Moving from paper to electronic prescriptions

EPS in a nutshell EPS enables prescriptions to be sent electronically from the GP to the pharmacy ready for collection. It makes the prescribing and dispensing process more convenient. 2

What happens now? Patient Pharmacy Surgery Pharmacist staff Doctor Pharmacy Pharmacist Payment agency First line FMcD MH the process, many hands, three computer systems, lots of trips for patient MH finish with ‘There must be a better way than this!’

EPS is a more efficient way! Patient Doctor Pharmacy Payment agency First line FMcD MH the process, many hands, three computer systems, lots of trips for patient MH finish with ‘There must be a better way than this!’

EPS is a more efficient way! Patient Doctor Pharmacy Payment agency X First line FMcD MH the process, many hands, three computer systems, lots of trips for patient MH finish with ‘There must be a better way than this!’

Key benefits Patients Prescribers Dispensers Greater convenience Increased freedom of choice Reduced pharmacy waiting times Potential reduction in workload. Easier to use repeat dispensing Greater efficiency and control . Greater efficiency Streamlined workflow Easier month end processing Patients Prescribers Dispensers 6

Tokens The legal prescription is now the electronic message Paper copies of electronic prescriptions are called tokens There are two types of token: Prescription Tokens (printed at the GP Practice) Dispensing Tokens (printed at the pharmacy) Even when the Electronic Prescription Service is fully introduced, paper copies of electronic prescriptions will always need to be made available, by the GP practice or the pharmacy, where necessary. Paper copies of electronic prescriptions are called ‘tokens’. They act as a hard copy of the details contained within the electronic prescription. There are two types of token, known as ‘prescription tokens’ and ‘dispensing tokens’.

Prescription tokens Are printed at the GP practice on paper FP10 prescription forms. Are not signed by the prescriber because they are only a copy of the electronic prescription which the prescriber has signed electronically. Must be printed and given to the patient where clinical information needs to be communicated to the patient (that would have traditionally been placed on the right hand side of the prescription) or at the patients request. Must be printed and given to the patient at the start of a repeat dispensing regime (this token will look the same as a prescription token but will also include the number of batch issues).

Prescription tokens Can be used by the dispenser to retrieve the electronic prescription from the Spine (although most nominated prescriptions will be automatically downloaded overnight). Are printed with a barcode and the name and address of the nominated dispensing contractor .This will help to ensure the patient always knows who they have nominated.

Prescription tokens Must not be manually amended in any way. If a prescriber wishes to amend what they have prescribed, the original electronic prescription must be cancelled (where possible) and a new prescription issued. Can be reprinted; the reprint will be an exact copy of the original prescription token. (Prescribing systems may show the user if a token has already been printed. Instances where a prescription token may need to be reprinted include if the patient loses the original).

Dispensing tokens Should be printed when the patient needs to sign for payment/exemption declaration purposes if a patient hasn’t got a prescription token (not required for patients that are age exempt). Should be printed when a patient needs to go to a different dispensing contractor to collect their medication, their nominated dispensing contractor can return the prescription to the EPS and provide the patient with a dispensing token to hand in at the other EPS Release 2 enabled dispensing contractor.

Dispensing tokens Should be printed when clinical information from the prescriber needs to be communicated to the patient (information that would have traditionally been placed on the right hand side of the prescription)  Can be reprinted; the reprint will be an exact copy of the original token. Dispensing systems may show the user if a token has already been printed.

Dispensing tokens look almost identical to prescription tokens except they are printed at the dispensing contractor on white stationary (FP10 DT). PCTs are responsible for providing dispensing tokens. Local processes for requesting these should be put in place. As dispensing tokens are simply a copy of the prescription details, they should never be signed.

Three essential requirements for EPS-R2 An adequately functioning EPS-R2 enabled dispensary system Sufficient staff authorised to use the system - each with their own R2 enabled smartcard Patients that have registered a preferred nominated pharmacy

Nomination Principle 1 Patients must be provided with sufficient information about EPS before nomination is captured Must be AN INFORMED DECISION

Nomination Principle 2 2(a) Dispensing contractors must not offer any type of inducement to encourage patients to nominate them 2(b) Primary medical care contractors shall not seek to persuade a patient to nominate a dispenser recommended by the prescriber or the contractor Patients must not be influenced to nominate a specific dispensing contractor Principle 2 – Dispensing contractors must not offer any type of inducement to encourage patients to nominate them

