Introduction To maximise the benefits of EPS Release 2, pharmacies and GP practices need to adapt existing business processes. These changes need to be.

Preparing for EPS in your GP practice and pharmacy Business Process Change Workshop

Introduction To maximise the benefits of EPS Release 2, pharmacies and GP practices need to adapt existing business processes. These changes need to be agreed and communicated to staff. Business processes are unique to every site so ensure any locums are briefed on these changes. All staff need to be aware of any agreed changes to process or new processes to be implemented Ensure all locum/new staff are briefed on agreed processes

Workshop overview Today we will be covering:
Overview of EPS Release 2 GP and dispenser site readiness Business process change for GP practices and pharmacies Business continuity & raising support calls Training and support for EPS Release 2 Patient communication Connect with EPS and learn more Question & answer session

Overview of EPS Release 2

EPS in a nutshell EPS enables prescriptions to be sent electronically from the GP to the dispensary of the patient’s choice. 5

Why is EPS needed? Over a billion prescription items were issued in 2012 About 70% of prescriptions are for repeat medication

What happens now? Map out your current local processes and use these to help consider how they might change with EPS Release 2. The following diagram shows an example of the current process.

What happens now? Patient Surgery staff Doctor Pharmacy Pharmacist
Payment agency Each GP Practices and pharmacy processes will be different, your processes may have more or different steps, this diagram shows the generic process.

EPS is a more efficient way!
Patient Doctor Pharmacy Payment agency

Where will EPS be used? GP practices (including dispensing practices)
Community pharmacies Dispensing Appliance Contractors (DACs)

A phased approach Release 1 introduced the technical infrastructure to enable prescribers and dispensers to operate the EPS. The implementation of Release 1 is now almost complete with over 95% of GP practices and pharmacies live with the service Release 2 provides enhanced functionality for users which will deliver tangible benefits for patients, prescribers, dispensers and their staff Release 1 was all about proving the infrastructure and end to end messaging worked. Release 2 is where we start to see the benefits for patients, GP Practice and dispensers, through enhanced functionality.

Release 2 overview Nomination Electronic Signatures Electronic
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. It is the application of the electronic signature to the electronic message that turns it into an electronic prescription. Nomination Nomination is a new 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 Electronic Prescription Service. Electronic Cancellation Prescribers (or other authorised staff working in the GP practice where the prescription was generated) will be 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 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 will allow dispensing contractors to electronically submit endorsement messages to the reimbursement agency for dispensed electronic prescriptions. Electronic submission of reimbursement endorsements Electronic cancellation Electronic repeat dispensing

Key benefits Patients Prescribers/ Prescription Clerks Dispensers
Greater convenience Increased freedom of choice Reduced waiting times in the pharmacy Potential reduction in workload. Easier to use repeat dispensing Greater efficiency and control . Greater efficiency Streamlined workflow Easier month end processing 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. 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 13

Prescribing and dispensing site readiness

Site preparation Ensure all staff who will be dealing with prescriptions have smartcards and the correct roles – consider nomination setting and cancellation Ensure all GP smartcards have been checked for duplicate certificates Smartcards Ensure all staff have Smartcards and the correct roles. Need to consider who needs the responsibility to cancel, will it be GPs or prescription clerks? In dispensary who needs to be able to set nominations, who needs to be able to mark items as dispensed and to submit electronic claims Duplicate Certificates Sometimes when a certificate is renewed on a Smartcard the old certificate remains on the card. If there is more than one certificate in place then when a GP signs an electronic prescription, the duplication will cause the electronic signature to be invalid when downloaded by the dispenser. A tool can be used to check Smartcards. If duplicate certificates are found then the smartcard needs to be cleared and a new certificate issued. RA team or sponsor should be able to support this.

Capture patient nominations Release 1 usage – dispenser & practice
Site preparation Capture patient nominations Release 1 usage – dispenser & practice Medication synchronisation Order dispensing tokens Capturing Patient Nominations GP Practice – Need to consider whether you want to capture any nominations prior to go live? This can’t be recorded on the system until go live but can be recorded on paper and entered on go live day. Dispenser – Capture nominations on the lead up to the practice go live, consider your patients who are on your collection/delivery services. Release 1 usage – dispenser & practice - Ensuring smartcards are working and that bar codes are being produced. From the pharmacy side ensuring all bar codes are being scanned and dispense notifications are sent back to the Spine. By doing all 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. Medication synchronisation – For some patients who are on multiple medications they may have different issue dates, so for example patient X collects items 1, 2 and 3 on day 15 of the month and the 4th item is due at the end of the month. If time can be spent bringing all drugs in line with the same due dates then it will mean you can produce just one script electronically and reduce the number of times a patients needs to request and collect medication. 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.

