Electronic Prescription Service Andy Williams ETP Development Manager October 2008

1. Electronic Prescription Service Andy Williams ETP Development Manager October 2008

2. National Programme for ITKey Delivery Systems A central email and directory service for the NHS Providing IT infrastructure and broadband for the NHS Capture, store, display and distribute static and moving digital medical images NHSMail PACS N3 National Programme for IT NHS Care Records Service EPS Choose & Book To make prescribing and dispensing safer, easier and more convenient for patients An individual electronic NHS Care Record for every patient in England Electronic booking service offering patients greater choice of hospital or clinic

3. Contents • Overview • Implementation • Business Process Changes • Benefits • Where are we now? • Communicating about the EPS • Action points

4. Overview

5. The need for change With about 1.8 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.

6. The need for change (continued) • In addition: • about 70% of prescriptions are now repeats, so we need a system designed for this pattern of prescribing • Strategy for pharmacists requires them to become better integrated into the primary care team and integrated IT will support this

7. A definition… “The Electronic Prescription Service enables electronic prescriptions to be generated, transmitted, received and once dispensed against, sent to the reimbursement agency for payment.”

8. Implementation

9. Nomination • Electronic signatures (nominated prescriptions only) • Electronic cancellation • Electronic repeat dispensing • Electronic submission of reimbursement endorsements Legislation change to enable most prescriptions to be signed electronically EPS Implementation Strategy • EPS is being introduced in four main phases: • Phase 1 – Initial implementers (early 2005) • Phase 2 – Nationwide deployment of Release 1 (now) • Phase 3 – Transition to the electronic service - Release 2 • Phase 4 – Full electronic prescription service

10. 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

11. 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

12. Nomination

13. What is nomination? • “Nomination is a new process that will give patients the option to choose, or ‘nominate’ a dispensing contractor(s) to which their electronic prescriptions can be sent automatically using the Electronic Prescription Service. • Nomination can be likened to existing prescription collection services, but with an increased choice of dispensing contractors”

14. 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

15. Supporting contractors in capturing the nomination • The primary point for nominating a dispenser will be with the dispenser themselves (not GP practices) • A patient leaflet will be available to contractors to explain the EPS to patients • Audit data will be available to PCTs to help ensure the principles are adhered to

16. Principles of nomination • In order for a patient to request a nomination they will need to be informed about the EPS service 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

17. Definition of timely • “If explicit consent is collected in advance of the pharmacy deploying Release 2, before setting the patient’s nomination on the Personal Demographics Service, the dispensing contractor should ensure there has been no change in the patient’s circumstances, including their choice of nominated dispenser, since the original consent was obtained.” Agreement between DH and PSNC

18. Legislation for dispensers state: • “A pharmacist or his staff shall not give, promise or offer to any person any gift or reward (whether by way of a share of or dividend on the profits of the business or by way of discount or rebate or otherwise) as an inducement to or in consideration of his nominating the pharmacist as his dispensing contractor (or one of them) in his NHS Care Record” The National Health Service (Pharmaceutical Services) Regulations 2005, SI 2005-641

19. Regulations for Prescribers state: • (a) “shall not seek to persuade a patient to nominate a dispenser recommended by the prescriber or the contractor; and(b) shall, if asked by the patient to recommend a chemist whom he might nominate as his dispenser, provide the patient with the list of all the chemists in the area who provide an ETP service as given to the contractor by the Primary Care Trust." The National Health Service (Primary Medical Services) (Miscellaneous Amendments) Regulations 2005, SI 2005-893

20. 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

21. 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

22. 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

23. Smartcards for EPS Release 2

24. Release 2 smartcards are a step to NHS CRS access Single Card, Policy requires CRDB Approval Single Card, Policy – RA01 CRDB Approved Shared Card, Policy – EPS01 Viewable access to the medication record Simple trace and update Messaging Access to PDS Simple trace and update Messaging Access to PDS LEVEL OF AUTHENTICATION Access to EPS as a messaging service Access to EPS as a messaging service Access to EPS as a messaging service Spine Authentication EPS Release 1 EPS Release 2 Future

25. Use of paper in EPS Release 2

26. The use of paper in Release 2 • Paper will never be completely removed from system. Paper copies of electronic prescriptions are known as ‘tokens’. There are two types: • “Prescription token” – printed in GP practice • “Dispensing token” – printed in dispensary. These are required to be printed:

27. 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

28. 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

29. EPS Release 2 Scenarios

30. Electronic Repeat Dispensing

31. Initiating electronic repeat dispensing • ERD is possible from 1 Electronic Prescription – authorised for up to 12 months. • 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

32. 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

33. 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 subsequent issue has been completed using the prescription ID, or it will be included in the nominated prescription response

34. Electronic Cancellation

35. 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”

36. Benefits • More convenient – Electronic cancellation does not involve the paper chase of existing cancellation processes • Easier to change medication – when combined with electronic repeat dispensing, electronic cancellation allows prescribers to manage a patients’ medication regime more effectively

37. Business continuity

38. Professional judgement is still required • The appropriate contingency process should be determined by the healthcare professional using their professional judgement and knowledge, based on the information available to ensure patient safety • Amongst the factors to be considered should be: • the estimated time needed to resolve the issue • the clinical need of the patient

39. Potential points of failure • National ‘Spine’ (EPS servers) • National ‘Spine’ (PDS servers) • Connectivity (N3) • Prescribing System • Dispensing System • Smartcards • Printers

40. Alternative Actions • Record information at a later time • Advise the Patient to come back • Contact the Prescriber to obtain FP10 • Use emergency supply • Advise to use an alternative dispenser • Other existing local procedures

41. Submission of electronic reimbursement endorsements

42. Key Points • 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 (including any reasons from a pre-defined list for not dispensing) before they can be reimbursed • The payment schedule is the same as for paper prescriptions

43. 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

44. 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

45. Benefits

46. Benefits for patients • Greater Convenience - reduction in trips to GP practice just to collect a piece of paper – particularly those on repeat medication • Greater freedom of choice – making it simpler for them to use a dispensing contractor convenient to them • Potentially, it could reduce pharmacy waiting times if electronic prescriptions are received in advance • Extent of benefits are dependent on individual circumstances

47. Benefits for prescribers • Reduction in workload generated by patients requesting and collecting individual prescriptions • Makes it easier to make wider use of the repeat dispensing service • Ability to sign prescription electronically – making the prescribing process more efficient • Ability to cancel prescriptions electronically at any point up until they are dispensed – and provide a reason for doing so

48. Free staff from work associated with re-keying prescription information • Provide scope to streamline workflow and manage stock control more effectively • Contractors offering prescription collection services will no longer need to physically collect prescriptions for patients who have nominated them • Electronic reimbursement endorsements will reduce the volume of paper that needs to be sorted and posted each month Benefits for dispensers

49. Whole System Impact

50. Where are we now?