I am a GP in Northampton and for some time, around 2006, I was concerned that my practice did not have a robust system for monitoring patients on dangerous drugs such as methotrexate and azathioprine. We tried to keep a manual database for our patient register, but with patients stopping and starting these drugs, moving in and out of the practice, and needing different tests at different time intervals, it was a really difficult task, and I suspected that we were missing patients and, therefore, it was hard to keep track of who needed reminding regarding tests.
I tried working with my Practice Manager to create a more sophisticated spreadsheet in Microsoft Excel, then when that failed, within Microsoft Access. Again, we kept on coming across problems and I knew we hadn’t cracked the problem yet.
Then I started talking to Tim – Tim is an IT software developer and, while we were watching our children’s swimming lesson, I was explaining to him the complexities of what I was trying to achieve, and he immediately took up the challenge and promised to write me a bespoke programme. Two years later and many Sunday afternoons spent drinking oodles of cups of tea, Neptune was created. We have been successfully running Neptune in my GP surgery since 2008, following which we introduced it to four beta testing sites. The system worked remarkably well from the start and very quickly we expanded to other local practices. Over the past 2 years we have been fortunate enough to roll out across the whole of Leeds Clinical Commissioning Groups (CCGs)(approximately 100 GP practices).
Neptune’s success lies in its simplicity. It is a relational database that stores information about as many drugs as you would like, such as generic and brand name, BNF category and what monitoring tests are required. It uses three simple reports from the GP practice system to upload patient, drug and testing information and then puts this all together into a reminder list and either prints reminder letters, sends an email through a secure nhs.net account or produces an SMS text alert via MJOG.
If the patient does not respond to their reminder, then a second reminder and then a third reminder is sent, with the final reminder being an alert to the prescribing GP.
Like all new developments, we have faced a few challenges along the way. Not least was how to roll out to 100 practices in Leeds which is a long way from Northampton. We brought other members on to our team, and now have two trainers and two other software support as well as me and Tim. We love going into GP practices and seeing how everyone has tackled this problem differently, or not at all in some places. We have found, in general, the better the system already in place, the more Neptune is appreciated as the practice already appreciates what a difficult task this is.
Neptune continually evolves and we love to change according to user feedback. We are now on to version 4, with version 5 just around the corner.
Our current project is to include not just CCG defined amber drugs for the Near Patient Testing Direct Enhanced Service, but all drugs that require monitoring such as diuretics, ACE inhibitors and thyroid drugs. This will increase the patient population that Neptune monitors considerably, but the impact on patient safety will be immeasurable and, hopefully, will improve safety, reduce hospital admissions and, ultimately, iatrogenic harm and even death.
We would love to roll out Neptune to as many practices as possible as we believe this is the best, most accurate and efficient way of performing this challenging task.