1. Rachel Habergham EPS Programme Head
Electronic Prescription Service Utilisation Workshop (Name) (Date) (Location)
Rachel Habergham
EPS Programme Head
Utilisation Toolkit v0.1

2. Agenda Welcome and introductions EPS Release 2 deployment status
EPS benefits
National and local EPS update
Nomination
EPS Prescription Tracker
Common queries/issues
Cancellation
Electronic Repeat Dispensing (eRD)
Complex scenarios
Top tips – GP practice and pharmacy
Questions
Further information

3. Introductions Your name Where you work
What is your role with EPS/prescriptions?
What would you like to get out of the session today?
If you have already gathered issues/questions prior to the event, mention this, and ask only for any additional queries now.
Suggest note them down, and revisit at the end if attendees don’t find they have been answered during the coming slides/agenda.

4. EPS Release 2 Deployment Status
>[]
prescription items claimed electronically
[]%
Pharmacies enabled
DACs
enabled []
patients with nominations
[]%
GP Practices
enabled
Follow the link to NHS Digital’s statistics webpage for EPS with the most up-to-date data to populate here.
For the latest statistics please visit

5. EPS Benefits Patients GP practice Pharmacy
choice and convenience of where they collect their prescriptions
potential of reduced waiting times at their chosen pharmacy
GP practice
can process prescriptions more efficiently
have greater control over the prescription
spend less time dealing with prescription enquiries
Pharmacy
spend less time sorting and have less paper to send to NHS Business Services Authority (BSA). Can claim for reimbursement electronically
have improved stock control.

6. National focus… Utilisation of EPS
GMS Contract 2016/17
Local Digital Roadmaps (LDRs)
Strategic Transformation Planning (STPs)
Universal Capability
GPs and community pharmacists can utilise electronic prescriptions
All permitted prescriptions are electronic
By the end of 2016/17 80% of repeat prescriptions to be transmitted electronically*
(80% of repeat prescriptions target = 56% of all prescriptions)
Repeat dispensing done electronically for all appropriate patients
(*non-dispensing patients only, until system available for GP dispensary)
Imp Team Note: Explain 80% target and 56% ‘proxy’ – nationally accepted that approx. 70% of all scripts are repeat. Therefore proxy is 80% of 70%, which equals 56%...

7. Local update for GP practices
Practice name
Utilisation (latest data)
IMP TEAM NOTE:
For the latest statistics please visit:

8. Local update for pharmacy
Pharmacy name
Nominations (data last week )
All pharmacy nomination statistics are now published by NHS Digital and can be found on NHS Digital’s website:
IMP TEAM NOTE:
Source? How to identify relevant pharmacies? Can NHS get trend data?

9. EPS utilisation – [Your Area] GP practices
“80% of repeats by EPS” target (56% proxy)
Average usage across CCG (inc. DD patients) is []%
Practice level:
Majority of live practices are already in range
A few not far off…
A small number of practices ‘stuck’ at a lower 30-ish%
A reminder of utilisation target/aim mentioned at the beginning…
Add data for your area, plus any local context/commentary etc
- “GP Practice planned EPSr2 and live usage” spreadsheet

10. Nomination the key to EPS

11. No Nomination in place, no EPS…
Nomination is not a pharmacy-only responsibility. GP practices should talk to patients about it too.
Encourage your patients to nominate - suitable for most patients, especially those on regular repeats and using a regular pharmacy.
Patient’s consent to be obtained.
Ensure the patient understands that future scripts will go to their nominated pharmacy, until they request otherwise.
Nomination can be set, changed or removed any time, but only at the request of the patient.
Direction of prescriptions is not permitted by pharmacy or practice.
Patients must not be incentivised to nominate.
Inappropriate nominations only cause confusion and frustration.
Nominations do not expire; think about new patient registrations.
The more we talk about nominations, the better informed patients will be.

