Electronic Prescription Service

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Electronic Prescription Service Moving to Release
2
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Prescriptions - the need for change
With about 1.5 million prescriptions being issued
every working day in England and this figure
expected to rise by over 5 each year we need
to change from a paper-based prescription system
to an electronic one which is more efficient.
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In addition

• About 70 of prescriptions are repeats so we need
  a system designed for this pattern of prescribing
  
• Future strategy for pharmacists requires them to
  become better integrated into the primary care
  team. Integrated IT will help to support this
• The development of the NHS Care Records Service
  (NHS CRS) requires the electronic capture and
  recording of prescribing and dispensing
  information

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How the EPS works
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Release 1
Electronic messaging
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Release 2
Electronic messaging
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Implementation
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Overview of implementation
R1 Initial implementer sites
R2 Initial implementer sites
National deploymentof Release 1
National deploymentof Release 2
FullEPS
Release 1
Release 2
No. of sites
Time
Transition with both Releases operating
Transition with Release 1 operating in some
places only
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Release 2 Initial implementers
Wave 1 1. Berkshire East 2. Leicestershire
County Rutland 3. Liverpool 4. Southwark 5.
Sunderland Wave 2 6. Berkshire West 7.
Birmingham East North 8. Blackburn with
Darwin 9. City Hackney 10. Haringey 11. Isle
of Wight 12. Leeds 13. North East Lincolnshire
14. Nottingham City 15. Nottingham County 16.
Suffolk 17. Trafford
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Smartcards for EPS Release 2
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Nomination
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The nomination process
Patient or their representative
can set at their nominated dispenser at any EPS
location
up to 3 dispensers
Dispensing GP Practice
GP
Community Pharmacy
Dispenser
Appliance Contractor
HealthSpace
Patients can view the status of dispensers online
at www.nhs.uk
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Principles of nomination

• In order for a patient to request a nomination
  they will need to be informed about the EPS and
  the ability to nominate a dispenser
• Contractors must establish Standard Operating
  Procedures for nomination
• Contractors must not offer any type of inducement
  to encourage patients to nominate them as their
  dispenser
• Contractors will need to capture, record, and act
  on a patients request in a timely manner

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Nomination process key points

• Setting the nominated dispensing contractor will
  require the patients NHS number (this can be
  obtained from the FP10 or by using a simple
  trace on the NHS Care Record)
• Updating of the patients record with the
  nomination status can occur at a convenient time
  to support smoothing of workflow requires
  smartcard
• Patients must nominate a specific dispensing
  location and cannot nominate a chain of
  dispensers

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Nomination process key points

• Dispensers will not be notified when they have
  been nominated
• If the patient does not wish to use their
  preferred dispenser, a prescriber will generate a
  prescription that the patient can get dispensed
  at any location
• Dispensers can query a patients list of
  nominated dispensers at any time, supporting
  scenarios such as aiding patients who try to get
  their medication at an incorrect location

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Nomination process key points

• Patients can change their nominated dispensing
  contractor at any time
• When a patient changes their nominated dispenser
• All existing nominated prescriptions and
  prescription issues that have not been downloaded
  are transferred to the new dispenser. This
  includes repeatable prescriptions.
• The existing dispenser is not notified of the
  change

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PCTs should ensure the principles ofnomination
are adhered to

• Develop processes for when a complaint has
  occurred
• Be aware that there will be reports available to
  audit how nominations are made
• Ensure Patient Advice and Liaison Services have
  been informed of the principles
• Ensure GP practices use the facilities for
  searching for nominated dispensers in an agreed
  manner (for example by using the patients
  postcode) to meet the requirement of providing a
  list for PCTs

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Use of paper in EPS Release 2
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The use of paper in Release 2

• Tokens are required when
• Capturing patient exemption declarations
• Presenting a prescription when the patient has
  not nominated a dispenser
• The patient needs to obtain their medication from
  a different dispenser
• Where clinical information needs to be
  communicated

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Prescription token content (LHS)

• The left hand side of the prescription token will
  contain the same information as an FP10. In
  addition, the following information will be
  printed
• Whether the prescription has been nominated or
  not
• A barcode and prescription ID
• Text in the signature box to invalidate the
  prescription as legally valid

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Dispensing token content (LHS)

• The left hand side will contain the same
  information as on a prescription token, except
• If the token is used when returning a
  prescription to the EPS and given to the patient,
  then no dispenser details are printed
• Pre-printed information within signature area

