Electronic Prescription Service

Moving to Release 2

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.

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

• The Electronic Transmission of Prescriptions Programme

will develop the Electronic Prescription Service and

integrate it with the NHS Care Records Service (NHS CRS)

…

The ETP Programme

How the EPS

works

Electronic copyof prescription

Electronic copyof prescription

Confirm what has been dispensed

Paper prescription

Prescription With barcode

Medication dispensed

Scanned barcode

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Release 1

Electronicprescription

Electronicprescription

Confirm what has been dispensed

Medication dispensed Dispensing token

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Tokens

Prescription token

Scanned barcodenon-nominatedprescriptions

Electronic Prescription & endorsementmessage

Release 2

Implementation

Overview of implementation

R1 Initial implementer

sites

National deploymentof Release 1

Release 1 Release 2

TimeNo

. o

f s

ite

s

Transition with both Releases operating

FullEPS

National deploymentof Release 2

Transition with Release 1 operating in some places only

R2 Initial implementer

sites

• Nomination• Electronic signatures

(nominated prescriptions only)• Electronic cancellation • Electronic repeat dispensing• Electronic submission of

reimbursement endorsements

Legislation change to enable most prescriptions to be signed electronically

Wave 11. Berkshire East 2. Leicestershire County & Rutland3. Liverpool4. Southwark5. Sunderland

Wave 26. Berkshire West7. Birmingham East & North8. Blackburn with Darwin9. City & Hackney10. Haringey 11. Isle of Wight12. Leeds13. North East Lincolnshire 14. Nottingham City15. Nottingham County16. Suffolk17. Trafford

Release 2 Initial implementers

Smartcards for

EPS Release 2

Nomination

The nomination process

ApplianceContractor

Dispensing GP Practice

Community Pharmacy

up to 3 dispensersPatient or their representative

GP

HealthSpace

Dispenser

can set at their nominated dispenser at any EPS location

Patients can view the status of dispensers online at www.nhs.uk

Only staff at adispensing GP practicecan set a patients nominateddispensing practice

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

patient’s request in a timely manner

• 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

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 patient’s list of nominated

dispensers at any time, supporting scenarios such as

aiding patients who try to get their medication at an

incorrect location

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

Nomination process – key points

• 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

PCTs should ensure the principles ofnomination are adhered to

Use of paper

in EPS 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

The use of paper in Release 2

Prescription token

The prescription token must be printed when:

• An electronic prescription is generated, but not sent to a

nominated dispenser

• The patient elects to receive a prescription token

• The prescriber decides a token is required

• An electronic repeatable prescription is generated

The token can be reprinted at any time

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

Dispensing token

• The dispensing token is similar to the prescription token,

except that it is printed on white stationery, labelled

“Dispensing Token” and has no security features

• In addition to capturing the patient’s declaration, a token

may be printed for a patient who needs to visit a different

dispenser for their medication

• Dispensing doctors can use the FP10SS stationery for

dispensing tokens

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

Dispensing token – content (RHS)

The right hand side of the dispensing token will contain:

• A repeat medication list

• Medication Review date

• Information related to individual prescription items

• Clinical information from the prescriber to the patient

Dispensing systems will also highlight non-routine information

such as:

• Patient or medication specific instructions from prescriber

• Review date is due in the next 4 weeks

• The last authorised issue of item has been given

Electronic

Cancellation

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”

• 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

Origination of cancellation request

• 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

Cancellation rejections

• 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

Amending a prescription

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

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

Initiating electronic 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

Changes to paper-based repeat dispensing

• 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

Availability of the next issue

Submission of

electronic

reimbursement

endorsements

• 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

Reimbursement endorsement process

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

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

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

PRESCRIPTION DATA              

Total forms received (including ETP forms)         3735

Total electronic prescriptions received         225

Total electronic prescription items received         561

Items at zero discount rate, for which a fee is paid       417

Items at standard discount rate, for which a fee is paid (including oxygen)   6576

Total of items, for which a fee is paid         6993

Where are we

now?

Timeline of achievements

Dec 04

Release 1 delivered into Spine

Feb 05

First GP and Pharmacy site

Go-live

May 06

1 million electronic prescriptionmessages transmitted

May 07

20 million electronic prescriptionmessages transmitted

Aug 06

Release 2 delivered into Spine

TodayJune 07

EPS Release 2Initial implementation

PCTs announced

135 million electronic prescriptionmessages transmitted

Jason.Clarke@nhs.net

www.connectingforhealth.nhs.uk/eps