North Hampshire CCG
Electronic Prescription Service Release 2
Agenda
• Introductions
• National and local utilisation
– Bramblys Grange
• Nominations
• EPS tracker
• Dictionary of medicines and devices
(dm+d)
• Cancellations
• Introduction to eRD
National Deployment Progress
86% of GP
practices
99.2% of
pharmacies
92.8% of
DACs
21 million patients have a pharmacy nomination
Over 349 million release 2 prescriptions sent
Over 786 million items dispensed & claimed
Over
http://systems.digital.nhs.uk/eps/stats (10th October 2016)
3
North Hampshire CCG EPS utilisation
Utilisation %
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
(bsa comparison August 16)
GMS Contract 2016/17
Electronic transmission of prescriptions
“Building on the 2015/16 agreement, practices will be encouraged to
transmit prescriptions electronically using Electronic Prescription
Services (EPS) Release 2, unless the patient asks for a paper
prescription or the necessary legislative or technical enablers are not in
place. It was agreed to aim for at least 80 per cent of repeat
prescriptions to be transmitted electronically using EPS Release 2 by 31
March 2017, where appropriate. This will apply to repeat prescriptions
only”
http://www.nhsemployers.org/~/media/Employers/Documents/Primary%2
0care%20contracts/GMS/2016%2017%20GMS%20guidance.pdf
Bramblys Grange Medical Practice
Utilisation % last 12 Months
100%
*Estimated
90%
80%
*
70%
*
60%
50%
40%
30%
20%
10%
0%
Nov-15
Dec-15
Jan-16
Feb-16
Mar-16
Apr-16
May-16
Jun-16
Jul-16
Aug-16
Sep-16
Oct-16
Bramblys Grange Medical Practice
North Hampshire nominations *
nominations %
60
50
40
30
20
10
0
* % of patient list size
Bramblys Grange Medical Practice
“EPS utilisation drive”
– Assign EPS Lead
– Engage team
– Establish pharmacy relationships
– Promote EPS
– Sign up every patient
– Housekeeping (dm+d, PDS, approvals…)
– Repeat Dispensing process
– Pharmacy support
Bramblys Grange Medical Practice
Benefits
– Less paper collections, less paper chasing
– Convenience for GPs
– No more lost prescriptions
– Pharmacies manage patient queries
– Free up resources
EPS Release 2
Spine
NHS BSA
Patient Nominations - Facts
• Patients must have a nomination to use EPS
• Patients can have up to three nominations:
– one pharmacy (must be a specific community or
internet pharmacy)
– one dispensing appliance contractor (DAC)
– one dispensing GP practice*
• Nominations can be set, changed or cancelled at any
Release 2 enabled site (GP and Pharmacy)
• Nominations reside on the spine and are set or amended
in real time by authorised smartcard users.
• NHS England has overall responsibility for monitoring
nominations and ensuring that complaints are dealt with
fairly.
Four Principles of Nomination
Patient information
Target:
Patients on regular
medication & using a regular
pharmacy
Key messages:
• Choice of pharmacy
• Safe
– Cannot lose
• Saves Time
– No need to collect paper
prescription
– Less waiting
13
EPS Prescription Tracker
The prescription tracker is a useful
tool for determining the status of
EPS prescriptions, please use and
promote it amongst colleagues.
http://webarchive.nationalarchives.gov.uk/20160921135209/htt
p://systems.digital.nhs.uk/eps/library/rxtracker
EPS Prescription Tracker
https://portal2.national.ncrs.nhs.uk/prescriptionsadmin
Search by Prescription ID – copy & paste from GP system
Search by NHS number and My Site
23
How to find the Prescription ID
Right Click to “copy identifier”
Left click to view
prescriptions
Detailed search results:
Prescription and Dispensing Details
EPS Tracker statuses
EPS Tracker
NHS Dictionary of Medicines
and Devices (dm+d)
dm+d is the standard for transferring
medicine and medical device information
between clinical systems.
Items need to be mapped to the dm+d to
enable them to be sent via EPS
Means the item is not dm+d
mapped
NHS Dictionary of Medicines
and Devices (dm+d)
•
The drug name is not in dm+d format
This is denoted by the following on the medication screen within EMIS Web
(i.e. the dm+d icon is immediately behind the drug name)
•
The drug quantity is not in dm+d format
This is denoted by the following on the medication screen within EMIS Web
(i.e. the dm+d icon is immediately behind the drug quantity)
NHS Dictionary of Medicines
and Devices (dm+d)
•
When a drug is added to a patients’ record the following warnings will
appear in the ‘add drug’ screen if a drug is not dm+d mapped.
