1. EPS and eRD
Great Yarmouth & Waveney

2. Agenda EPS Overview & Update eRD & the Benefits
Patient Selection & Synchronisation
How does it work - Animation
eRD Prescribing and cancelling – basic principles.
Questions & Feedback?

3. EPS Overview & Update

4. Local Overview – GY&W 100 successfully deployed
Average usage in April 2017 was 74%
120,133 nominations
51.7% of registered population
3rd highest nominated CCG in England (% terms)
1.9% eRD in April

5. National Perspective GMS Contract 2017/18
Local Digital Roadmaps (LDRs)
Strategic Transformation Planning (STPs)
Universal Capability i
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)
25% Electronic Repeat Dispensing for all appropriate patients by 31/3/18
*non-dispensing patients only, until solution available for GP dispensaries

6. eRD & the Benefits

7. What is eRD?
Electronic Repeat Dispensing (eRD) is an integral part of EPS which offers extra benefits over paper repeat dispensing and regular repeat prescribing.
eRD allows regular medicines to be prescribed for suitable patients in batches of up to a year and stores the prescriptions securely on the spine.

8. What is eRD?
Prescriber issues batch of EPS prescriptions in one go for suitable patients with repeat medication, for up to 12 months.
Pharmacy responsible for carrying out checks with patient before dispensing each issue.
Patient liaises regularly with pharmacy and has flexibility throughout the regime.
Can use v1 or v2 dependant on end user preference – V2 more of a definition.
Prescriber issues batch of EPS prescriptions in one go for suitable patients with repeat medication, for up to 12 months.
Pharmacy responsible for carrying out checks with patient before dispensing each issue.
Patient liaises regularly with pharmacy and has flexibility throughout the regime.
NMC best practice prescribing guidelines state independent nurse prescribers, where issuing an RD prescription, should review the patient preferably face to face at least every 6 months 

9. How does eRD work at a practice?
Prescriber can authorise and issue a batch of repeat prescriptions until the patient needs to be reviewed.
Repeat dispensing can be issued for up to 12 months, but can also be issued for shorter periods.
Repeat items that have not yet been downloaded by the pharmacy can be cancelled by the GP Practice.
An electronic prescription for repeat dispensing this will contain the following information:
the intended interval between each issue
of the repeatable prescription
how many issues the repeatable prescription
can be dispensed

10. Benefits for the GP practice
Reduction in workload in re-signing requested repeat prescriptions.
Reduction in the amount of requests/queries coming into the practice.
Cancellation at any point during the regime at item or at prescription level.
New medication can be added to the regime.
Possible reduction in medicines waste.

11. Benefits for the patient
Reduction in unnecessary visits to the GP practice.
Ability to request multiple issues of medication when necessary e.g. holidays, Christmas, Easter
Potential reduction in out of hours requests for routine medication.
Patient doesn't need to remember to order their prescription.
Patient cannot lose their prescription.
Pharmacy nomination can be changed in the middle of a repeat dispensing regime.
Note:
patients can receive their prescription items from a different pharmacy which may be more convenient

12. Benefits for the Pharmacy
Improved stock control.
Increased efficiency.
Effective time management.
Reduction in managed repeat workload.
Less “Emergency Supply” at peak periods
pharmacists will be able to order stock and prepare prescriptions in advance – reduction in owings
Dispensing work can be done in quieter times in the pharmacy,
Reduction in Managed Repeats
Reduction in queries

13. Patient selection & synchronisation

14. 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

15. Prescribing eRD
When a prescriber issues an electronic prescription for repeat dispensing this will contain the following information:
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
6 issues x 28 day duration = 6 months supply

16. Preparing repeats for eRD
Check the issue duration / interval is correct for each repeat template.
Synchronise all items to be issued in the same eRD batch.
Ensure the number of authorised issues and/or review dates match up.
Consider issuing items in separate batches – eg CD 4 or 5 (28 day expiry) or PRN items (irregular issue duration).
Use the patients’ usage history to calculate PRN intervals e.g. 4 issues in 12 months = 84 days between issues.

17. How Does eRD process Work?

18. 1 2 3 4 5 6
1 x Passcode

19. 6 5 4 3 2 1 28 28 28 28 28

20. 6 5 4 3 2 1 28 28 28 28 28 ?

21. 6 5 4 3 2 28 28 28 28 13 15 14 12 11 8 9 10 7 18 26 25 27 28 28 24 23 19 17 16 20 21 22 1

22. 6 5 4 3 2 28 28 28 28 13 14 15 12 16 7 17 8 9 10 11 22 26 27 28 28 18 25 19 24 20 21 23 1 ?

23. 6 5 4 3 28 28 28 28 14 13 15 16 12 8 7 17 9 10 11 21 26 27 28 28 18 25 19 24 20 23 22 1 2 ?

24. 6 5 4 3 28 28 28 28 2 1

25. 6 5 4 3 28 7 28 7 28 7 28 7 1 2

26. 5 1 6
Review?

27. Patient going on holiday.

28. 6 5 4 3 28 28 28 28 14 13 15 16 12 8 7 17 9 10 11 21 26 27 28 28 18 25 19 24 20 23 22 1 2
Patient requests additional medication because they are going on holiday?

29. 6 5 4 3 28 28 28 56 28 14 13 16 12 15 7 17 8 9 10 11 22 26 27 28 28 18 25 19 24 20 21 23 1 2

30. 6 5 4 28 28 56 13 14 15 12 16 9 7 8 17 10 11 19 26 27 28 28 18 25 20 24 21 22 23 2 3

31. 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.

32. 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

34. eRD Prescribing and cancelling – basic principles.
Dependant on audience – system specific except Microtest. Use e presentation only eRD set up and cancelling basics ~ 5minutes. More information in handouts if required. Use this slide to embed the e learning tool.

35. Do you need an RA token?
No, it is no longer mandatory to print an RA token at the start of a repeat dispensing regime, but all systems still do RA Token can be passed to patient, pharmacy or shredder A token can still be printed at the request of the patient or pharmacy.

36. Can a patient change nomination part way through the regime?
Yes. Patients can change their nominated pharmacy before the end of the repeat dispensing period.
Any outstanding issues which have not been downloaded will be available to download at the new nominated pharmacy.

37. Patient changes practice or dies.
Any outstanding repeat dispensing batches should be cancelled.
Make it part of your deduction checks.
If PDS is notified of death the spine will automatically cancel outstanding prescriptions.

38. Prescriber changes practice
Any outstanding repeat dispensing batches should be cancelled and re-issued by another prescriber
eRD Prescriptions would move with the Prescriber and be charged to their new practice.
Ensure any new eRD regimes are authorised by a GP least likely to leave

39. How to get started? Start small! Identify potential patients
at medication review
opportunistically
by advertising in the surgery.
Target specific conditions/regimes
Hypertension, thyroid
System reports to identify suitable patients – contact on mass and ask them to change to eRD
Involve pharmacy – pharmacist signposts
At medication review – GP reviews meds and sees if any are suitable for eRD
Opportunistically – during acute appointments
Target patients with specific conditions/regimes – hypertension, diabetes, seasonal conditions
Advertise to patients in the surgery – “ask your GP”

40. eRD Resources and Activities
NHS England eRD Guidance
CPPE e-learning has been updated
eRD Toolkit for Prescribers
NHS Digital EPS

41. Questions & Feedback