Preparing for EPS2 LPC Forum 8th May 2014 Intro. Today is about adding to the information you already have about EPS2 and to look at the topics that need thinking through in terms of changes to your business processes, in good time before your Go Live. We have x hour(s)…check

Who's Who Amanda Marshall Assistant Contract Manager (Pharmacy) Surrey & Sussex Area Team - NHS England amanda.marshall@nhs.net Area Team Role: Authorising GP practices to go-live Assurance of CCG deployment Provision of dispensing tokens Monitoring nominations and dealing with complaints Provision of Registration Services (smartcards)

Who's Who Gary Mortimer Senior Implementation Manager, EPS Health and Social Care Information Centre gmortimer@hscic.gov.uk HSCIC Role: Support the delivery of IT infrastructure, information systems and standards to ensure information flows efficiently and securely across the health and social care system, to improve patient outcomes. Support local deployments. Share lessons learnt from other deployment Provide escalation and feedback.

Who's Who Becky Gayler Clinical Informatics Manager Brighton and Hove Clinical Commission Group becky.gayler@nhs.net CCG Role: Responsible for implementation of EPS: Project Management Engagement Communications Business change Training for GP practices Benefits realisation

EPS2 In a Nutshell What? Why? How? It enables prescriptions to be generated, transmitted and received electronically – without the need for paper in some cases

Patient decides which Release 2 enabled dispensing contractor to nominate by either looking for the EPS sign displayed in the dispensary or by searching online at www.nhs.uk Patient asks a member of staff at either a Release 2 enabled dispensing contractor or at their GP practice to record their nomination for them. Over time the patient will be able to record their own nomination on HealthSpace Next time the patient needs a prescription, they request it in the same way as today The GP generates an electronic prescription and signs it electronically. The electronic prescription is then sent to the Electronic Prescription Service The nominated dispensing contractor’s system retrieves the electronic prescription automatically The dispenser can choose to prepare the prescription in advance of the patient arriving Patient goes directly to their nominated dispensing contractor without having to call at the GP practice first to collect a paper prescription Upon arrival at the nominated dispensing contractor, the patient confirms their personal details and their prescription item(s) is handed to them If required (to capture payment/exemption declaration or at the patient’s request), the dispenser prints a dispensing token The dispenser sends a dispense notification to the Electronic Prescription Service which records what was dispensed The dispensing contractor sends all endorsements electronically to the reimbursement agency to claim payment

EPS2 Features Electronic submission of reimbursement endorsements Signatures Nomination Electronic Signatures One of the fundamental changes between Release 1 and Release 2 of the EPS is the ability for prescribers to apply electronic signatures to prescription messages. These electronic signatures are unique to individual users and are applied using their Smartcard and passcode. The application of an electronic signature makes the prescription message ‘the legal entity’. Nomination Nomination is the process that gives patients the option to choose, or ‘nominate’ a dispensing contractor(s) to which their electronic prescription(s) can be sent automatically, using the Electronic Prescription Service. Electronic Cancellation Prescribers (or other authorised staff working in the GP practice where the prescription was generated) are able to cancel electronic prescriptions at any point up until they are downloaded at the pharmacy. When an electronic prescription is cancelled, a reason for the cancellation must be given. A message is then sent to the Electronic Prescription Service. Electronic Repeat Dispensing (aka batch scripts) Electronic repeat dispensing is possible from a single electronic prescription, it does not require multiple paper issues to be printed. The first prescription is available straight away at the pharmacy and then each subsequent repeat will be made available to download seven days in advance Electronic Submission of reimbursement endorsements To support the reimbursement claim process, Release 2 of the EPS allows dispensing contractors to electronically submit endorsement messages to the reimbursement agency for dispensed electronic prescriptions. Electronic repeat dispensing Electronic cancellation

Prescriptions - the need for change 1.7 million paper prescriptions are issued every working day in England This figure is expected to rise by over 5% each year About 70% of these prescriptions are for repeat medication Around 1.5 million paper prescriptions are issued every working day in England. With this figure expected to continue rising by around five per cent each year, we are moving to a more efficient and consistently accurate electronic system that is better able to cope with this continuing increase in prescription volumes. In particular, about 70 per cent of prescriptions are for repeat medication.