NHS Dictionary of Medicines
and Devices (dm+d)
•
Where a product is not dm+d mapped then these courses should be
cancelled and alternatives prescribed
Common examples:
Non-dm+d drug
dm+d alternative
Doublebase Gel (pump dispenser)
Doublebase Gel (Dermal laboratories)
Use 500g quantity for pump dispenser
Paracetamol 500mg caplets
Paracetamol 500mg tablets
Ensure Plus Juce Liquid (mixed flavours)
Note to pharmacy: Please supply in caplet form
Ensure Plus Juce Liquid (flavour not
specified)
AF prescriber endorsement required*
*AF endorsement will be a tick box on the drug information screen
AF Endorsement
NHS Dictionary of Medicines
and Devices (dm+d)
Identification of unmapped items
• Legacy data mapping tool
On the Mapping screen, an
icon is displayed next to any preparations with dm+d
equivalents. After mapping, you need to end these items and then restart them in
Medication. You can use the Select Patient and View Medication link from the mapping
screen to access Medication
• Use a bespoke search of patients by common items
NHS Dictionary of Medicines
and Devices (dm+d)
dm+d EPS factsheets for prescribers
http://webarchive.nationalarchives.gov.uk/20160921135209/http://systems.d
igital.nhs.uk/eps/library/dmanddfact1.pdf
http://webarchive.nationalarchives.gov.uk/20160921135209/http://systems.d
igital.nhs.uk/eps/library/dmanddfact2.pdf
Cancellation
(Spine)
Cancellation – To be dispensed
Cancellation – With dispenser
Request pharmacy to return to the spine
Mark as cancelled
Cancellation - Dispensed
Leave as issued
Cancellation – Post dated scripts
Cancellation – Post dated scripts
Immediately cancelled when post date script is
released form EMIS
Must still action task manually
Single item vs entire prescription
Scenario
Solution
Cancellation of entire prescription
Return whole prescription
Single item on a multi item
prescription
Two options:
1. Return the whole prescription, the spine
will cancel the item and then you can redownload the prescription manually
2. Mark item requiring cancellation as ‘notdispensed’ and dispense remaining items
Other triggers for cancellation
When amending a repeat template
– This will trigger a notification message to the user to cancel the last
issue or not.
Other triggers for cancellation
When ending a course
– If configured to “automatically cancel last
issue” or ticked in the end course notification
screen.
Other areas to maximise utilisation
• Absence or validity of smartcard (especially locums)
•
PDS record not synchronised
•
Controlled drug item – use pharmacy message
• Use EPS for acute scripts
• Staff Training https://supportcentre.emishealth.com/
• Electronic Repeat Dispensing
Work closely with your local pharmacies
Who is using electronic repeat
dispensing already?
What is eRD?
66
Repeat Dispensing
“batch prescribing”
 Prescribe a batch of EPS prescriptions in one go
for patients with repeat medication, for up to 12
months
 Pharmacy responsible for carrying out checks with
patient before dispensing each issue
 NHS Community Pharmacy Contractual
Framework essential service
Why use eRD?
68
Why?
Two thirds of prescriptions issued are for repeat prescriptions.
These prescriptions account for almost 80% of NHS medicine
costs.
The time involved in processing them is significant.
There are over 400 million repeat prescriptions generated
every year
(Average 200 per GP per week).
69
Electronic Repeat Dispensing
- Benefits
 Reduction in monthly repeat requests,
issuing, signing, collection, medicines waste
 Patient convenience – just collect from
pharmacy
 No piles of paper FP10s/RA forms
 Greater control and flexibility with EPS
safeguards, tracking, and cancellation
Who is suitable for eRD?
71
Suitable patients
•
•
Long term condition, stable therapy
Medication expected to remain stable
between reviews, eg 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
Pharmacy
second issue is
downloaded
automatically and
has 7 days to
prepare before
due date.
Pharmacy
third issue is
downloaded
automatically and
has 7 days to
prepare before
due date.
Day 21
Day 49
Pharmacy
last batch is
dispensed.
Informs patient
this is the last
issue
Last Issue
Day 1
GP
signs eRD prescription
and uploads to Spine.
Pharmacy downloads
and prepares
medication.
Cont….
Issue 2
Issue 1
Day 28
Patient
collects second
issue.
Pharmacy
Sends dispense
notification.
Day 56
Patient
collects third issue.
Pharmacy
Sends dispense
notification.
Patient collects
Pharmacy
Sends dispense
notification.
The prescriber can track the progress of the
prescription using the Prescription Tracker and can
cancel items at any point during the regime.
Last Issue
Patient
Collects last
issue and
contacts GP
GP
conducts review
if required and
issues next eRD
prescription.
73
Guidance
NHS Digital EPS website
http://systems.digital.nhs.uk/eps
NHS Digital eRD toolkit and e-learning
https://digital.nhs.uk/article/913/Electronic-repeat-dispensing-for-prescribers
NHS Digital eRD webinar
https://youtu.be/jzDkpaYibws
NHS England eRD guidance
https://www.england.nhs.uk/digitaltechnology/wpcontent/uploads/sites/31/2015/06/electronic-repeat-dispensing-guidance.pdf
NHS GP Bulletin
[email protected] (title email: GP bulletin subscription)
74
Where to find further information?
1. Our homepage http://systems.digital.nhs.uk/eps
2. GP and surgery staff information http://systems.digital.nhs.uk/eps/gppractice
3. Dispenser information http://systems.digital.nhs.uk/eps/dispensing
4. FAQs http://systems.digital.nhs.uk/eps/library/faqs
5. Prescription Tracker https://portal2.national.ncrs.nhs.uk/prescriptionsadmin/
6. Progress and Statistics http://systems.digital.nhs.uk/eps/stats
7. All practices usage data http://systems.digital.nhs.uk/eps/stats/10novgpstats.xls
8. EPS Bulletin sign-up [email protected] (title email: GP bulletin
subscription)
9. Enquiries [email protected]
10. Facebook www.facebook.com/epsnhs
11. Twitter @EPSnhs
12. You Tube http://www.youtube.com/EPSnhs
Any other questions?
Contacts
Dion Gordon
Project Manager – Digital Transformation
NHS South, Central and West
Commissioning Support Unit
Ph: 023 9222 4306 | M: 07481 281645
Email: [email protected]
Gary Mortimer
NHS Digital
Senior Implementation Manager
Mobile: 07768302186
Email: [email protected]
Nicola Chapman
NHS Digital
Implementation Support Manager
Mobile:
Email: [email protected]