12. Reminders about nomination
Provide sufficient information to the patient, nomination requires informed consent.
Nomination consent doesn’t have to be in writing - you just need to have an auditable process in place.
All staff need to know about EPS and should be able to explain EPS and nomination to patients walking into the practice, the pharmacy and over the telephone (including pharmacy delivery drivers).
Update the nomination promptly in your system (practice or pharmacy). Most sites do this daily.
Nomination is not a static process. Check with the patient regularly to check that the nomination is still appropriate.
NHS Choices patient information:

13. Dispensing Appliance Contractors (DACs)
Are you using EPS for your DAC scripts?
Patients can nominate a pharmacy and a DAC.
If a nomination is not set, why not ask the patient? “We normally post your prescriptions, but we could now send them electronically, which is safer and more efficient. Would you like us to?” Verbal consent is acceptable.
Or contact the DACs to let them know you are live with EPS and ask them to contact the patient.
Check when issuing items to make sure prescription items are going to the intended dispenser (pharmacy/DAC).

14. Nomination complaints
It is important that any complaint about nomination is investigated and dealt with appropriately. By following this guidance complaints about nomination will be minimised.
If the patient wishes to register a formal complaint, they should make that complaint to the pharmacy, DAC or GP practice.
If the complaint can’t be resolved, patients should be informed of the procedure to complain to NHS England. This can be done by:
Telephone:
with ‘your prescription your choice’ in the subject line.
Post: NHS England, PO Box 16738, Redditch, B97 9PT
If a GP practice, pharmacy or DAC wishes to make a complaint about another contractor, they should discuss with their local NHS England contact the most appropriate method to raise the complaint.

15. EPS Prescription Tracker

16. EPS Prescription Tracker
Ensure you can access the Prescription Tracker.
Some pharmacy systems have the Internet blocked but access is obtained through intranet - check with your IT helpdesk
If your CCG has access issues then contact your local IT helpdesk.
The prescription tracker is a useful tool for determining the status of EPS prescriptions.
Provides a detailed prescription event history – is prescription on spine, with pharmacy (which one?), with patient…
Please use and promote it amongst colleagues.
Add it to your favourites bar, or as a quick link from your practice or pharmacy system if you can.
Add to Favourites

17. EPS Prescription Tracker
Search by Prescription ID – copy & paste from your system – using Ctrl+c and Ctrl + v
Search by NHS number and My Site

18. EPS Prescription Tracker - results
Detailed search results:
Search results – script(s) found. In this case NHS number search was used, hence multiple scripts found
Prescription type – will show Acute/Repeat/Repeat Dispensing.
Acute can be useful as not all pharmacy systems display prescription type Acute/Repeat
Can use search box to type “acute” or click on any header to sort

19. EPS Prescription Tracker
Prescriber and dispenser details …
…and full event history for the prescription
Nominated dispenser.
Dispenser which has the prescription.
Click on Organisation code in event history to show address and phone number of practice or pharmacy.
Cancellations pending or applied.
Click on message in bottom window will display how many items on script and status of each.
… displays barcode for scanning
Utilisation Toolkit v0.1

20. EPS Prescription Tracker
Help
Tracker has a help menu with instructions

21. Utilisation FAQs

22. Personally Administered
Non-compliant items
Controlled drugs (CDs) Schedules 2 & 3
Private prescriptions – out of scope
Personally Administered
Can be actioned on the clinical system to produce an FP10 to enable claiming for payment
Quantity mapping – TPP is there any outstanding work in ‘Repeat Template Quantity Replacement’ report? Can save you amending each item in patient record.
PA tick will prevent item being sent by EPS (mostly correct for jabs etc which are claimed by practice). But tick can be removed if item (eg diabetic injectables) need to be sent via EPS.

23. Drug mapping
The NHS Dictionary of Medicines and Devices (dm+d) is the standard for transferring medicine and medicinal device information between clinical systems and is required for all EPS Release 2 prescribing. Refer to factsheets on dm+d and prescribing - which can be found here.
Re-authorising items: delete old templates and re-prescribe using a dm+d item.
Paracetamol caplets – replace with tablets.
The following can be actioned to send via EPS:
Suppressed/discontinued/free-text products need to be replaced with current product.
Quantity mapping.
Non-compliant items – check your system for tools to help identify items which need mapping
Paracetamol caplets – a unique issue – can prescribe tablets. Caplets not a recognised term in the dictionary.
IMP TEAM NOTE: these 2 key factsheets (as well as the rest of them) are all now in ‘national archives’ – can we get them on the proper website before this is released???

