1. Let’s talk EPS
“Developing the best way forward for practices and pharmacy to maximise EPS”

2. Agenda Objectives Introduction to the NHSBSA Primary Care Services
Icebreaker
EPS and benefits
NHSBSA offering
Where are we now? Barnet CCG
Group Session 1
All things EPS (tokens, claiming, RBs, Tracker, Cancellations)
Patient Engagement
Group Session 2
BREAK
eRD
Group Session 3
Useful tips
Phase 4
Group Session 4
Close

3. Objectives
“Developing the best way forward for practices and pharmacy to maximise EPS”
Develop and agree a way forward which improves patient experience with EPS and eRD
Discuss the challenges related to EPS and eRD
Discuss the benefits of EPS and eRD and how we can help to maximise usage

4. An Introduction to NHSBSA Primary Care Services

5. The NHSBSA’s services include:
helping patients pay for their health costs
providing EHIC cards
calculating reimbursement and remuneration to dispensing contractors and NHS dentists
providing prescribing and dispensing information to the NHS
assessing bursary claims from healthcare and social care students
preventing and investigating fraud, and protecting NHS staff
administering pensions for NHS staff

6. ICEBREAKER!
Has your EPS % improved?

7. The Electronic Prescription Service
The Electronic Prescription Service (EPS) creates savings by making prescribing and dispensing processes more efficient while improving patient care. EPS currently accounts for 70% of all primary care prescribing*, which has already created significant benefits across the NHS. If the level of EPS use reached its full potential (currently 91%), the associated benefits would be huge.
*as of June 2019

8. Benefits for prescribers, patients and the wider NHS

9. Benefits for prescribers, patients and the wider NHS

10. Benefits for prescribers, patients and the wider NHS

11. Benefits for Dispensers
Automated downloads, making prescription processing more efficient
Less time spent on administration and collecting prescriptions, which means more time for helping customers
Improved stock control and greater accuracy
A prescription collection service no longer required
between pharmacy and practices

12. Benefits for Dispensers
Improved patient satisfaction through reduced waiting times
Increased accuracy, meaning fewer prescription queries
Less sorting and less paper to send to NHS Prescription Services

13. NHSBSA Offering
We are working in collaboration with NHS Digital and are committed to supporting CCGs, practices, pharmacies and other NHS organisations in maximising their EPS use, delivering the best possible service to patients.
To help us understand the support required, we work on an individual basis with practices, maintaining a close working relationship throughout the EPS process. We can offer a range of reports and other resources to help your organisation at each stage of the journey towards making the most of EPS.
We have developed an EPS Prescribing Dashboard which offers key metrics on EPS use, electronic repeat dispensing volumes and EPS opportunity items.

14. Where are we now – Barnet CCG
70.64%
49%
39%
70.44%
449038
19.20%
449038
10.17%
417505

15. Group Session 1
Have a discussion about the problems you currently experience with EPS- can anyone come up with a solution?

16. How we process prescriptions
In 2007 we redesigned our systems to ensure that we would be able to accept electronic prescriptions
We use scanners and intelligent character recognition software (ICR) to read a lot of the information on paper prescriptions we need to calculate payments.
We follow the rules set out in the NHS England and Wales Drug Tariff for both paper and EPS forms

17. Electronic prescriptions and tokens
Tokens are scanned for exemption purposes, there is no need to submit tokens that are automatically age exempt. We use the exemption / charge paid status that you have submitted in your claim message
Ensure all patient information regarding exemption or charge paid is set up in your system before you send the Dispense Notification when the patient collects their medication - some systems default to ‘chargeable’ status
You don’t need to send tokens that are automatically age exempt (i.e. for patients below the age of 16 or over 60) to NHS Prescription Services.
Tick both boxes on the submission document if you’re submitting ETP tokens and EPS release 2 claim messages.

18. Electronic claiming
Electronic claim messages (CN) don’t need to be sent all together at the end of the month
you can send them in real time, at the end of the day, in batches or weekly.
We must receive by the 5th of the month following the DN being sent to be paid in the correct month.
If a DN is sent in August and the claim message is received by 5th September, payment will be made in August. However if the item is dispensed in August but the claim message is not received until 6th September, payment will be made in September.
However .. if an item is dispensed on 1st September the dispense notification must also be sent on 1st September. However, even if the corresponding electronic claim message is sent to NHS Prescription Services on or before 5 September, payment will be made for September and not for August.

