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

Where is EPS used? GP practices (including dispensing practices) Community pharmacies Dispensing Appliance Contractors (DACs) NHS England area only

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

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

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

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

“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

Processes for pharmacy staff Looking at issues for pharmacy staff

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 - email 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

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.

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.

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??

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.

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.

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.

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

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 https://nhsuk.epticahosting.com/selfnhsukokb/template-group.do?name=NHS+Prescription+Services&id=5201  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

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."

Business Continuity

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.

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: http://nww.hscic.gov.uk/servicemanagement/status/subscribe Prescription Tracker: https://nww.spine2.ncrs.nhs.uk/prescriptionsadmin/ Smartcard status: http://nww.hscic.gov.uk/eps/cardexaminer/start.html 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

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

Training and Support

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?

Patient Communication

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

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

Connect with EPS and learn more

www.hscic.gov.uk/epsgp

factsheets

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

Questions?