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Electronic Prescription Service EPS support provided by NHSBSA
Electronic Prescription Service
EPS support provided by NHSBSA
Agenda
• Icebreaker
• Introduction to the NHSBSA and Prescription Services
• The Electronic Prescription Service: Benefits
• Increasing your EPS use: NHSBSA Support
• Your CCG data
• Group Session 1
• eRD: The Basics
• Group Session 2
• Cancellations and the Tracker
• Increasing your eRD use: NHSBSA Support
• Phase 4
• Group Session 3
• Contact us
ICEBREAKER!
What % EPS is your practice at?
NHS Business Services Authority
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
History of NHS Prescription Services
• There has been a prescription pricing function since at least 1911.
• We‟ve gone through a number of different identities over the years, but since
2008 we‟ve been called NHS Prescription Services, part of the NHS
Business Services Authority (NHSBSA).
• We handle all the processing work for English dispensing contractors from
three regional offices; Middlebrook (Bolton), Newcastle and Wakefield.
Our processing volumes
• The NHS spends £9.4 billion* a year on prescription drugs in primary care in
England.
• We process over 1.1 billion* prescription items from over 11,500 contractors
in England including pharmacy contractors, dispensing doctors and
appliance contractors.
• The amount of prescriptions we process increases every year by around 5%.
* based on the Prescription Cost Analysis report 2018
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 66% 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 Feb 2019
Benefits for prescribers, patients and the wider NHS
Benefits for prescribers, patients and the wider NHS
Benefits for prescribers, patients and the wider NHS
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.
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.
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.
Data
Our dashboards and comparators help CCGs and practices to identify
opportunities for increasing EPS which can be found at
www.nhsbsa.nhs.uk/EPSDashboard.
We can also discuss potential admin
time savings based on these
opportunities.
Increasing EPS use – 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.
Increasing EPS use – 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.
Increasing EPS 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.
Increasing EPS use – Identifying challenges &
addressing these
• Communication is key.
• Arrange workshops with local pharmacies.
• Educate and inform patients.
• Work with PPGs.
Barnet CCG
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EPS
eRD
Barnet CCG
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EPS
eRD
EPS and admin time:
• Barnet CCG current EPS 68.15%, potential 98.07%, admin time saved
approx. 164 hours per month.
eRD and GP time:
• Barnet CCG current eRD 18.14%, Top 10 Region Average 39.17%, GP
time saved approx. 343 hours.
Benefits for Barnet CCG
Group Session 1
What is the most effective tool/technique/method you have implemented in your
practice to increase EPS utilisation?
What is the biggest challenge you have faced when trying to push EPS?
Let‟s share some best practice!
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.
eRD – Making it work
• https://wessexahsn.org.uk/projects/120/electronic-repeat-dispensing
Prescribing an eRD batch
When a prescriber issues an electronic prescription for repeat dispensing this will
contain the following information:
• total quantity per issue.
• the intended duration of each issue of the prescription.
• how many times the repeatable prescription can be issued before the
patient/medication should be reviewed.
2 per day x 28 day duration = quantity of 56
13 issues = 1 year’s supply
Content created by NHSDigital
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Content created by Gary Mortimer @ NHSDigital
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Review?
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Content created by Gary Mortimer @ NHSDigital
Community Pharmacy – The 4 Questions
• Have you seen any health professional (GP, nurse or hospital doctor) 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?
• eRD and this monthly “review” is part of the Community Pharmacy
Contractual Framework
How does eRD Work? In words!
• Once the prescription is signed; the 1st prescription will be available
immediately for download by the nominated dispenser (unless post-dated).
• All other prescriptions will remain on the spine until the previous issue has
been completed i.e. „Dispensed‟ or „Not Dispensed‟ and a Dispense
Notification (DN) sent to the spine.
• Subsequent prescriptions will automatically download into the pharmacy
system 7 days in advance of its due date.
• Where clinically appropriate, a prescription can be downloaded early as long
as a DN has been sent for the previous issue.
Suitable patients
• Long term condition, stable therapy.
• Medication expected to remain stable between reviews, e.g. 3m, 6m, 12m.
Exclusions:
• Patients with unstable condition or frequent admission to hospital.
• Patients requiring frequent testing and/or review of their medication or
condition.
• Patients who do not wish to participate in the service.
Content created by Kim Keeley @ NHSDigital
Group Session 2- eRD scenarios
https://learning.necsu.nhs.uk/nhs-digital-electronic-repeat-dispensing-elearning/
Type 2 Diabetes
Asthma
Angina
Hayfever: Seasonal and well controlled hay fever
Eye Drops
Cancellation
(Spine)
Cancellation Guidance http://webarchive.nationalarchives.gov.uk/20160921135209/http://systems.digital.nhs.uk/eps/library/0212.pdf
Content created by Ali Shariff @ NHSDigital
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.
Content created by NHSDigital
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.
https://portal2.national.ncrs.nhs.uk/prescriptionsadmin
Content created by NHSDigital
Repeat Dispensing and the Prescription Tracker
All issues have the same Prescription ID
EPS Prescription Tracker shows each issue individually
You can manually pull down next issue once previous issue collected. Copy/paste or [show barcode]
Content created by NHSDigital
Introduce eRD – Getting started • Ensure everybody in the practice is aware of eRD and how it works.
• Run an eRD workshop.
• Create/update your surgery's eRD strategy (include admin team and clinical team).
• Review current eRD performance and set a target.
• Invite local pharmacy and encourage collaboration.
• Nominate champions for the practice and pharmacy.
• Start slowly, identifying and engaging with patients:
• At medication reviews
• Opportunistically
• By advertising throughout the surgery
• Target specific conditions/regimes (hypertension/diabetes).
Introduce eRD – Patient engagement
• NHSBSA patient flyer
GP practices, Dentists, Opticians and
Pharmacies can order through the
following link www.pcse.england.nhs.uk
Trusts, CCGs, Local Authorities etc. can
order here www.nhsforms.co.uk • Work with PPGs
• Patient presentations
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 www.nhsbsa.nhs.uk/eRD
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!
Phase 4
• 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 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 Shariff @ NHSDigital
Phase 4 continued…
• 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 Shariff @ NHSDigital
Group Session 3- FAQ activity
A script sent by a practice via EPS, the patient goes to pick up their
medication from chemist, who claims the has script not been
received. What do you do?
• Ideally ask the Pharmacist to check the EPS Prescription Tracker which will have all the information
about the EPS script. This will help with not having to ask patients to go back to the practice which
could increase frustration for both, the patient and the practice.
• It is also possible that the Pharmacist has not „refreshed‟ their screen by the time the patient arrives
at the Pharmacy (i.e. happens occasionally when acute script is generated at the practice whilst the
patient is in consultation with the prescriber), in which case once this is done the script will
download from the spine to the pharmacy system.
• Another alternative would be to re-print the token of the EPS done if the patient has come back to
the Practice so they can take this to the Pharmacy. The Pharmacist could then use the barcode in
the script to download this from the spine.
• There is a „messenger system‟ between the spine and the pharmacy system which may cause
delay with downloading the scripts from the spine from time to time. The method of giving the token
to the Patient will also help overcome this issue.
A script was sent via EPS, and then patient's dose changed. How do
you request the script back?
• Depending on what the status of where the script is, the script can be
cancelled straight away if sitting on the spine.
• If the pharmacist has downloaded this in their system, then the pharmacist
needs to be called to send this back to the spine and then the practice will
need to go to the Workflow manager in the cancellation rejection mailbox to
complete the task of cancellation.
5 items are sent on a script via EPS and one item is out of stock,
what do you do?
• The Pharmacist can dispense the other 4 items and mark them as
„dispensed‟ in the system, which will also update the spine and hence the
EPS Tracker. Then the pharmacist can order the 5th item and mark it as
dispensed once they have given this to the patient. The claiming will only
happen at the Pharmacy once the whole script has been dispensed.
A patient has a nominated chemist but then wants to get medication
from another chemist near where they work. How do you do this?
• Currently an FP10 or EPS r1 barcoded script can be printed to give to the patient to
take to another pharmacy of their choice.
• With Phase 4, there will be a capability to print one off Phase 4 tokens to be given to
nominated patients who may wish to collect their medication from another pharmacy.
Are pharmacists allowed to download EPS scripts before patient is
physically at the pharmacy?
• Yes, this will give them time to prepare the medication before the patient
arrives at the pharmacy to collect their medication.
An urgent message has arrived from the pharmacy when
medication is not due, stating that it is urgent. What can you do?
• A prescriber at the practice will need to decide whether the „urgent‟ request from the
pharmacist matches with the need for the patient to have the medication at that time.
• If the prescriber decides that they wish to see the patient to assess the urgency, the
practice will have its protocols in place to deal with this.
• The prescriber may also decide that this is not „urgent‟ in which case there will be
protocols in the practice to deal with this i.e. informing the pharmacist that the
prescriber doesn‟t feel this is an urgent request etc.
How can we avoid over issuing problems with repeat dispensing?
• It is vital to set up the eRD templates correctly when starting a repeat dispensing
regime. The success of eRD depends on how the eRD regime is set up.
• It is vital that the pharmacy asks all 4 questions to the patient, „Are there any items on
your repeat prescription that you don‟t need?‟ should help to reduce waste.
For eRD how many can you issue, how long can you issue for and
timescales?
• eRD allows you to set up a regime for 13 issues (counting over 4 weekly intervals
instead of monthly intervals, hence 13 issues instead of 12 annually).
• The durations and number of issues should be decided at the Practice level adhering
to the Meds Management policy of the local CCGs.
• Respective CCGs / Practices may have different policies to set up patients for eRD
and this may differ. Hence please kindly follow local guidelines and internal practice
decisions on this.
If patient is on repeat dispensing and requires medication in
between as they are going away, how do you sort this out?
• As an example, if the practice has set 5 issues in the eRD regime and patient has
collected 3 issues, but is now going on holiday – they will not need to come to the
Practice to request this, the pharmacist can manually download the 4th issue for the
patient from the spine by making a clinical decision that it is safe to give the patient the
additional issue due to them going away.
• The practice and pharmacy need to have an understanding on how the pharmacist
can deal with this and if they need to inform the practice when they dispense additional
issue to reasons mentioned above.
Can you issue 4dossette scripts on eRD?
• Yes, in this case the duration will be 7 days over 4 issues to cover for the 4
weeks
Should chemists download all 4 weeks in one go
• The concept of Dossette boxes is since the patient may forget to their medication or may take
double the dosage and hence the need to have these separate on weekly intervals in order to cater
for Clinical and patient safety. By this principle, the chemist needs to download each script in the
Dossette box regime at the correct intervals.
• Having said this, the chemist may prepare all 4 boxes together to reduce their workload.
• In some cases, where a patient may have carers, District nurses or family members to help
administer medications at the correct intervals and hence the chemist may choose to dispense all
the scripts together in blister packs with agreement of the people administering the medications etc.
• The concept of how Dossette boxes are issued and how the chemists can download rely on CCG‟s
Meds Management policies. This policy takes precedence over above solutions.
• The concept of eRD regime is to set this up for stable patients, if the patient is not „stable‟ and has
constantly changing meds then eRD will create more work at the practice. Which will then in turn
reduce the Practice‟s confidence in eRD system.
Contact Us
Email us at [email protected]
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:
www.nhsbsa.nhs.uk/EPS
www.nhsbsa.nhs.uk/eRD
www.nhsbsa.nhs.uk/EPSdashboard
Also see:
https://digital.nhs.uk/services/electronic-prescription-service
