1. 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

2. Who's Who Amanda Marshall Assistant Contract Manager (Pharmacy)
Surrey & Sussex Area Team - NHS England
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)

3. Who's Who Gary Mortimer Senior Implementation Manager, EPS
Health and Social Care Information Centre
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.

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

5. 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

6. 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
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

7. 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

8. 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.

9. 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

10. 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

11. 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.

12. 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 /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

14. 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,

15. Processes for pharmacy staff
Looking at issues for pharmacy staff

16. 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

17. 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
Special arrangements have been made for locum pharmacy staff to use a virtual national locum organisation code: FFFFF.

18. 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.

19. 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

20. 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

21. 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…

22. 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?

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

26. 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

27. Questions?