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Electronic Cancellation
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What is electronic cancellation?
Electronic cancellation enables a prescriber (or
authorised person in the GP practice with
cancellation rights on their smartcard) to cancel
an electronic prescription at any point prior to
it being dispensed. GP clinical systems will
allow cancellation of either whole prescriptions
or individual items on that prescription
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Origination of cancellation request

• A prescriber within the organisation where the
  prescription was originated can authorise the
  cancellation
• Prescribers will always have the authority to
  cancel prescriptions. Sponsors can choose to add
  cancellation authority to any smartcard
• A prescriber should never assume a prescription
  has been cancelled unless a positive response has
  been received. A prescribing system will inform
  the prescriber if a positive response has not
  been received within 5 minutes

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Cancellation rejections

• Where a prescription cannot be cancelled (for
  example because it is with a dispenser) existing
  procedures for stopping the dispensing of a paper
  prescription should be followed
• To support this, the prescribing system will show
  which dispenser has downloaded the prescription,
  together with their contact details
• No further action is required if a prescription
  has expired or has already been cancelled

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Amending a prescription

• Cancellation requests cannot be cancelled. To
  reinstate a prescription, a new prescription
  must be generated
• Prescriptions cannot be amended once sent. To
  make amendments, prescriptions have to be
  cancelled and regenerated

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Electronic Repeat Dispensing
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Initiating electronic repeat dispensing

• Patients must consent to share information
  between their prescriber and dispensers. Existing
  agreements in place for paper based repeat
  dispensing can be used for electronic repeat
  dispensing this is not related to PDS consent

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Initiating electronic repeat dispensing

• Paper based repeat dispensing prescriptions are
  not migrated to electronic repeat dispensing when
  a GP Practice implements EPS Release 2
• If a patient can be transferred manually from
  paper based repeat dispensing to electronic
  repeat dispensing, the prescribing systems will
  notify the prescriber

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Changes to paper-based repeat dispensing

• A patient will always receive a prescription
  token when they receive a repeatable prescription
• The patient can use the prescription token to get
  medication dispensed from any EPS Release 2
  dispenser.
• When a patient changes their nominated dispenser,
  all repeatable prescription issues not downloaded
  will transfer to the new nominated dispenser

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Availability of the next issue

• All items on a repeatable prescription issue must
  be processed (dispensed or not dispensed) before
  the next issue can be released
• The dispenser can retrieve the next issue at any
  point after the previous issue has been completed
  using the prescription ID, or it will be included
  in the nominated prescription response

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Submission of electronic reimbursement
endorsements
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Reimbursement endorsement process

• Reimbursement endorsements for electronic
  prescriptions must be submitted electronically,
  at the end of the month as now
• There is no time restriction between retrieving a
  prescription and submitting a dispense
  notification, other than the legal validity of
  the prescription. However, a claim must be made
  within 180 days of dispensing the medication
• Prescribing and dispensing tokens, where they
  contain a patient declaration, must be submitted
  to the PPD in the same month as the claims that
  they pertain to

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Reimbursement rules remain the same

• The existing endorsement rules operate in the
  same way
• Declarations (signatures) for exemptions and
  chargeable prescriptions must be captured on
  paper
• Prescriptions must be completed before they can
  be reimbursed
• The payment schedule is the same as for paper
  prescriptions

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Submission requirements

• Combined number of prescriptions and items (both
  paper and electronic) that have been submitted
  must be declared on the FP34
• Additional boxes have been added to the
  submission document, in order for the contractor
  to inform the PPD that electronic prescriptions
  and tokens have been submitted

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Payment schedule

• Payment for both electronic prescriptions and
  paper FP10 prescriptions is combined as one
  monetary total
• Prescription data on schedule shows additional
  information detailing total electronic
  prescriptions/items received

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Where are we now?
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Timeline of achievements
Release 1 delivered into Spine
EPS Release 2 Initial implementation PCTs
announced
Release 2 delivered into Spine
130 million electronic prescription messages
transmitted 80 Technically enabled
First GP and Pharmacy site Go-live
20 million electronic prescription messages
transmitted
1 million electronic prescription messages
transmitted
Dec 04
Feb 05
May 06
May 07
Aug 06
Today
June 07
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Jason.Clarke_at_nhs.net www.connectingforhealth.nhs.u
k/eps