Electronic Prescription Service (EPS) Release 2. Implementation Guidance for Pharmacies

Transcription

1 Electronic Prescription Service (EPS) Release 2 Implementation Guidance for Pharmacies

2 Dear Pharmacy Manager As you are aware we are rolling out the new Electronic Prescription Service Release 2 and the GP Practice in your area is planning to switch it on shortly. This will mean that you will start to receive electronic prescriptions so you will need to change the way that you work in the pharmacy. You will need to liaise closely with your system supplier to ensure that your system is upgraded and you receive full training before you start using the system. You will need to go through the checklist before we allow the Practice (s) to start sending you prescriptions so please ensure that all tasks are completed before the go live date. There are a number of tasks which you will need to do to be able to receive the EPS Release 2 prescriptions from the GP Practices and this document sets out what they are. The main points are outlined below ALL of your staff will need to be registered and have a Smartcard You must have an EPS Release 2 compliant system You need the correct software to enable you to manage Smartcard certificates You need to have looked at your processes and ensure that you can manage the EPS R2 process safely. Contact the EPS R2 GP Practices in your area and talk to them about their processes and what types of prescription they are going to be sending to you. You will need a stock of EPS Dispensing Tokens available from the FHS Team (Controlled Stationery), Isaac Maddox House, Shrub Hill Road, Worcester, WR49RW. Fax: Tel: We recommend you start collecting nominations from patients who wish to use you for EPS R2 prescriptions well before go live date so that patients can use your system from day one see notes below on Nominations We will be organising workshops for you and the GP Practices that are implementing EPS R2 to help you work out how you will manage the EPSR2 scripts you will be getting. Additional information is also available on the EPS part of the Health & Social Care Information Centre website: If you have a video information screen it may be a good idea to show a power-point presentation on there to inform patients of the change while they are waiting. Contacts for the Project are: Sara Spencer, [email protected], Tel Mobile: Alison Rogers, [email protected] Tel: Smartcard Contacts are: Hoople Ltd,

3 Ensure that you also have Smartcard software Main Points Install EPS R2 system Obtain EPS R2 Smartcards Get training from system supplier Enable system using EPS R2 Smartcard Produce golden script to enable payment and ensure that you appear Order FP10 from FHS Team Start to enter nominations onto system Contact FHS Team (Controlled Stationery), Fax: Tel: Confirm date GP starting EPS R2 Scripts Liaise with GP Practice from early on Go Live Day Download EPS R2 Scripts Print script onto FP10 DT forms Process script and attach FP10 DT to drugs Dispense to patient and make as Dispensed Keep FP10 DT to send to PPA as normal Include FP10 DT s as normal scripts as they will ask for them

4 Nominations Patients must not be offered any reward or inducement to nominate a pharmacy by either the Pharmacy or GP Practice. Patients can only nominate one community pharmacy and one dispensing appliance contractor at a time. In each case a specific location must be nominated. An organisation or chain of premises cannot be nominated. Once the patient has been provided with the information they need to support their choice of nomination, a member of staff can set the nomination on the patient s personal demographics service (PDS) record within 24 hours. Nominations can be collected before a dispensing location goes live with EPS Release 2 To record the nomination, the staff that have the necessary rights authorised on their Smartcard, can process the nomination by searching for the patient s name, registered address, date of birth and gender. They can also use just the NHS number to locate the patient if this is available. The record can then be updated with the patients chosen dispensing contractor. The process will have to be repeated if the patient would also like to nominate an appliance contractor. Patients who are currently registered with a community pharmacy for a prescription collection service cannot be automatically migrated on to EPS for nomination purposes. However these patients may be approached by the pharmacy individually where appropriate and the patient will be able to nominate them. Provision of information Before a nomination is set by a patient, it is up to the nominator (prescriber or dispenser that is setting the nomination on behalf of the patient) to ensure the patient has been given all specific information and that the patient fully understands the nomination process. This information should help the patient make an informed decision as to whether or not nomination is suitable for their circumstances. If nomination is being considered then the following information must also be provided: EPS involves electronic transmission of prescriptions safely and securely. Paper is not always required. Any dispensing contractor operating Release2 can be nominated Patients are not restricted to nominating a dispensing contractor close to their home or GP practice. The prescription will be sent automatically to the dispensing contractor that has been nominated. If a patient chooses not to use their nominated dispensing contractor for a particular prescription, they must notify the practice at the time of requesting the prescription This includes when they are part way through a repeat dispensing cycle; The remaining prescriptions which have not been downloaded will be accessed by the nominated contractor