Site preparation Patient communication – leaflets/posters
Site Lead (admin and GP) – nomination, prescription preparation, issue resolution. Review available factsheets: Leaflets/Posters –Think about how you will communicate to patients and where you will place posters/leaflets etc Site Lead (admin) – Great idea to identify two leads who will ‘champion’ the service. These should be people that other members of staff can go to and who are willing to share their knowledge and offer support. Review Top tips and available factsheets Some useful tips and factsheets are available for you to review

Ensure ODS code in dispenser system is correct
Site preparation Ensure ODS code in dispenser system is correct Ensure NHS Choices information for dispensers is correct Schedule and agree system training Ensure ODS code in dispensing systems is correct Each pharmacy site has an ODS code which is provided by NHS Prescription Services. This is entered into the system, it is important to check with your system supplier that the correct code has been entered, as incorrect codes could result into nominations being set against the wrong code and electronic payments being incorrectly paid. Ensure NHS Choices information for dispenser is correct and if not please contact the NHS Prescription Services to amend Schedule and agree system training – Ensure training is scheduled in a timely manner on how to use EPS in your system. Training is very important to ensure everyone knows how to use the system properly and reduce errors.

Processes for prescribers

Key processes to consider before go live at the GP practice
Approach to capturing nominations Preparing a repeat prescription Signing electronic prescriptions Electronic repeat dispensing Split prescriptions. Electronic Cancellation We will now go through each of these processes/areas and discuss them in turn.

Approach to capturing nominations
Will the practice be proactively capturing nominations? How far in advance? Will the practice target specific patients? What will the practice do if a patient asks about EPS and nomination? What literature will the practice use to support patient communication? What will the practice do if a patient asks about EPS and nomination? Some patients might ask for a nomination to be set / removed there and then e.g. if they are unhappy with a pharmacy or if they want to change pharmacies. Staff and GPs will have to be able to add a nomination / remove a nomination if requested by a patient.

Preparing a repeat prescription
Are they prepared by prescription clerk, pharmacist, prescriber? Depending on who prepares, consider: Who edits or amends the prescription How do you deal with issues needing re-authorisation How and when are queries communicated to the prescriber – virtual sticky note, , diary entry, clinical note, Does the prescriber amend or edit the patient repeat master? Or is it returned to the prescription clerk to amend master? Consider how you will deal with urgent requests Discussion on : Who prepares repeat medication currently? Discuss who is responsible for editing or amend repeat templates – is it only GP ? How do you currently handle re-authorisations, each system deal with these differently...for example EMIS web you might use request issue, or TPP you might use a task. EPS will support requests for re-authorisation Consider how you will deal with urgent requests – will it be using online messaging, phone calls...discuss how the practice currently deal with them and is there a more efficient way.

Signing electronic prescriptions
What is your current process? Scripts divided equally into pigeon holes/ baskets? Patient’s Usual GP signs all? GP registrar signs all repeats? All to duty Dr? Will you allocate electronic scripts in the same way? What about annual or sick leave cover? End of day process – ensuring all scripts have been signed – who is responsible, Admin, duty GP etc...? Discuss what the practices current process is and how this will fit with EPS. Allocating scripts: Need to consider whether scripts just go to the usual GP, each script allocated, bulk authoriser change or do GPs just go in and sign which ones they choose too. End of day process- Important for someone to check at the end of day all prescriptions have been signed

Electronic repeat dispensing
Who will set up the repeat regimes – prescriber, medicines management, practice nurse/nurse practitioner/admin? Which patients – any on repeats? When – during medication review, during long term condition reviews, at the end of current authorised issues or ad hoc consultation? How long are regimes set up for – determined by clinical judgement Electronic Repeat Dispensing. Practice needs to decide when they want to start using electronic repeat dispensing, might depend on whether they already do paper repeat dispensing. Things they need to consider are: which patients, when will regimes be set up and who will do this. How long regimes are set up for is determined by clinical judgement as this will vary per patient. Practices will see greater benefit from EPS if they do electronic repeat dispensing.

