcomes associated with the service. To reduce distortion caused by the introduction of generic rivaroxaban and apixaban during implementation, the prescribing items and costs of these direct oral anticoagulants (DOACs) were excluded from comparative analysis.

The primary evaluation compared the fully operational six-practice period from December 2024 to February 2026 with the equivalent prior-year comparator period from December 2023 to February 2025. Expected prescribing growth assumptions of 3% annually for prescribing items and 5% annually for total actual cost (TAC) were applied to estimate projected growth trajectories.

During implementation, the POD service processed more than 49,000 prescription requests across the participating practices. Operational performance — including patient satisfaction — improved progressively throughout implementation. A satisfaction survey conducted in August 2024, which received 423 responses from the initial four practices, showed a satisfaction rate (extremely satisfied or satisfied) of 65%, with 57% respondents stating they would recommend the service to a family member or friend.

A second satisfaction survey carried out in April 2025, which involved 979 responses from all six practices, showed a patient satisfaction rate of 73% (extremely satisfied or satisfied), while 69% of respondents stated they would recommend the service to a family member or friend.

Prescribing analysis demonstrated measurable reductions in prescribing growth. Total prescription items reduced from 1,279,565 during the comparator period to 1,268,715 during the POD evaluation period, representing a reduction of 10,850 items (0.85%).

Based on expected annual prescribing growth of 3%, prescribing volume would have been expected to increase to 1,317,952 items. The POD service achieved an estimated prescribing growth avoidance of 49,237 items, which is equivalent to 3.74% below projected growth.

Total actual cost reduced marginally from £10,888,968 to £10,882,985, a reduction of £5,983. However, when compared with projected 5% annual growth, costs were £550,431 lower than expected, which is equivalent to 4.81% below the projected growth.

The evaluation demonstrated that a clinically governed POD model can release GP administrative capacity while supporting medicines optimisation objectives across primary care. The most significant finding was not simply a reduction in prescribing items but suppression of expected prescribing costs across participating practices.

The findings suggest that centrally managed repeat prescription ordering may help reduce unnecessary medicines ordering activity. Wider system benefits included workforce release, improved patient access and standardised governance processes.

Strong engagement between NHSML, GP practices, community pharmacy stakeholders and the ICB was critical to successful implementation. Clear patient communication and a phased rollout also supported operational stability and service adoption.

As a real-world NHS transformation programme, the evaluation cannot demonstrate direct causation. However, the findings provide evidence that POD services may represent a scalable approach to managing repeat prescribing demand while improving operational resilience within general practice.

Over the past decade, there have been many POD services in the NHS. These have been developed in areas including Coventry and Warwickshire, Luton, Bolton, Norfolk and Waveney, Shropshire, Telford and Wrekin, Birmingham, Bath and north-east Somerset, Swindon and Wiltshire. There is surprisingly little in the published literature evaluating POD schemes.

In 2023, Healthwatch Suffolk published the results of an independent analysis of the POD service in Norfolk and Waveney, focusing on patient, carer and public feedback^​1​. A total of 92% (n=2,482) of responses were negative about the proposal to close the POD service. Responses highlighted the benefits of telephone ordering for groups such as the elderly and vulnerable.

The NHS App is increasingly being promoted as the national system to order repeat medication. A systematic review of the NHS App in 2026 highlighted that there is an inverse deprivation gradient with use of the app^​2​. The POD model may still have merit at neighbourhood level across groups of GP practices, delivering an efficient telephone ordering system, with the opportunity for medicines optimisation interventions to support those who are unable to access or use the NHS App.

Gurjinder Samra, senior pharmacist at NHS Midlands & Lancashire

Jonathan Horgan, director of pharmacy services at NHS Midlands & Lancashire

Paula Wilson, associate director of pharmacy – partnerships at NHS Midlands and Lancashire