5 When a dispensing contractor has been nominated this gives the dispenser the opportunity to access the electronic prescription and prepare the prescription in advance of the patient arriving at the pharmacy to pick up the prescription. If the patient decides to go to a different dispensing contractor to the one that has been nominated, the dispenser may not be able to access the prescription, unless they have been given a dispensing token by their GP. Patients do not have to partake in the Electronic Prescription Service, if that is the opted choice by the patient then they will not be able to nominate a specific pharmacy nor will they be able to use any of the other services associated with EPS, they will carry on collecting their medication as they have been doing so. This information can be communicated verbally to the patient and/or to the carer or they can be given the patient information literature to read in their own time before making the decision. Using the Nomination Once a nomination has been set by the prescriber or dispenser, all electronic prescriptions thereafter will be sent automatically to the nominated dispensing contractor unless the patient requests otherwise from their GP at the time of issue. If the patient takes their prescription token to a different dispensing contractor, there is a strong possibility that the prescription will have already been retrieved by the original nominated dispensing contractor in anticipation of the patient s arrival. In this case, the patient should be encouraged to return to their nominated dispensing contractor to collect their prescription items. Changing the Nomination Changing the nominated dispensing contractor of the same type will instantly overwrite the existing nominated dispenser. Any electronic prescriptions that have not been retrieved by the previous dispensing contractor will be transferred over to the new nominated site (including any outstanding repeats). The patient should be advised by the prescriber or dispenser that s/he will be registering the change. When changing the nominated site midway through a cycle the patient may have to collect the current issue (owed items) from the previous nominated site, if the prescription had been retrieved before the new nomination had been processed. It is important to inform the patient that the best time to change their nomination is soon after they have collected an issue, this reduces the risk of the previous nominated dispensing contractor retrieving the prescription in anticipation of the patient s arrival.

6 Cancelling the Nomination Initially if a patient cancels a nomination and doesn t nominate an alternative dispenser and they are part way through an electronic repeat dispensing cycle, they will need to go back to their GP to obtain a paper based repeatable prescription, as electronic repeat dispensing will only be available to patients who decide to use a nominated dispensing contractor. The person requested to remove the nomination must clear the nomination within 24 hours of the patient making the request. From this point onwards the patient will receive a paper prescription to take to the pharmacy of their choosing.

7 EPS Release 2 - Pharmacy Plan and Checklist 1 Item Week Done 2 Obtain go-live date from GP Practice /CSU 8 3 Ensure you have an EPS compliant system or ordered your upgrade 8 4 Request Smartcards from Hoople Ltd Tel: Check that your pharmacy details are correct on NHS Choices & register to edit 8 details 6 Review business continuity SOP s & update or draft for EPS release Receive new EPS R2 Smartcards 8 8 Order dispensing tokens from the FHS Team Fax: Tel: Review nomination SOPs & update or draft for EPS Release Review dispensing SOP s & update or draft for EPS release Review accuracy checking SOPs & update or draft for EPS Release Review Smartcards SOPs & update or draft for EPS Release Review claiming SOPs & update or draft for EPS Release Review endorsements SOPs & update or draft for EPS Release Review exemptions SOPs & update or draft for EPS Release Familiarise yourself with your local nomination policy 6 17 Consider how you will promote EPS Release 2 to your patients (posters, leaflets etc) 6 18 Ensure you have the latest drug dictionary update and regularly backup system 6 19 Ensure you know how incidents should be raised (discuss this with your systems 6 supplier) 20 Familiarise yourself with sending dispense notifications 6 21 Check that your pharmacy is listed and EPS enabled on NHS Choices 2 22 Capture exemption details in system 4 23 Align labelling with products dispensed 4 24 Order dispensing tokens from FHS Team Fax: Tel: Discuss Workflow with Pharmacy System Supplier 4 26 Hardware requirements with system supplier/it dept Receive training from system supplier 4 28 Discuss with local GP practices on Go-Live date and their procedures 4 29 Check dispensing tokens have arrived from PCSS 3 30 Installation of EPS release 2 system 3 31 Run the validation script to commission your EPS Release 2 system 3 32 Check that EPS Release 2 Smartcards are working correctly for all staff 2 33 Continue as per usual process until you receive your first EPS release 2 Prescription 1 34 Start receiving EPS release 2 prescription from GP EPS Release 2 enabled sites 35 Familiarise yourself with the claiming process for EPS Release 2 36 Implement exemption SOPs (if patient is exempt from prescription charges and the exemption is non-age related) 37 Refresh training if appropriate (consider timescales, staff turnover etc.) 38 Continue to promote EPS Release 2 with your patients 39 Continue to capture nominations 40 Continually evaluate process with staff Go Live Day

