Electronic Prescription Service Moving to Release 2

1. Electronic Prescription Service Moving to Release 2

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.

3. 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

4. The ETP Programme • The Electronic Transmission of Prescriptions Programme will develop the Electronic Prescription Service and integrate it with the NHS Care Records Service (NHS CRS)…

5. How the EPS works

6. Scanned barcode Confirm what has been dispensed Paper prescription Electronic copy of prescription Electronic copy of prescription Prescription With barcode Medication dispensed Release 1 Electronic messaging

7. Scanned barcode non-nominated prescriptions Confirm what has been dispensed Electronic prescription Electronic prescription Tokens Electronic Prescription & endorsement message Medication dispensed Dispensing token Prescription token Release 2 Electronic messaging

8. Implementation

9. Legislation change to enable most prescriptions to be signed electronically • Nomination • Electronic signatures (nominated prescriptions only) • Electronic cancellation • Electronic repeat dispensing • Electronic submission of reimbursement endorsements Overview of implementation R1 Initial implementer sites R2 Initial implementer sites National deploymentof Release 1 National deploymentof Release 2 FullEPS Release 1 Release 2 No. of sites Time Transition with both Releases operating Transition with Release 1 operating in some places only

10. Release 2 Initial implementers Wave 1 1. Berkshire East 2. Leicestershire County & Rutland 3. Liverpool 4. Southwark 5. Sunderland Wave 2 6. Berkshire West 7. Birmingham East & North 8. Blackburn with Darwin 9. City & Hackney 10. Haringey 11. Isle of Wight 12. Leeds 13. North East Lincolnshire 14. Nottingham City 15. Nottingham County 16. Suffolk 17. Trafford

11. Smartcards for EPS Release 2

12. Nomination

13. Only staff at a dispensing GP practice can set a patients nominated dispensing practice The nomination process Patient or their representative can set at their nominated dispenser at any EPS location up to 3 dispensers GP Dispensing GP Practice Dispenser Community Pharmacy HealthSpace Appliance Contractor Patients can view the status of dispensers online at www.nhs.uk

14. 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

15. Nomination process – key points • 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

16. 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

17. 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

18. PCTs should ensure the principles ofnomination are adhered to • 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

19. Use of paper in EPS Release 2

20. The use of paper in 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Electronic Cancellation

27. 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”

28. Origination of cancellation request • 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

29. Cancellation rejections • 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

30. Amending a prescription • 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

31. Electronic Repeat Dispensing

32. Initiating 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

33. 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

34. Changes to paper-based 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

35. Availability of the next issue • 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

36. Submission of electronic reimbursement endorsements

37. Reimbursement endorsement process • 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

38. 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

39. 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 Submission requirements

40. 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

41. Where are we now?

42. Timeline of achievements Release 1 delivered into Spine EPS Release 2 Initial implementation PCTs announced Release 2 delivered into Spine 135 million electronic prescription messages transmitted First GP and Pharmacy site Go-live 20 million electronic prescription messages transmitted 1 million electronic prescription messages transmitted June 07 Dec 04 Feb 05 May 06 Aug 06 May 07 Today

43. Jason.Clarke@nhs.net www.connectingforhealth.nhs.uk/eps