19. EPS v Paper returns
Only around 0.05% of all EPS items are referred back to contractors compared to around 0.17% of paper items
The majority of returns are due to missing packs, prices and suppliers
As items prescribed via EPS must match the DM+D listing, this also avoids the return of a lot of appliances and handwritten items
The prescription details are returned if it isn’t clear what has been dispensed or if a price is endorsed, it isn’t clear what this relates to.
Prescriptions may referred back for a product is any part of the Tariff, so will also cover Appliances, Specials, ACBS list etc
See hand out with ‘referred reasons’
The majority of our returns are missing packs, price and suppliers. We also return a lot of appliances which are not listed in dm+d, and we require a brand. For example, pen needles and eye drops.

20. Access to EPS Prescription Tracker
Ensure you can access the Prescription Tracker.
Provides a detailed prescription event history
Some pharmacy systems have the internet blocked but access is obtained through intranet - check with your IT helpdesk
If you don’t know what the prescription tracker is or what it looks like
it basically lets you look into the Spine to see a detailed history of the prescription for every step of the process using the prescription ID or a patients NHS number.
As it says on the slide – some systems do or can block access but if you just call the systems IT helpdesk they can help as they are fully aware of what the tracker is and does.
For a lot of people who use the tracker it often becomes their best friend and go to place if they need to locate a prescription or find out its history and it can save users a lot of time and effort so please make the most of it when you can.
Content created by NHSDigital

21. Repeat Dispensing and the Prescription Tracker
All issues have the same Prescription ID
EPS Prescription Tracker shows each issue individually
All issues have the same Prescription ID.
You can manually pull down next issue once previous has been collected if you need to: you can copy/paste or ‘show barcode’
EPS Prescription Tracker shows each issue of the prescription individually.
Marking the prescription as collected starts ‘clock’ for release of next issue from the Spine.
Issues should only be marked as dispensed when patient has collected.
The GPs do use this to see what you have given to the patient
You can manually pull down next issue once previous issue collected.
Copy/paste or [show barcode]
Content created by NHSDigital

22. Cancellation
(Spine)
3 channels
Content created by Ali NHSDigital
Cancellation Guidance

23. Cancellations
A 'prescription cancelled successfully' response confirming that the prescription has been cancelled
A 'cancellation unsuccessful with dispenser' response, confirming that the patient's nominated pharmacy has already downloaded the prescription from the NHS Spine
A 'cancellation unsuccessful dispensed' response, confirming that the prescription has already been dispensed to the patient
In this case, a new electronic prescription can be generated, signed and sent to the patient's nominated pharmacy. The patient does not need to return to their GP practice. The prescriber can add additional notes to the prescription to give the dispenser and/or patient more information. The EPS Prescription Tracker status will show as 'cancelled' and the pharmacy will not be able to download the prescription.
In this case, the prescriber should contact the dispenser (contact details will be displayed on the screen) and discuss the next steps. The dispenser can return the prescription to the Spine, where it will be automatically cancelled, or the dispenser can mark the prescription as 'Not dispensed'. The EPS Prescription Tracker status will show as 'With dispenser'.
In this case, the prescriber should contact the patient and discuss the next steps. For example, the patient could be asked to return to their pharmacy to collect a new prescription.
Content created by NHSDigital

24. Increasing EPS and eRD usage

25. Patient engagement
Many patients not using EPS may not be convinced by the benefits to themselves
The NHSBSA has developed content specifically to engage these patients looking more at the impact to the wider NHS
This content is available for use:
As a slide show
Text messaging content
We also have other resources to help engage pharmacy and identify suitable patients for EPS
TOP TIP: Search for patients on repeats and send them this content via SMS (iPLATO /MJog ) to inform them of the EPS service

26. Nominations EPS still relies on patient choice through nomination.
Patients must be fully informed about EPS before the nomination can be set on the system.
Nomination consent doesn't have to be in writing, but you do need to have an auditable process.
TOP TIPS:
Set monthly nomination targets
Incorporate a section on recording patient consent for EPS nominations in New Patient Registration Processes.
Set up alerts to remind GPs to speak to non-nominated patients during consultations
Encourage local pharmacy to nominate prescription collection service patients
Promote EPS and acquire nomination information on recall letters
Promote EPS to all patients using online access
(e.g. protocol alongside a data entry template that captures the way with which the patient was asked the nomination question)

27. Group Discussion 2
Patient Engagement- how can we work together to give the patient the best experience?

28. Electronic Repeat Dispensing (eRD)
Up to 410 million repeat prescriptions are generated every year, which is equivalent to an average of more than 375 per GP, per week.
Two thirds of prescriptions issued in primary care are repeat prescriptions
This accounts for 80% of NHS medicine costs for primary care.