8 Working in Partnership to Deploy EPS Release 2 Checklist for GP Practice-Pharmacy Local Business Change Discussions One of the key lessons from the implementation of EPS Release 2 to date is that good communication between GP Practices and pharmacies is essential to ensure smooth implementation of EPS Release 2. This checklist above, developed with input from GPs and pharmacists that have recently deployed the service, has been designed to support local inter-professional discussions before, during and after golive. Establishing Communication Channels Identify named contact points at the GP Practice and Pharmacy for queries and to ensure regular two way communication. Consider how best to engage. In some areas, immediately following deployment, GP Practices and pharmacies have booked a series of weekly 10 minute catch-up meetings to review problems that have arisen in the previous 7-days. This could be face-to-face meetings or a pre-booked telephone call. Often a pharmacy will dispense prescriptions from multiple GP Practices. This needs to be considered when planning a local engagement strategy. To improve understanding of new processes within the GP Practice and pharmacy, in some areas, GPs and pharmacists have arranged reciprocal visits to walk through new processes. Another approach tried is exchanging updated SOPs of key processes such as repeat prescription ordering. There is scope for LPCs and LMCs to work jointly to facilitate local dialogue, for example arranging an event for GP Practices and pharmacies in the locality to meet jointly. Discussion Points: Preparing for Deployment Using EPS Release 1 prior to go-live: A lesson learned from early implementation of EPS Release 2 is that using EPS Release 1 prior to go-live helps to smooth implementation of EPS Release 2; it gives pharmacy staff the opportunity to get used to prescription scanning and populates PMR systems with patient NHS numbers to support efficient administration of patient nomination requests. This is also an opportunity to discuss any current problems being experienced with EPS R1 prescriptions such as problems with prescriptions that won t scan because of faint barcodes. Capturing nominations prior to a local surgery going live: Where pharmacies have captured large volumes of nominations prior to a local surgery going live, this has enabled staff to cement business process change early. Where low numbers of nominations are recorded, the re-education of staff to new processes has been slower. Checking patients want the prescription sent to their nominated pharmacy: If there has been a long gap between the pharmacy setting the patient s nomination preference and the GP Practice going live, it is possible some patients will have forgotten the choice they previously made, early on in the deployment of EPS R2, will the GP be checking when EPS is initially deployed that patients want the prescription sent to their nominated pharmacy? (the nominated pharmacy will be printed on