24. Product selection matters
Prescribe exactly what is required
Generic or specific brand/manufacturer?
No free-text amendments (eg ‘preservative free’, ‘multiple flavours’, ‘please dispense xxxx brand’)
Assorted flavours – prescribe flavour required or ‘flavour not specified’ product with AF endorsement ticked if you wish pharmacy to dispense multiple flavours to patient

25. Split prescriptions What is a ‘split prescription’?
When one or more items issued can’t be sent electronically (e.g. CD or unmapped item).
System will offer to send some items by EPS and print paper prescription for others, or option to revert all items back to a paper prescription at the patient’s request.
Add a message to advise pharmacy of items on paper (pharmacy or counterfoil message, system specific, pre-sets)
*TPP practices – are you enabled to split prescriptions?
If not, you will be prevented from using EPS at all for a patient who has at least one non-compliant item on repeat – even you are not issuing it!
If you have no TPP practices in your area, delete bottom section.

26. Can all GPs and prescribers use EPS?
EPS can be used by appropriate clinicians.
Check:
Smartcard access rights
User profile – default roles and professional codes
Prescriber codes – own or using another GP’s
User-level configuration options
Training
Locums may not be able to have scripts allocated to them to sign but can still sign repeats, make sure that system configured to allow this:
Reassign scripts, or configure, EMIS Global viewers, TPP access to Prescription Search screen, etc.
Check with system supplier if unsure.

27. Generating and signing repeats
Allocation of repeats for signing
Consider how you will distribute prescriptions for electronic signing.
Processes for query items
Consider electronic query/requesting methods rather than printing scripts and handwriting queries.
Make sure staff know how to check status of a script within your system - issued, paper/EPS? in signing queue, and when signed and sent.
Locums may not be able to have scripts allocated to them to sign but can still sign repeats, make sure that system configured to allow this:
Reassign scripts, or configure, EMIS Global viewers, TPP access to Prescription Search screen, etc.
Check with system supplier if unsure.

28. EPS is not just for repeats
Acutes in surgery
Ask: Is patient planning to use their nominated pharmacy?
Yes. Advise them to go to counter and say and electronic script has been sent. Pharmacy then download again if not already in the pharmacy system.
Yes, but nominated pharmacy is not open. Patient can be provided with prescribing token to take to another pharmacy for a one-off dispense.
No. Issue FP10.

29. EPS is not just for repeats
Acutes/urgents when patient not present
Telephone consultations or patient out of town
Nominated pharmacy may not be appropriate.
Send to a pharmacy convenient to patient.
Advise patient to remove/change nomination when ready.
No faxing (pharmacies within England).
Reduction in need for patients to register as temporary patient.

30. Pharmacy queries
This nominated patient script is not showing in my system, where is it?
When did you last download? Try again.
Make sure everyone knows how to download in your pharmacy system.
Check the patient is still nominated to your pharmacy?
Is your pharmacy system/smartcard working correctly?
Check the EPS Prescription Tracker
System config options / training needs?
Split scripts not enabled (TPP)
Smartcard use/PDS synching
Eg TPP Quick Print button (bypasses EPS) – can be removed and/or, users trained to use other button.
EMIS ‘ fallback authorisers’ setting

31. Pharmacy – missing EPS prescription?
Prescription Tracker Outcome
Solution
Prescription found is:
To be dispensed
Script is available for download, attempt manual download - may need to scan, click ‘show barcode’ from EPS tracker
Prescription status is:
With dispenser
Dispenser is your pharmacy? If still can’t be found contact your IT helpdesk
Dispenser is another pharmacy? Contact the pharmacy, ask them to return the prescription to spine. When ‘To be Dispensed’ attempt manual download.
Check nomination with patient and set accordingly for future.
Prescription Status is:
Dispensed, claimed or cancelled
A pharmacy has already dispensed or claimed the prescription, or the practice has cancelled it.
Prescription on tracker with long Prescription ID A6CC0C22-814E-11E4-8BE9-AC162DB0AB40R
Practice have printed a Release 1 prescription – check for paper prescriptions or check with practice.
No prescription found
Contact GP practice