Split prescriptions What is a split prescription? Possible options:
Replace the item with another description of the same product that is dm+d mapped and can be sent through EPS. Revert all items to FP10 Agreement that patient attends surgery to collect out of scope items on a FP10. Agree prescription collection service (if appropriate) and add note to dispenser attached to release 2 prescription advising of extra items on prescription collection service. Discuss with patient suitability if all items out of scope. What is a split prescription? This is where the system can not send all items being issued electronically so it will ‘split’. This means the items that can go electronically can and the ones that can’t will print as normal. There are a number of options to consider: Replace the item with another description of the same product that is dm+d mapped and can be sent through EPS. – Except Controlled drugs which cannot be prescribed using EPS. Agreement that patient attends surgery to collect out of scope items on a FP10. Agree prescription collection service (if appropriate) and add note to dispenser attached to release 2 prescription advising of extra items on prescription collection service. Discuss with patient suitability if all items out of scope – If a patient can not use EPS for some reason for example they are on controlled drugs then discuss this with them. Revert all items to FP10 Some systems functionality varies – if unsure speak to supplier. SystmOne It is important to note that SystmOne does not support split prescriptions. If any item on the repeat template can’t go via EPS for example not mapped to dm+d or CD then the system will not allow anything to go via EPS, even if the items you are issuing can go via EPS

Electronic cancellation
Who will be responsible for cancelling electronic prescriptions? How will this process be handled? Who will be responsible for contacting the patient and/or pharmacy? Ensure all staff are aware of the processes around each type of cancellation response. Successful cancellation Unsuccessful cancellation, prescription is with the dispenser Unsuccessful cancellation, prescription has been dispensed Electronic Cancellation Practice needs to consider who will be responsible for electronic cancellations, don’t assume it will be the GPs as it might more than likely be the prescription clerks. Ensure the appropriate Smartcard access is granted for whoever will be doing it. Business processes need to be agreed for each cancellation response, these are: Successful cancellation – prescription has been successfully cancelled off the spine. This will not be available to the dispenser. Unsuccessful cancellation, prescription is with the dispenser – this means prescription has already been downloaded by the dispenser but not yet dispensed. They should be contacted and asked to ‘return’ the prescription to the spine and at this point the prescription will be cancelled automatically. Unsuccessful cancellation, prescription has been dispensed – this means the dispenser had dispensed the prescription and patient has collected their medication. Patient should be contacted.

Processes for pharmacy staff

Key processes to consider before go live at the pharmacy
Approach to capturing nominations Dispensing and downloading electronic prescriptions Dispensing tokens Electronic cancellation Electronic endorsement and patient declarations Electronic claims End of month processes

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? What do they want to know? 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
Consider the 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, and this is when a patient is exempt of needs to pay for their medication. 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 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 process in place for checking for replacement prescriptions. 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. Replacement prescriptions Sometimes prescribers might replace a cancelled prescription with a new one. This will come through on to your system as a new prescription but ensure that you request for new nominated prescriptions so it can be pulled down into your system for dispensing. Returning prescriptions What if a practice contact 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 dispensing tokens. Electronic prescriptions must be electronically endorsed. Paper prescriptions must be endorsed and submitted in the usual way Do not handwrite endorsements on a dispensing token, 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.

Electronic claims All electronic prescriptions must be claimed 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 As patient collects their medication, 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. 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. Unsigned tokens should be confidentially destroyed

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 with GP practices if: A patient’s prescription does not arrive at the dispenser straight away? GP reports their system is unavailable? Dispenser system is unavailable? EPS is unavailable nationally? Sign up for alerts: 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.

Raising support calls Ensure you know how to log calls to your supplier and know their escalation procedures GP: 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

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 Will you want/need post training support?

Patient Communication

Patient communication
How will you communicate with patients? What tools will you use to help communication Do you know what is available to order or download? Patients should be fully informed about nomination This information should include: Nomination is not mandatory No need to collect paper prescription from the GP practice Patient can choose who they wish to nominate Nomination is flexible and can be changed or removed Not restricted to nominating a pharmacy close to their GP practice Patients don’t need a computer to set a nomination This infomration can be given to the patient in a variety of ways including: Face to face Leaflet telephone

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

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Introduction To maximise the benefits of EPS Release 2, pharmacies and GP practices need to adapt existing business processes. These changes need to be.

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Introduction To maximise the benefits of EPS Release 2, pharmacies and GP practices need to adapt existing business processes. These changes need to be.

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Presentation on theme: "Introduction To maximise the benefits of EPS Release 2, pharmacies and GP practices need to adapt existing business processes. These changes need to be."— Presentation transcript:

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