Benefits Patients Prescribers/ Prescription Clerks Dispensers Greater convenience Increased freedom of choice Reduced waiting times in the pharmacy Potential reduction in workload. Easier to use repeat dispensing Greater efficiency and control . Greater efficiency Streamlined workflow Easier month end processing Patients Prescribers/ Prescription Clerks PATIENTS Greater convenience / Increased freedom of choice – Patients now have more flexibility in where they can collect their medication from. For example people who commute may wish to use a dispenser close to where they work. Patients can change their minds/change nomination at any time Patients can receive medication in advance of going away - if on repeat dispensing. Reduced waiting times in the pharmacy – dispensers will get repeat prescriptions in advance, giving them more time to prepare for patients. PRESCRIBERS Potential reduction in workload. – Reduced number of prescriptions to sign, reduction in number of paper prescriptions to sort, reduced footfall in the practice, reduction in the number of lost prescriptions. Easier to use repeat dispensing – Electronic repeat dispensing is simpler electronically, and with electronic cancellation gives you greater control Greater efficiency and control - Electronic cancellation allows you to cancel prescriptions up to any point before the prescription has been dispensed. DISPENSERS Greater efficiency/ Streamlined workflow – Receiving prescriptions early allows more preparation time, time for ordering in stock if required. Easier month end processing – reduction in the number of paper prescriptions that need to be sorted and posted to the reimbursement agency. Dispensers 9

EPS a brief history…. EPS 1 Started 2005 Test IT and auto-populate local system, identify issues EPS 2 2012 Pharmacies 47% live Full roll-out / all dispensing systems complaint 2014 Pharmacies 94% Live Golden Script “technically EPS2 live” Pharmacies received one-off and monthly payment

Latest statistics (14th April 2014) Where are we now? Latest statistics (14th April 2014) 1,996 (24%) GP practices live 11,015 (94%) Pharmacies live 49 (43%) Dispensing Appliance Contractors live 24,327,281  Release 2 prescriptions sent 56,207,000 Items dispensed and claimed 7,271,631 Nominations set 33% average live site usage After such a long time coming, waiting for systems to become accredited and so on, R2 is now gathering pace rapidly, and will hit very close to 25% of GP sites live by end of March, and there are some very large numbers for scripts sent/items dispensed there too.

Brighton and Hove CCG Plans B&H CCG = 47 GP Practices, 63 Pharmacies, 270k+ residents Early Adopter Phase ( approx 10% of population): Sackville Road Hove 22/5/14 Ardingly Court Brighton 04/6/14 Stanford Medical Brighton 05/6/14 Full B&H CCG roll-out: EMIS Web (13) Oct - Nov 2014 TPP SystmOne (26) Dec - Feb 2014/5 Vision (8) March - April 2015 Rest of Sussex – planning for 2014/15 and 15/16

www.hscic.gov.uk/epsmap

Standard Deployment Model Communications and Engagement At least 8 weeks notice for pharmacies, Nominations and Patient information, GP Practice based “Kick-Off” meetings Business Process Change, Training, Technical Workshops, Checklists, System Training, SOPs, Smartcards, Medicines Management "housekeeping”, IT checks Go-live Support and trouble-shooting Post go-live Benefits evaluation, develop good practice and lessons learned,

Processes for pharmacy staff Looking at issues for pharmacy staff

Dispensers - Site preparation Capture patient nominations. Scan Release 1 scripts Patient details on local PMR Order dispensing tokens Printing capability (2nd tray for tokens) Supplies: printer toner / dispensing tokens System training SOPs Smartcards Capturing Patient Nominations . Dispenser – Capture nominations on the lead up to the practice go live, consider your patients who are on your collection/delivery services. Advise to keep signed/dated form. Release 1 usage - Ensures smartcards are working. Ensure all bar codes are being scanned and dispense notifications are sent back to the Spine. Doing this will identify any issues and it is important to get these resolved before moving to Release 2 as it will make the move smoother. Scanning Release 1 prescriptions will also update your PMR with NHS numbers which will make nomination setting much easier. Dispensing Tokens – Ensure these are ordered and received. Important to check whether your printer needs an additional tray to hold them. Contact your system supplier if unsure. Training- Do you know which buttons to press to pull down scripts from spine/return script t spine/sent a dispensed message to spine? Have all staff involved read and signed SOPs? Smartcards - Who needs to be able to set nominations, who needs to be able to mark items as dispensed and to submit electronic claims

