Getting urgent medication into the hands of those who need it with REMEDY

It was the middle of a wild, stormy January night in 2023 in Orkney, where I was working clinically in out-of-hours. Three times, I had calls from patients that I dealt with by video or phone. But they needed medication urgently. Three times, I left my nice, warm bungalow through the storm, trudged up to the hospital and dragged these poor patients in. Some of them were from areas four islands away, where they had to travel across a sea-level causeway, with the sea crashing on them.

That’s the sort of journey many patients have to make for medication.

Everywhere is struggling with the same problem

I’m a remote and rural GP, and my DPhil focus is part of a broader project that I’ve set up, assessing the potential solutions to getting access to urgently required medication after a 111 call. 70% of 111 calls are entirely dealt with by phone. However, many people urgently need antibiotics or other medications, but then need to travel considerable distances overnight and at the weekends when local pharmacies are shut!

After that night in January 2023, I was so frustrated that I went on an online rant: ‘It’s the 21st century! There must be a technological solution! Has anybody got a machine that we could pre-position and allow access to medication?!’

A potential REMEDY?

Rebecca and the REMEDY machine have been featured by the BBC several times

Someone suggested I speak to a professor in Aberdeen who had looked at something similar a decade ago; another person from a technology company got in touch saying, ‘I’ve got a machine that we could adapt for this.’ I took it to academia: I was an NIHR In-Practice Fellow at Oxford in Trish Greenhalgh’s team, which works on healthcare and technology. I spoke to a range of people, including the professor in Aberdeen and colleagues in England and Wales, and brought those interested to the manufacturer’s factory to discuss future steps.

REMEDY (Remote Medication Made Easy) is a medication vending machine that’s preloaded, remotely controlled, and the clinician from 111 can issue medication through it via PIN code, which the patient enters while still in their local community, to get the medication that they need.

North Wales were very keen and, two years later, we have a REMEDY up and running in Dolgellau, issuing medications to people that really need them (it’s otherwise a three-hour round-trip during out-of-hours). There’s been a lot of interest worldwide, including Australia.

People find it transformative. The most enthusiastic people are the local GPs. People turn up in very bad condition on their doorsteps, having delayed seeking healthcare because they can’t travel to access medication. They anticipate that it’ll make a big difference to workload, too.

The academic side

The project belongs to the NHS in North Wales, but it’s a three-part effort also including me (and the University) on the research side and the manufacturer who lent us the machine and funded the software development. I use something called developmental evaluation, where I’m embedded within the project team and feed in insights to optimise the chances of success. It’s worked really, really well.

For me, the most important question is: Does it work and is this an effective use of taxpayer money? I’ve successfully secured funding from the Welsh government through Health and Care Research Wales for an evaluation, of which my DPhil is one component, but also includes a health economics assessment.

I think there’s a real risk of unintended consequences, which is why the academic piece is so vital for understanding the nuances and ensuring we’re not causing new problems while attempting to solve old ones. We have to be extremely careful to really understand the potential impact because what we don’t want to see is community pharmacies shutting down.

The support from Reuben College and the Reuben-Clarendon Scholarship

I’m a part-time student and Reuben-Clarendon Scholar. My advisor, Ben Lambert, and the Senior Tutor are great: it’s nice to be somewhere and people know my name, know what I do and say hello! Oxford is such a big university, particularly as a part-time member who lives away – it’s easy to feel lost. And then, you come into Reuben College and you feel like you belong. When I come up, I try to cram in as many meetings and collaborations as possible. Having somewhere that I can bring people to and have meetings? It’s just fantastic.

Reuben just feels like a home away from home when I’m in Oxford.