1. EPS Phase 4 Business Change Workshop

2. Overview of Phase 4
Non-dispensing patients can continue to nominate their preferred dispenser to receive their prescriptions
Where no nomination is in place (or the patient chooses not to use their nomination on this occasion) the patient will be given a token to take to an NHS England dispenser of their choice
Phase 4 is where EPS becomes the default for ALL prescriptions whether the patient has a nomination or not.
1. Nominations are still completely valid and will continue to go to the nominated pharmacy as before – no change
- Dispensing practices – if the practice don’t have a dispensing solution (i.e. where they can nominate themselves (currently only EMIS) then they are completely unaffected by EPS Phase 4 and an fp10 will print for their dispensary.
2. If the patient does not have a nomination then the prescription will be signed electronically and sent to the spine. The prescription doesn’t know which pharmacy to go to so a token will print. The token will need to be scanned by the pharmacy to download the legal prescription and then this will be processed by the pharmacy as an eps prescription i.e. endorsed and claimed for electronically.
See next slide for a token

3. Phase 4 token Talk through the difference to an FP10 Digital signature
Different to dispensing pharmacy
Highlight the wording now over writing the signature box
Not to be used as a prescription even if signed by an authorised prescriber as not legal
Phase 4 token = “EPS Token”
See next screen for a token which has been printed for a nominated prescription.
Prescription Tokens will be printed on fp10 paper. They can be used in the same way as a pharmacy dispensing token to capture exemptions and send to the BSA for non-exempt and paid.
Be aware – some pharmacy systems will still print a white dispensing token., The pharmacy may decide to shred the green one and keep the white one. Some pharmacy systems can turn off ‘token printing’ but others can’t.
Prescription tokens can be reprinted for patients who may have ‘lost’ their first copy. The major benefit of this compared to fp10 is that the token will not need signing again. The legal prescription is on the spine so the patient can only have the medication dispensed once even if they have multiple tokens, The prescriptions can tracked using the EPS tracker.
The difference between an fp10 and a token is that an fp10 is printed before the prescription is signed. A token will only print once the legal prescription has been signed and sent to the spine.
See next slide for differences in process when issuing.
If asked how this is any better than producing an FP10 – benefit that we can’t lose the legal prescription, we can reprint them without re-issuing the drug and the vision is that the barcode will be sent to electronic devices when IT systems (mainly in pharmacy) are able to cope with this functionality.

4. Nominated EPS token
Make sure staff are aware and able to distinguish the difference between an “EPS phase 4 token” (previous slide) and a “Nominated EPS token”
A nominated EPS token is a copy of a prescription that has been sent to a EPS nominated pharmacy. This should only be taken to the patients nominated pharmacy.

5. Processes in GP practice

6. Processes in GP practice
Admin/Prescription clerk issuing
GP or other signing prescriber issuing
Ordering processes remain the same
Prescription raised as normal
EPS nomination/no nomination – both sent to EPS signing queue to be signed as per EPS2
Prompt for EPS PIN to sign
Prescription signed and a token will print where configured
The Phase 4 token is only printed after signing
Non-prescribing clinician issuing (nurse, paramedic etc.)
User can actively change an individual nominated script to Phase 4
Prescriptions will be issued to the prescriber signing queue
Prescription destination/preferred pharmacy entries are still printed on the token
Need to review current processes for when prescriptions are required immediately (even for nominated patients), for example screen messaging clinician
Issuing – no real change to normal EPS.
Admin will raise prescription as normal but where an fp10 would print it will be sent to the signing queue.
The GP will go into their signing queue and sign all prescriptions as EPS.
Nominated prescriptions will go to the spine as per normal.
Phase 4 prescriptions will go to the spine but a token will print . The systems know which prescription type it is. System Specific guidance will be provided to define where the tokens can be printed – either locally on the GP’s printer or another networked one .
There is a default setting in EPS2 which will have defaulted the system to not print tokens for EPS2… this still remains! It will not print tokens for nominated patients.. Only for patients that are non-nominated.
Individual prescriptions can be reverted from EPS2 to phase 4.. This will be the same way as they reverted prescriptions from EPS2 to FP10.
If a prescription is reverted from a nominated prescription to a phase 4 prescription
The nomination still remains unchanged for future prescriptions
when the prescription is on the spine it will always remain as a phase 4 prescription even if a nomination is changed or added at a later date.
Prescription destination / preferred pharmacy free text entries, normally used for prescription collection services with fp10. will still be displayed but some systems may display it in a slightly different location.
Exceptions will be issued as previously. PDS mismatches and unmapped DM+D items should be dealt with prior to issuing the prescription.
All CDs in Microtest sites , Non-DM+D, PA, Private, non-PDS records
How/Where to Print Tokens
System specific guidance