Smartcards Everyone who dispense prescriptions and / or process patient nomination requests will need a smartcard: Pharmacists and locum pharmacists Accredited dispensing technicians Counter assistants and pharmacy support staff Contact Sussex IT Services 0845 845 4488 Special arrangements have been made for locum pharmacy staff to use a virtual national locum organisation code: FFFFF.

What’s new? Capturing nominations Downloading electronic prescriptions Cancellations and returning scripts to Spine Printing dispensing tokens Information from Prescriber for Patient Dispense notifications Electronic endorsements Record exemptions on system Electronic claims Send in signed tokens – no sorting These are the key processes to consider before go live. We’ll look at these one by one over the next group of slides.

What if …. Business Continuity A patient’s prescription does not arrive at the correct dispenser site? GP reports their system is unavailable? Dispenser system is unavailable? EPS is unavailable nationally? It is important that GP Practices and Pharmacies develop a close working relationship, and this is very important in the event of a failure either at a local level or a national level (EPS becomes unavailable) A patient’s prescription does not arrive at the dispenser straight away? Dispenser : Ensure you have requested for prescriptions from the spine Practice : Check the prescription was signed and sent to the spine. Once the script has been signed, it is marked as ‘sent’ and has been sent to the Spine. If a pharmacy calls up to say they can’t access the script, you should check that it has been sent in prescription history and you can check on the patient’s record. If it is marked sent, the issue possibly lies with the dispenser system and a call will need to be logged with their system supplier. Locally you have to decide how you will dispense the prescription GP Reports their system is unavailable GP practice will have local continuity processes in place to deal with this, they would possibly revert to paper prescriptions if system is going to be unavailable for an extended period of time. Dispenser system is unavailable If the dispenser system is unavailable then it is possible that they would not be able to download and dispense electronic prescriptions. It is important to contact your system supplier, and gauge how long the system may be unavailable for to determine the right course of action. EPS is unavailable nationally If EPS is unavailable nationally then GP Practices will be unable to prescribe using EPS and dispensers will be unable to download prescriptions, therefore business continuity procedures will need to be implemented. You can sign up for alerts that will notify you if EPS becomes unavailable nationally. Prescription Tracker

Communicate and Check…. Patient Right pharmacy? Right time? Check nomination Return to spine. GP Practice Script signed and sent? Check “EPS Prescription Tracker”. Pharmacy Spine / Internet down? Local system? Smartcard working? IT Supplier Report all problems

If problem can’t be resolved… Can patient wait? Yes No Is GP practice available? Fax Token / request FP10 Can patient go elsewhere? Emergency supply Refer to another pharmacy Consider expected downtime and urgency…

Business processes in line with site / company policy Training and Support Concept training - CCG Business processes in line with site / company policy System training from your supplier Live pharmacies - review and refine processes Locums / temporary staff Lots of resources online Pharmacy chains…will there be a staff member available at Go Live from another branch with relevant experience? Do your locums have experience/how will they receive training?

www.hscic.gov.uk/epsgp

“Doing it for Real” Ravi Vatma Top Tips “Doing it for Real” Ravi Vatma

Top Tips Scan EPS1 scripts – populate local system Start collecting exemptions Collect tokens in separate basket Submit dispense notifications in batches Use consultation room PC if possible – can do other processes in background Incorporate electronic claiming in next day process, deadline on 5th, 180 days expiry Send back to Spine when errors Blister packs – need to dispense before next issue available Set to print dispensing tokens automatically

Questions?