9 the prescription token) Split prescriptions: There are some prescription items that cannot be transmitted electronically, for example it is currently not permitted to issue an electronic prescription for a Controlled Drug specified in Schedule 1, 2 or 3 of the Misuse of Drugs Regulations. Patients not being able to obtain all medicines electronically has created problems. A key lesson from experience to date is that pharmacists need to work with GPs to have a process in place to be able to identify patients who may have split prescriptions and ensure that affected patients are aware of the risks that nomination could create. Nomination may not be the best option for these patients. Post-dated Prescriptions: Does the GP Practice plan to post-date electronic prescriptions? A post-dated electronic prescription will be held locally within the clinical system and will only be sent to the EPS service on the specified date. This has created confusion. An alternative to post-dated prescriptions is use of the repeat dispensing functionality which will allow the pharmacy to access the prescription in advance of the due date. Prescription Tokens: Does the GP Practice plan to issue prescription tokens for acute prescriptions? Although an electronic prescription will be available for download from the Spine shortly after it has been issued by the prescriber, pharmacies need to manually check and download messages during the day so an acute prescription is unlikely to have been downloaded by the time the patient visits the pharmacy. Depending on how local processes are configured, providing a prescription token for acute prescriptions may support pharmacy staff in quickly accessing the prescription message when the patient visits the pharmacy. Repeat Prescription Collection Services: Are any changes planned to local repeat prescription collection services following the introduction of EPS Release 2, for example the cessation of services or reduction in the frequency of collections? If repeat prescription collection services are stopped or reduced, how will prescriptions that cannot be sent electronically, for example Controlled Drugs, be sent to the pharmacy? Repeat Prescription Order: Do patients currently place repeat order requests using a list of repeat medicines printed on the right-hand side of paper prescriptions? If so, how will patients make repeat prescription order requests in future? Repeat order processes currently vary around the country, use of lists of repeat medicines are common but new options are emerging including online repeat request ordering solutions. As part of the EPS Service, pharmacy staff are required to provide a list of repeat medication to patients, where the patient has requested this and where this information has been made available to the pharmacy through an electronic prescription message. Communicating Supplementary Clinical Information to Patients: The right-handside of prescription forms are often used by GP Practices to communicate clinical information to patients. In Release 2 of the Electronic Prescription Service, where there is no paper document flow between the prescriber and the patient, pharmacies are able to pass this information on to patients, where it has been provided in the electronic prescription message. It is mandatory for community pharmacies to pass on non-routine information relevant to the clinical care of the patient including: patient

10 or medication-specific instructions, the patient s review date if within 4 weeks; and when the last repeat prescription authorised by the prescriber is dispensed. Pharmacies are not required to pass on other information that may currently be printed on the right-hand-side of prescriptions such as GP Practice opening and closing times or advertising for local services such as flu clinics. Pharmacies have flexibility in how this information is passed to patients, for example proving information in writing or verbally. How will supplementary information be passed to patients by the GP Practice and pharmacy? If this functionality is used by the GP to send a message electronically to pharmacy staff, for example to alert them that the patient also has a paper prescription, how can the GP staff make it clear to pharmacy staff that the information is for pharmacy rather than patient-information. Re-issue of prescriptions where amendments are required: If there is an error or omission on a paper NHS prescription, pharmacies will normally send back the paper prescriptions to the GP Practice for a manual amendment to be made by the prescriber. An NHS electronic prescription cannot be amended once sent to the spine. If amendment is required, the prescriber would need to cancel the prescription and then regenerate it in amended form. How will requests for amendment be passed to the GP Practice and how will the GP Practice action this request? Dosage instructions: At present there is no standard dosage syntax. The dosage information in the electronic prescription is sent and stored electronically using 'free text'/text strings. A key potential benefit of EPS for pharmacies is that the dosage instruction information in the electronic message can be used to pre-populate the medicine label, supporting an efficient dispensing process. If however, pharmacy staff have to edit the label, for example if Latin abbreviations were used in the prescription message that are not suitable for direct transcription, this can slow down the dispensing process. Dosage instructions should be in English and ideally in a form of words that can be passed directly to the patient. Discussion Points: Making the most of EPS R2 Repeat Dispensing: Repeat Dispensing has the potential to offer significant benefits to GPs, pharmacies and patients including workload savings in the GP Practice and improved workflow management at pharmacies. Where repeat dispensing is not already common place, there is potential to discuss how this can be rolled-out locally in parallel with EPS Release 2 deployment. Numerous resources are available to support GP Practices in implementing Repeat Dispensing including guidance from the BMA/PSNC/NHS Confederation ( Discussion Points: Business Continuity Contact points: If there is a problem identified at the GP or pharmacy, who will be proactively alerted and what contact points will be used? Where is my prescription? A scenario that has arisen in EPS Release 2 sites is patients visiting the pharmacy but not finding their electronic prescription as expected. In some cases, where pharmacy staff have contacted the GP Practice, surgery staff have indicated that the prescription has been sent leading to the patient being caught in the middle. In many cases, this has been down to staff training but in