7. Processes in GP practice
Queuing prescriptions for digital signature
Virtually all prescriptions will be EPS
How to deal with exceptions
Controlled drugs (oral liquid methadone)
Non dm+d
Personally administered
Private prescriptions
Non-PDS records
How/where to print tokens
See system specific guidance

8. Unexpected FP10s
All practice colleagues should be aware that if EPS could be used for a prescription then it should be used.
When might an FP10 be printed?
Non dm+d items
PDS mismatch
No smartcard
Border patients (Scotland, Wales and Northern Ireland)
Controlled drugs (oral liquid methadone)
Basic EPS rules still apply otherwise and FP10 will print
Always ask – if it is an FP10 – WHY?
Expiry date remains as per prescribing regulations and will expire on the spine so will not be able to be dispensed once expired.
Some appliance contractors are not set up to, or refuse to, accept EPS prescriptions so we still need to be aware of this,

9. Processes in pharmacy
What do you think will be the differences in your processes? Then talk through any not already mentioned…

10. token submissions as now i.e. non age exempt and paid sent unsorted
Processes in pharmacy
Tokens instead of FP10s
All tokens the same – green/white
No need to print a white dispensing token in addition to the green
Scan Phase 4 tokens as per R1 FP10s
Make sure scanners work and check barcode quality
Once scanned and prescription downloaded, all processes as per EPS R2
Returns to spine/token to patient
Cancellations/NDs
Exemptions and endorsements
Virtually all claims via EPS - claim regularly!
Token submissions – (green and white)
Keep encouraging your regular patients to nominate
token submissions as now i.e. non age exempt and paid sent unsorted

11. Post dating and eRD in Phase 4
EPS prescription is not released to NHS Spine until post-date is reached
The Phase 4 token is printed at the point of signing with the intended dispensing date – explain date to patient
Pharmacy – check for validity/date on token
Repeat Dispensing
If no nomination = eRD batch to spine, token is printed
Patient takes token to pharmacy each time
Pharmacy must check dispense history – EPS tracker, script date and issue number

12. Issue management Communication – work together!
Issue reporting and escalation
Patient communication
Prescription tracker:
Alert services:
us/ 
us/subscribe/ 

13. Patient communications
Communications materials
Posters/digital display
nhs.uk web content
Key messages
Little change for patients
Still get a ‘paper copy’ of prescription to take to pharmacy
More safe and secure, seen only by the same people
Posters purposefully do not say anything specific .. Legislation has changed that states we do not need patient consent to send a prescription electronically. We still need consent to set a nomination as we are directing to a specific pharmacy but we don’t need consent to sign it and send it electronically.
Saving to the NHS are currently mainly realised at the latter end of the process when prescriptions are processed for payment ..

14. Phase 4 pilot Talk through All prescribing & dispensing systems
60 sites nationally
All prescribing & dispensing systems
High/low utilisation, Urban/rural
Dispensing Practices
Anticipated to remain enabled at end of pilot (linked to successful outcome)

15. National deployment support
Local implementation contact
System supplier helpdesk
Factsheets, web content, system guidance…
Patient communication materials
posters, website information etc.

16. Any questions?
Right click on picture to open hyperlink and run patient animation….. Will hyperlink and revisit if audience wish