29. Introduce eRD – NHSBSA data
To support GP practices we can provide NHS numbers for patients who are potentially suitable for eRD.
This data shows “stable” patients who have had no change in their medication in at least 10 of the last 12 months
Information governance protocols need to be observed to receive the data
To request this information, please visit
Practices receiving our data in 2017/18 increased their eRD over 3% more than similar practices who did not get our data
That equates to a minimum of 5 hours GP time saved each month!

30. Introduce eRD – Patient information
NHSBSA patient flyer
GP practices, Dentists, Opticians and Pharmacies can order through the following link
Trusts, CCGs, Local Authorities etc. can order here  
Work with PPGs
Patient presentations

31. Pharmacies & eRD Contractual obligation to ask 4 questions on eRD:
Have you seen any Health Professional since your last repeat was supplied?
Have you recently started taking any new medicines either on prescription or that you have bought over the counter?
Have you been having any problems with your medication or experiencing any side effects?
Are there any items on your repeat prescription that you don’t need this month?
Identify potentially suitable patients
Greater Manchester LPC conducted a project which used pharmacy to support eRD getting started

32. EPS and eRD utilisation
Communication is key between practice and pharmacy which is why we are arranging workshops such as this to facilitate communication
The prescription tracker is a key component of EPS as electronic prescriptions can’t get lost
Promote to patients using BSA messaging, if we do not hold materials suitable for your needs we may be able to build specific packages
Identify patients potentially suitable for eRD
We are also working closely with system suppliers for Pharmacy software

33. eRD- how can we work together to enhance utilisation?
Group Discussion 3
eRD- how can we work together to enhance utilisation?

34. Increasing EPS and eRD use – Other useful tips
Correct and consistent smartcard use
Ensure no PDS mismatches
Staff training – both existing and new staff
Regularly monitoring stats
Use searches regularly to identify suitable patients
Use the EPS Tracker
Use EPS for Appliances with patient consent
Locums – Some ideas but will depend on if can be applied by practices:
Add roles to smartcards (as per practice policy) – regular locums
Re-allocation of Locum and regular GPs workload - regular GPs to do on EPS / All Scripts :

35. Phase 4

36. Phase 4: Prescribers
Currently, patients have to nominate a pharmacy in order to send scripts electronically, and non-nominated patients receive a paper FP10
After phase 4, a token will be printed rather than a paper FP10 for non-nominated patients
EPS will therefore be a default method to send most of your scripts
KEY POINTS:
There will be no downtime to enable phase 4
Full rollout is aimed for Summer this year. To reduce the impact this will have, try and increase your EPS usage as much as possible now by encouraging your patients to nominate
If a token is lost, the GP practice will be able to re-print the token
Content created by Ali NHSDigital

37. Patients on repeat prescriptions (i. e
Patients on repeat prescriptions (i.e. they request their repeats) will be given a new token for each time a repeat prescription is issued, unless they are on eRD
For patients mid way through a paper-based repeat dispensing regime when phase 4 is switched on, they will continue the batch on paper until the full batch has been issued and dispensed. Patients without a nomination will receive one repeat dispensing token for the entire regime, they can keep hold of this or leave it with their chosen pharmacy until the end of the batch
Content created by Ali NHSDigital

38. Phase 4: Dispensers Top Tips from PSNC:
If you receive a Phase 4 token, you should scan the barcode and dispense it as you would any other electronic prescription.
Pharmacy teams can use the green Phase 4 prescription tokens to capture any patient exemption-related or charge-related signatures.
Some pharmacy teams that process the Phase 4 token used a highlighter pen to highlight the ‘Prescriber signature not required’ wording on the token, to highlight that it is a Phase 4 token rather than a barcoded paper prescription.
Green Phase 4 tokens should be filed with all the other white EPS tokens and not within the main bundle of paper prescriptions before the submission is sent to the NHSBSA.

39. Consider your system and print settings
Consider your system and print settings. Many PMR systems have settings to customise which types of EPS prescriptions may automatically have a white EPS dispensing token printed.
During the pilot, patients have sometimes filled in the back of the green Phase 4 token before they arrived at the pharmacy. If the pharmacy process involves shredding the green Phase 4 token and replacing it with a newly printed white dispensing token, the patient will have to complete the reverse of the dispensing token. To address this scenario, some pharmacy teams have changed their initial Phase 4 approach so that they use the green Phase 4 token for patient declarations, rather than printing out a new white EPS dispensing token for each Phase 4 script.

40. Group Discussion 4
Commit to 3 actions

41. Contact Us
us at We’ll contact you to discuss the support you need. We may already have resources that can help you, or we can work with you to develop a bespoke support package to help you achieve your targets. We’d also like to gather some examples of best practice to further develop the support we can offer. Visit us at: Also see: