1. Preparing for EPS2 LPC AGM Haider Al-Shamary EPS Project Manager
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. Where is EPS used? GP practices (including dispensing practices)
Community pharmacies
Dispensing Appliance Contractors (DACs)
NHS England area only

3. Release 2 overview 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

4. The spine is a secure central component which holds data including the PDS and EPS messages, accessed by authorised users via smartcards and PINs

5. Key benefits Patients Prescribers/ Prescription Clerks Dispensers
Greater convenience
Increased freedom of choice
Reduced waiting times in the pharmacy
Electronic batch signing of scripts by GPs
Easier to use repeat dispensing
Greater efficiency and control
Reduced footfall
No lost scripts- prescription tracker
Greater efficiency/Streamlined workflow
Easier month end processing
Reduced collection of paper scripts
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.
Footfall - reduction in workload at GP practices generated by patients/pharmacy staff collecting prescriptions.
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 5

6. Pharmacy readiness
So that’s the background. Now looking at getting ready for it here….

7. “The key to success has been our close relationship with our community pharmacy colleagues. Traditionally we haven't spoken to them frequently but we have a number of meetings with them and we've come to understand each others' processes a lot better."
John Hampson, GP
Green Mount Medical Centre, Bury

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

9. Site preparation Release 1 usage – PDS synch Order dispensing tokens
Printing capability (2nd tray for dispensing tokens)
System training / SOPs
Smartcards -expired or don’t remember the pincode - to Swindon office to be reset, with a covering note clearly explaining why the cards have been returned, and where they have to be sent.
Any staff that have an EPS01 card will need to complete the RA01 to be upgraded to EPS R2. They will not be required to present ID as they have already done this.
The sponsor will be responsible for authorising the access rights.
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

10. Key processes to consider before go live at the pharmacy
Approach to capturing nominations
Electronic Cancellation
Dispensing and downloading electronic prescriptions
Dispensing tokens
Electronic endorsement and patient declarations
Electronic claims
End of month processes
These are the key processes to consider before go live. We’ll look at these one by one over the next group of slides.

11. Approach to capturing nominations
Who will capture nominations in the pharmacy?
Consider patients who have delivery service
Consider process for inputting the nominations onto the system
How will you communicate with patients?
Consider who will capture nominations, will all staff?
Will it be pharmacist, dispensing technicians, delivery drivers?
Consider patients who have delivery service
Will your delivery driver capture nominations?
Process for inputting the nominations onto the system
Need to consider who and when nominations will be put on the system, remembering that all nominations (additions, changes and removals) need to be acted upon in a timely manner (recommend no more than 24 hours)
Consider patient communication – what should the patient be told prior to capturing/setting the nomination
Ensure patients are clear on their re-ordering process, and the service is explained to them following key guidance. Provide leaflets were possible.

12. Dispensing and downloading electronic prescriptions
Consider process for requesting prescriptions (frequency/responsibility)
Overnight download
Requesting throughout the day
When will you send dispense notifications?
Clinical information from the prescriber needs to be communicated to the patient – how will you do this?
Frequency – Overnight download, check with system supplier that your system supports this.
Requesting throughout the day – recommendation is as frequently as you can, consider the practice may be sending acute prescriptions through
Whose responsibility – is it just the pharmacist or technicians also?
Dispense Notifications
Once a patient has collected their medication then you need to send a ‘dispense notification’ which confirms to the Spine the prescription is complete and will then allow you to electronically claim for the prescription. You need to think about when you will send this, as patient collects, end of day?
Clinical information to patients
Prescriber may input information that needs to be passed to the patient, for example please book for a blood test. As a dispenser you have an obligation to pass this information on to the patient. You need to think about how to do this, will you pass it on verbally, use a dispensing token??

13. Dispensing tokens Ensure dispensing token stationery has been received
Use of dispensing token for:
capturing signatures for payment/exemption declaration
giving to a patient who needs to go to a different pharmacy to collect their medication
aiding with dispensing process
Ensure you have ordered and received your dispensing tokens and that your printer has been set up to print them. If you are unsure about printer set up then you must contact your system supplier.
Dispensing tokens need to be used to capture patient signatures.
Patient wants to go to another pharmacy – if for some reason you can’t fulfil a prescription and the patient wishes to go elsewhere then you can print a dispensing token for the patient. Return the prescription to the spine and the patient can take the token to another Release 2 dispenser who can scan the bar code and retrieve the prescription.
Some dispensers use tokens to aid with their picking processes
Month End Process
All signed tokens need to be sent to the prescription services unit but they need to be sent separately to FP10 paper prescriptions. There is no need to sort dispensing tokens, they are not used at the NHS Prescription Services only stored.

14. Electronic cancellation
Ensure all staff are aware of electronic cancellation
What do cancelled prescriptions look like in the system?
Consider a local process for returning prescriptions to the spine if a GP practice advises they wish to cancel a prescription after it had been downloaded in the pharmacy
Electronic cancellation
All staff need to be trained on electronic cancellation.
What does a cancelled prescription look like – if you are unsure then please refer to your training or contact your system supplier.
Returning prescriptions
What if a practice contacts you to advise they are trying to cancel a prescription that is in your system – ensure you are aware of how to return prescriptions to the Spine.

15. Electronic endorsements and patient declarations
Ensure all staff are aware of capturing patient declarations and ensure they are recorded on the system
Capture patient signatures on the reverse of tokens
Electronic prescriptions must be electronically endorsed. Paper prescriptions must be endorsed and submitted in the usual way
Do not handwrite endorsements on tokens, these will not be used for pricing
Ensure electronic exemptions are correct before sending
Signatures
Ensure all staff are aware of the need to still capture patient signatures, and that you need to record patient exemption status on your system.
No point writing/printing endorsements on tokens.

16. Electronic claims
All electronic prescriptions must be claimed for electronically
An electronic claim can only be sent once the prescription has been completed; items should be marked as either ‘dispensed’ or ‘not dispensed’
Consider when you will be submitting electronic claims
on patient collection, end of day, in batches, weekly
Once an electronic claim has been sent to NHS BSA Prescription Services, it cannot be amended or cancelled
Electronic prescriptions must be claimed electronically.
Once a prescription has been marked ‘dispensed’ or not ‘dispensed’ your system will allow you to submit an electronic claim
FP34
The FP34 form you complete at month end will ask you to declare both paper and electronic prescriptions
Check with your system supplier/training on whether your system is capable of easily reporting on electronic prescription submitted to support this process.
Paper prescriptions
Normal process applies to FP10 prescriptions
Amending claims
Once an electronic claim has been submitted it can not be amended or cancelled, therefore it is very important to ensure you are endorsing and recording exemption status’ correctly.
When to submit electronic claims
With EPS release 2 you don’t have to wait until the end of the month to make an electronic claim, once you have sent a dispense notification confirming what you have or haven’t dispensed and that the patient has collected the medication then you are able to submit an electronic claim. As a site you need to think about when you will be submitting these, some suggestions: As patient collects their medication/ End of day /In batches of 5/10 /Every couple of days

17. End of month Processes
One FP34C form must be completed and submitted to the NHS BSA Prescription Services to cover both paper and electronic prescriptions
The NHSBSA has a new “ask us” facility on their website in the EPS section
 Understand month end process in relation to tokens
Signed tokens need to be separated from the FP10 paper prescriptions at the end of each month and sent to the NHS BSA Prescription Services
Age exempt patient tokens to confidential waste

18. Gary Warner, Pharmacist, Regent Pharmacy, Isle of Wight
"We have found that EPS has reduced the risk of labelling errors and has meant that we often receive repeat prescriptions earlier."

19. Business
Continuity

20. Business continuity and troubleshooting
Ensure local processes are in place to continue dispensing process if EPS becomes unavailable either nationally or locally
How are you going to work if:
A patient’s prescription does not arrive at the dispenser site straight away?
GP 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. Sign up to EPS alerts.
Prescription Tracker.
Tool to check the whereabouts of a particular prescription.

21. Business continuity and troubleshooting
Surgery to pharmacy / pharmacy to surgery contact
Know who to contact for hardware support
Know who to contact for software support
Sign up for alerts:
Prescription Tracker:
Smartcard status:
Prescription Tracker
This application allows you to search for prescriptions within the Electronic Prescription Service (EPS). It will not return any patient sensitive information, like the medication prescribed, but will confirm if the prescription exists and whether the prescription is available for dispensing.
Smartcard Examiner A nice tool for checking if there are issues with certificates smartcards

22. Raising support calls
Ensure you know how to log calls to your supplier and know their escalation procedures
Pharmacy: Escalation procedures should be obtained from your supplier. It is important to:
Keep a log of calls made, ref numbers and time to resolve
Follow up and escalation

23. Training and Support

24. Consider the best time to undertake EPS training
Training and Support
Plan training in advance of going live or in pharmacy case before your local GP practice goes live
Consider the best time to undertake EPS training
Consider what kind of training will work best in the GP practice/pharmacy
Admin Staff/GP staff training. What training materials to support training are available from GP supplier? Will you be able to visit another GP practice with the same system already live?
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. Patient Communication

26. Patient communication
Patients should be fully informed:
1. Nomination is not mandatory
2. No need to collect paper prescription from the GP practice
3. Patient can choose where they wish to nominate
4. Nomination is flexible and can be changed or removed by their GP or any EPS2 pharmacy
5. Not restricted to nominating a pharmacy close to the GP practice

27. Planned implementation dates and next steps
Local information to be given at this stage

28. Connect with EPS and learn more

30. factsheets

31. Go-Live Dates – Oct/Nov
Quedgeley Medical Centre
Gloucester
Dr Siva
14/10/2014
Cam and Uley Family Practice
Stroud
Ian Cawthorne
15/10/2014
College Yard Surgery
Dr Atkinson
16/10/2014
Rowcroft Medical Centre
Janice Anderson
21/10/2014
Hadwen Medical Practice
Ian Roberston
22/10/2014
Churchdown Surgery
Trudy Morris
23/10/2014
Watledge Surgery
Tewkesbury
Angela Lynch
28/10/2014
Jesmond House
Bridget Derrett
29/10/2014
Church St. Surgery
Deborah Matson-Beale
30/10/2014
Overton Park Surgery
Cheltenham
Jayne Folwarski
03/11/2014
Underwood Surgery
Fred Whalley
04/11/2014
Leckhampton Surgery
Sue Careswell
06/11/2014
Corinthian Surgery
Linda O'Hara
10/11/2014
St. George’s Surgery
Paul Keen
11/11/2014
Crescent Bakery Surgery
Wendy Gasson
Portland Practice
Laurella Parffrey
13/11/2014
Stoke Road Surgery
Lester Pygott
17/11/2014
Berkeley Place Surgery
Rob Noel
18/11/2014
Yorkleigh Surgery
Caroline Cole
20/11/2014
Rosebank Surgery
Wyndham Parry
24/11/2014
Pavilion Family Doctors
Julie Rudd
25/11/2014
London Medical Practice
Beverly Lewis
27/11/2014

32. Questions?