32. Patient was nominated – why have we got a paper prescription?
Item issued may be a CD (Schedule 2 or 3)
Item may not be mapped to the dm+d drug database
Is the patients PDS record not synchronised?
Was the issuer or signer not using their smartcard?
Could there be an invalid GP authoriser?
Has the practice decided to print acutes?
System configuration options incorrect?
Is there a training need?
Did the patient request a paper prescription?
Has the nomination been changed or removed?
Is there a reported/unreported business continuity problem?
System config options / training needs?
Split scripts not enabled? (TPP)
Smartcard use/PDS synching
Eg TPP Quick Print button (bypasses EPS) – can be removed and/or, users trained to use Print Unprinted Scripts instead.
EMIS ‘ fallback authorisers’ setting

33. Electronic Cancellation

34. Electronic Cancellation
The practice can cancel an electronic prescription at whole prescription or item-level, after it has been signed, and will receive one of the following possible responses:
Successful, confirming the prescription has been cancelled.
Unsuccessful – with dispenser, notifying that the prescription cannot be cancelled because it has been downloaded by a pharmacy. Practice should contact the nominated pharmacy and ask them to return the prescription to the NHS Spine.
Unsuccessful – dispensed, notifying that the prescription cannot be cancelled because it has already been dispensed to the patient.
Unsuccessful – not found, indicates that the EPS prescription was post-dated and no cancellation will be applied until the set date.
The EPS Prescription Tracker will display any pending or applied cancellations.
There is also a ‘unsuccessful, not found’ or similar – if trying to cancel a post-dated script which has not yet been released to spine.

35. GP Practice – process reminder
Do all staff know how to cancel?
Who is responsible for following up unsuccessful cancellations in your practice?
Contact the pharmacy if ‘with dispenser’ to advise them of cancellation and ask them to return to spine. Be clear about whether whole prescription or item(s) being cancelled.
Once dispenser has taken action , ‘subsequent cancellation’ response should be received* if they have returned to spine
Contact the patient if ‘dispensed’.
*EMIS practices – must check tracker to confirm cancellation has been applied – before processing the cancellation rejection task.
Best to have a team responsible – eg script/admin team – rather than individual (what happens if individual is not there). Make sure there are task rules/global viewers.
EMIS – subsequent cancellations not working, therefore must check tracker.
IMP TEAM NOTE: Remove this bit if EMIS fix canc req defect before release

36. Pharmacy – actions for cancellation processes
A practice cannot cancel a prescription that is ‘with dispenser’ (already in the pharmacy system) or has been dispensed to the patient.
The practice will contact the pharmacy and request that they return the prescription to the NHS Spine.
Pharmacies cannot cancel an EPS prescription – if an item is identified in pharmacy as needing cancellation, return it to spine and ensure that you ask the practice to cancel it.
Scenario
Solution
Cancellation of entire prescription
Return whole prescription
Single item on a multi item prescription
Two options:
Return the whole prescription, the spine will cancel the item and then you can re-download the prescription manually
Mark item requiring cancellation as ‘not-dispensed’ and dispense remaining items

37. Electronic Repeat Dispensing (eRD)

38. Electronic Repeat Dispensing (eRD)
eRD simplifies the repeat prescribing process.  
Just one digital signature needed for eRD batch (up to 12months).
Each issue is then managed between pharmacy and patient.
Patients don't need to contact the surgery to re-order each script, (unless their condition changes).
Dispensers are mandated to ask patients if they require all items on their prescription before each issue. This improves patient compliance and reduces medicine wastage. 
eRD puts the prescriber in control rather than allowing the patient or dispenser to continue re-ordering unnecessary items. 
NHS Digital have released an eRD Toolkit for Prescribers and Dispensers

39. Complex scenarios

40. Post-dating Refrain from post-dating prescriptions in EPS.
Can cause confusion, questions, calls from pharmacies, due to:
post-dated prescription is not released to spine until that date.
Post-dated prescription can then not be seen on the tracker until that date.
Will not be visible to pharmacy in advance of that date.
Cancellation cannot be applied prior to that date*
Discuss options with pharmacy if there is a clinical need for post-dating.
Cancellation of post-dated – Will get ‘cancellation rejection – not found’ as cancellation will get to spine before script. Once the post-date is reached the script will be sent and cancellation will be applied, but clunky…
Often used for weeklies? Dailies? Dosett/MDS boxes.
Sometimes post-date may still be best option due to pharmacy allowed no flexibilty on dispense date. Also for drug-seekers, preventing overdose etc. Consider tokens?