11 a minority of cases there has been a technical problem that has led to a delay in the prescription being received. There is a need for local agreement on how this will be managed. This is also an area where there is scope to jointly agree a form of words to use with patients when this scenario arises. Problems resulting in reduced access to the EPS Service: If a GP cannot send an electronic prescription or a pharmacy cannot access electronic prescriptions, how will this process be managed locally? In some areas this has been managed through the prescriber authorising an emergency supply with the prescription token used to support communication with the pharmacy on the products required. Once the pharmacy can access electronic prescriptions again, their dispensing records from the emergency supply can then be reconciled with the electronic prescription. Another option is reverting to paper prescriptions. Discussion Points: Patient Communications and avoiding the Blame Game Immediately after deployment: there are likely to be teething problems as staff get used to new processes. When problems do arise what message will be given to patients? One approach that has been tried has been proactively alerting the public to the introduction of new ways of working and asking for their support and patience during early implementation. Managing Patient Expectations: Another problem identified in EPS Release 2 sites has been patients not being given realistic expectations about the time to prepare prescriptions, for example patients leaving the GP surgery with a prescribing token for an acute medicine, visiting the pharmacy next door and expecting the medicine to be bagged-up ready for collection. Areas where it is helpful to discuss messaging to manage patient expectations include: the timescale from placing a repeat prescription request to collection of the prescription at the pharmacy and in what scenarios the patient should/ should not expect their prescription to be ready waiting for collection, for example it is unlikely an acute prescription will be prepared in advance of the patient visiting the pharmacy.

12 Smartcards for EPS R2 All staff needing to use EPS R2 will need a smartcard. This includes Dispensing Technicians and Medicine Counter Assistants. To get your pharmacy team registered with smartcards, you need to contact one of the RA Agents please call Hoople Ltd at The process will then be: 1 The RA Agent will send the pharmacy manager a spread sheet to complete detailing the pharmacy team. 2 He/she will need to decide what position each member of the team will need from the table below: 3 Once the RA Agent has received this information a meeting can be set up at the pharmacy for the staff to be registered. 4 At this meeting, all staff must have completed the RA01 form and have their 3 forms of ID (originals) with them. Their photo will be taken at this point to go on the smartcard. 5 The nominated sponsor for the pharmacy will check and sign off the RA01 forms and after this the RA team will create the smartcard.

13 Electronic submission of prescriptions for reimbursement Release 2 will support the electronic submission of reimbursement for prescriptions from a patient s nominated dispensing contractor to the NHS Prescription Services (NHSRxS). Endorsement The process for endorsing and submitting paper prescriptions for reimbursement continues and is unchanged. Guidance on this available on the NHSRxS website For EPS Release 2 the endorsement guidance is exactly the same as for paper prescriptions but the endorsement is entered and submitted electronically. EPS Release 2 Month End Process With EPS Release 2 the submission for reimbursement is significantly simpler and quicker. Most contractors submitting EPS Release 2 prescription messages will however, also continue to submit their paper prescriptions for reimbursement in the usual way. The FP34 The FP34 Submission Document will continue to be the official means of claiming payment and contractors should complete the document as follows: At the end of the month, pharmacy contractors must use this form to declare the combined total of paper and electronic prescriptions, for both messages and items, being submitted to the NHSRxS for reimbursement. The pharmacy contractor must also tick the Electronic Prescriptions box to confirm that EPS Release 2 prescription messages have been included within the monthly submission.

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15 The number of EPS Release 2 prescription reimbursement messages and items submitted online added to the number of paper FP10 prescriptions and items. Enter the combined figure for each in the appropriate box. Tick if EPS tokens for non-payment are being sent (See notes) Tick if EPS Release 2 prescription reimbursement messages have been submitted and included in the Part 1 totals of prescriptions and items submitted. Notes Where a prescription token or a dispensing token has been used to record a signature for a non-age related exemption or the patient has signed the token and paid for the items the dispensing contractors must submit these to the NHSRxS monthly along with the FP34 Submission document. These tokens, which are required for audit purposes, do not need to be sorted. They must be bundled separately from the paper FP10 prescriptions. Paper FP10 prescriptions must continue to be sorted according to the guidance on the FP34 form. Resolving issues Initially it will not be possible for the NHSRxS to electronically return prescriptions submitted this way. Issues will either be resolved using either a paper representation of the claim as usual or by phone call. Ultimately the transfer of electronic prescriptions will become all encompassing. Schedule of payments The Schedule will provide information on the number of prescription forms and items received electronically for each month. The numbers provided will relate to

16 the physical receipt of the paper and electronic forms and items before the calculation of any additional fees. This figure will exclude any paper tokens for nonpayment received by the NHSRxS for audit purposes as outlined in the notes above.

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