Improving patient service

With a significant proportion of GP practices and community pharmacies now technically enabled to operate Release 1 of the Electronic Prescription Service (EPS), we are now on the brink of moving to Release 2, which will bring new opportunities to improve the service offered to patients.
    
The scale of introducing the EPS is significant. Connecting over 8,000 GP practices and about 10,000 community pharmacies to enable prescriptions to flow securely between a variety of different clinical systems poses not only a huge technological challenge, but also a logistical one. This is compounded by the fact that over 1.5 million prescriptions are issued each working day in England – a figure that continues to rise by around five per cent each year.
    
Due to the complexities of introducing a system of this scale, a decision was made early on to split implementation over two ‘Releases’ of software, known as ‘Release 1’ and ‘Release 2’.
    
Release 1 is primarily concerned with implementing the technical infrastructure required to support an electronic service. This involves suppliers of GP and pharmacy systems developing their systems to comply with a series of clinical and safety standards set by NHS Connecting for Health (NHS CFH). Once a system is awarded EPS accreditation the supplier is permitted to deploy the system to its customers. In addition to having an accredited system in place, users must also have an N3 connection (most pharmacy systems suppliers offer an integrated system/connectivity package) and possess a smartcard and PIN in order to operate EPS Release 1.
    
Business change
The only real business change associated with Release 1 relates to data entry. When a prescription is generated using a Release 1 GP system, a unique barcode is printed on the prescription form which corresponds with an electronic prescription message that is sent to the EPS (through the N3 connection). When a patient takes this prescription to a Release 1-enabled pharmacy, the barcode is scanned to retrieve the prescription details from the EPS. This alleviates the need for the prescription details to be re-keyed manually as they were previously. In some instances this can save time but more significantly, it contributes to a reduction in transcription errors that account for a large percentage of patients admitted to hospital as a result of an adverse drug reaction (ADR).
    
The critical factor in Release 1 is that the paper prescription is still signed by the GP and can therefore be used to dispense medication if taken to a non-EPS enabled pharmacy. This upholds the principle of maintaining patient choice as patients are not limited to only using EPS-enabled pharmacies. The fact that electronic prescription messages are in essence flowing in parallel with paper prescriptions means there is always a back-up in place if something goes wrong – which again is critical when implementing a system of this size and nature.
    
With Release 1 now technically enabled in around 80 percent of GP practices and pharmacies, we are now on the brink of moving to Release 2. Once introduced, Release 2 will enable real, tangible benefits to be realised.

Electronic signatures
One of the fundamental changes that will enable a fully electronic service in Release 2 is the ability for prescribers to sign prescription messages electronically. These electronic signatures are unique to individual users and are applied using their smartcard and unique passcode. It is the application of the electronic signature to the electronic prescription message that turns it into an electronic prescription.
    
Not only will this make the administrative task of signing large volumes of prescriptions easier, it will also mean that paper batch issues for repeat dispensing regimes will no longer need to be printed. Instead, each issue will be held electronically on the EPS.

Nomination
Nomination is a new process that gives patients the option to choose, or 'nominate' a dispensing contractor(s) to which their prescriptions can be sent automatically, via the EPS.
    
Nomination could be likened to existing prescription collection services offered by some community pharmacies as it removes the need for patients to call at their GP practice just to collect a paper prescription form. Instead, when a nominated electronic prescription is generated, it is sent to the EPS where it can be retrieved by the nominated dispensing contractor's system - without the need to scan a barcode. Also, the patient is not restricted to using a dispensing contractor located near their GP practice, thus improving convenience.  
     
Patients can choose to nominate up to three different dispensing contractors, including:

  • One community pharmacy
  • One dispensing appliance contractor
  • One dispensing GP practice (subject to local system configuration)

Only patients who are eligible to have their prescription dispensed by their GP practice will be able to have the practice dispensary as a third option.
    
Nomination is a flexible process. Patients can request for their nomination to be set, changed or removed at any time simply by asking a member of staff at a dispensing contractor or their GP practice.  
    
Nomination will bring many benefits for community pharmacies and should help to streamline current day-to-day working practice. Pharmacies currently offering prescription collection services will no longer need to physically collect prescriptions for patients who have nominated them. Also, as nominated electronic prescriptions may arrive prior to the patient arriving to collect them (in most cases overnight), it will give scope to manage stock control more effectively – providing the opportunity to order out of stock items in anticipation of the patient’s arrival.

Electronic endorsement messages  
Instead of having to batch and send paper prescription forms to the reimbursement agency at the end of each month, dispensers will be able to submit electronic endorsement messages for electronic prescriptions dispensed.
    
Prescription and dispensing tokens that have been signed by patients to either confirm payment or declare their exemption from payment will still need to be posted to the reimbursement agency - with a signed FP34c prescription claim form. However, considering that around 70 percent of exemptions are for patients who are age exempt (and who are not required to sign to declare their exemption under current arrangements), there will be a significant reduction in the volume of paper that needs to be sent to the reimbursement agency.
    
Claims for dispensed FP10 prescription forms will continue to be submitted in the same way as today.
 
The role of paper
It is important to remember that paper will probably never be completely removed from the process. Paper copies of prescription information that are produced alongside electronic prescriptions are called 'tokens' and act as a hard copy of the details contained within the electronic prescription. There are two types of token, known as 'prescription tokens' and 'dispensing tokens’. Prescription tokens are printed at the GP practice and will always be issued to patients who are not using nomination. This will allow any dispenser to scan and download their prescription details. Prescription tokens may also be issued alongside nominated electronic prescriptions if either the prescriber or patient deems it necessary.
    
Dispensing tokens are a new piece of stationery (provided free of charge by the PCT) and are printed at the dispensing contractor. They will mainly be required in situations where no prescription token is presented and the patient is required to sign to declare payment/exemption of prescription charges. They may also be required in other situations, such as at the patients’ request to enable them to order their next repeat prescription issue.

Moving forward
Getting to this stage of implementation has involved extensive consultation and discussion with GPs, pharmacists, patients and other stakeholders. As the programme moves forward we will undoubtedly face new challenges, so ongoing consultation will be invaluable to overcoming them. From day one we have been committed to delivering a service that is robust, fit for purpose and helps end users undertake their day-to-day operations. This will continue to be the case as we draw closer to the realisation of EPS Release 2.

For more information
More information about the EPS is available at www.connectingforhealth.nhs.uk/eps . Specific queries can be emailed to cfh.eps@nhs.net    

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