41. Post-dating
Consider the clinical/patient requirements behind use of post-dated prescriptions. Could there be an alternative?
Think about the clinical requirements for your patients.
Would eRD functionality be useful?
Enables visibility, cancellation, and also flexibility.
Consider any local policies/medicines management guidance.
Revert to paper if necessary.

42. Care/Nursing Homes Do you look after care home patients?
Joined-up approach between Practice – Pharmacy – Care Home to discuss:
Patient nomination and consent.
Weekly prescriptions.
Urgent medications and post-hospital/treatment medication changes.
Local checking processes by care home and whether tokens would be appropriate.
IMP TEAM NOTES: do we want to ‘go here’ too much, other than say discuss in 3-way, re nomination, weeklies, local checking processes etc etc?

43. Business Continuity

44. Things are going wrong - what do I do?
Report all issues to your system supplier helpdesk as soon as possible.
You can report issues with local practices or pharmacies via your own system supplier.
All system suppliers have an escalation process – make sure you know what it is and act on it as required.
COMMUNICATE – if you are having problems, inform the other practices or pharmacies who may be affected.
Be an informed user of EPS:
NHS Digital Service Status page
Sign up for Service Alerts
IMP TEAM NOTES: need updated links for service bridge etc
Add to Favourites

45. Tips for increasing utilisation in GP practice
Keep collecting patient nominations during patient consultations, at reception or over the telephone when prescriptions are requested. Nomination is not a pharmacy-only responsibility.
If a patient uses an Dispensing Appliance Contractor (DAC) collect verbal consent for the prescription to be sent electronically and not in the post.
Ensure all appropriate staff are trained in using EPS, and have an EPS Lead available to support staff, answer questions and to train any new starters.
Ensure all staff have and use their own Smartcards with the correct roles so that everyone can use the service.
All clinical prescribers can use EPS to sign prescriptions, including Locums and Nurse Prescribers.
Use EPS for acute prescriptions and not just for repeats.
In the case of ‘Split Prescriptions’ ensure that messages are added to the pharmacy to alert them of paper prescription which will require collection.
Ensure that staff understand about prescriber endorsements such as assorted flavours.
Consider suing Electronic Repeat Dispensing (eRD) for suitable patients already on paper repeat dispensing or on regular medication regimes.

46. Tips for increasing utilisation for pharmacy
Keep collecting and entering nominations on a regular basis.
Ensure all staff, including delivery drivers, have knowledge of EPS and can encourage patients to nominate and use the service.
Ensure there are sufficient nomination forms, leaflets and posters around the pharmacy for patients to read.
All staff to have their own smartcards with the correct roles and activities applied so that everyone can use EPS.
Ensure all appropriate staff know how to report issues to your system supplier helpdesk and have the contact details available.
Ensure you know what is in your Business Continuity Plan to do in the event of local system problems or outages.
Download EPS prescriptions regularly throughout the day.
All appropriate staff to know how to download, dispense, edit, endorse and claim.
Send your dispense notifications as soon as possible after the patient has collected.
Telephone your system supplier to report any problems. Do not ask the GP practice to cancel EPS prescription and issue an FP10.
All staff to be familiar with returning EPS prescriptions to the NHS Spine and how to mark items as ‘not dispensed’ where appropriate.

47. Questions
Encourage your patients to nominate if they use a regular pharmacy.
Maintain good communication with pharmacies, to resolve queries, processes, and discuss any complex scenarios.
Discuss any barriers to increasing your utilisation and benefits
Consider eRD…
Visit the EPS website for information, advice & guidance

48. Further support Local resources National resources CSU/CCG EPS Lead
Local Prescribing Lead
Medicines Management Team
Local Pharmaceutical Committee link here
Local Medical Committee (LMC) link here
National resources
NHS Digital EPS website link here
NHS Choices link here
Business Services Authority (BSA) link here
Pharmaceutical Services Negotiating Committee (PSNC) link here
This slide needs to be localised.
Further support could include:
CSU/CCG EPS lead
Local prescribing/EPS leads
Medicines Management team
Local Pharmaceutical Committee (LPC)

49. IMP TEAM NOTE: old HSCIC – assume comms will ‘standardise’…
Utilisation Toolkit v0.1