Nomination Principle 3 Prescribers and dispensing contractors will need to capture, record and act on a patient’s nomination request in a timely manner. This principle has two distinct aspects: Setting, changing and cancelling a patient’s nomination request in a timely manner making sure that the re-confirming of nomination is done in a timely way. Principle 3 – Dispensing contractors will need to capture, record and act on patient’s nomination request in a timely manner

Nomination Principle 4 Standard Operaing Procedure Prescribers and dispensing contractors must establish Standard Operating Procedures for nomination Principle 4 – Prescribers and dispensing contractors must establish standard operating procedures for nomination

Management of nominations Pharmacists need to think about how they are going to obtain nomination requests Need to check what their PCT expect in regards to written consent Are they going to use leaflets to explain the service and capture written patient nominations Are they going to write down nominations in a book What if they have delays in getting their system – how are they going to confirm nominations Who will enter the nominations on the day of go live?

Electronic Repeat Dispensing Will become the most common type of prescription Unlike paper-based repeat dispensing, electronic repeat dispensing is possible from a single electronic prescription and does not require paper batch issues to be printed.

Electronic Repeat Dispensing If the patient needs to sign for payment/exemption declaration purposes, the pharmacist is required to print a dispensing token each time. The pharmacist should inform the patient once all authorised repeats have been dispensed or the prescription is complete to go back to their GP.

Electronic cancellation of prescriptions If you receive a cancelled electronic prescription, you should manually download all electronic prescriptions on your system as the prescriber may have replaced the cancelled prescription with a new one. It is likely the prescriber may have added a message to the right hand side to say that this prescription replaces the cancelled one.

Electronic submission of reimbursement endorsements Electronic prescriptions must be claimed via EPS. An electronic claim can only be sent once the prescription has been completed; items should be marked as either ‘dispensed’ or ‘not dispensed’. One FP34 form must be completed and submitted to the NHS BSA Prescription Services (NHS RxS) to cover both paper and electronic prescriptions.

FP34C The number of EPS Release 2 prescription reimbursement messages and items submitted online added to the number of paper FP10 prescriptions and items. Enter the combined figure for each in the appropriate box Tick if EPS tokens for non-payment are being sent Tick if EPS Release 2 prescription reimbursement messages have been submitted have been submitted and included in the part 1 totals of prescriptions and items submitted

What should I do about business change? To maximise the benefits of EPS Release 2, pharmacies need to adapt existing business processes. These changes need to be communicated to staff. Business processes are unique to every pharmacy so ensure locums are briefed on these changes.

Standard operating procedures (SOPs) Business continuity Nomination Dispensing Accuracy checking Smartcards Claiming Endorsements Exemptions

New processes for pharmacies obtaining prescriptions using tokens accuracy checks managing patient nominations sending dispense notifications electronic endorsements and exemptions electronic claiming end of month processes

Tip Remember to order the dispensing token stationary before you go live with EPS Release 2.

Tip Make sure you have plenty of Dispensing Tokens in stock so that you don’t run out!

Tip Ensure that you always have a spare cartridge available for your laser printer before the old one runs out to enable you to print dispensing tokens.

Sending Dispense notifications Dispense notifications must be sent as soon as electronic prescription items have been collected/delivered to the patient. The dispense notification message informs EPS which medication has/has not been supplied to the patient and also ensures the next repeat dispense issue comes down from EPS on time.

Endorsements All endorsements for electronic prescriptions must be submitted electronically to NHS RxS. In the same way as now other endorsements will also be required such as endorsements to claim broken bulk, out of pocket expenses or the ‘No Cheaper Stock Obtainable’ (NCSO) concession.

Payment / Exemption Declarations FP10’s and tokens will need be accompanied by a signed FP34C prescription claim form indicating the total number of prescriptions submitted (electronic and paper combined) The FP34C form has already been updated with these changes.

Key Points Ensure that everyone in your pharmacy that needs an EPS-R2 smartcard has one – PERSONAL USE ONLY – no sharing! Understand how processes will change - use the training provided by your system supplier and involve the whole team Know how to check, register and amend patient nominations Know what to do when a patient arrives expecting a Rx which you don’t have Search by nomination Retrieve from another pharmacy (patient choice is paramount) Liaise with surgery System supplier trace by GUID

What to do when things go wrong Report in the first instance to your system supplier – get a reference number If response is unsatisfactory escalate through the PCT Keep the LPC informed any major issues

Questions ?