Electronic Prescribing EPS and eRD inc. Remote Consultations
Electronic Prescribing Service – EPS
NHS Digital are continuing to drive Electronic Prescribing.
Electronic Prescribing Service – Phase 4 was deployed from 18th November 2019, initially to TPP SystmOne following a pilot in 2018, and then to EMIS. It has recently also been enabled for the Vision and Microtest GP clinical systems (2023).
Prescribers can generate a prescription in the traditional sense using EPS, but the electronic prescription is sent to the Electronic Prescription Service, where it can then be downloaded by a dispenser (Pharmacy) available on the EPS system. Patients have the option to choose, or ‘nominate’ a dispensing contractor to receive their electronic prescription automatically without the need for any paper.
At the end of a consultation, where traditionally a paper prescription would have been generated, the prescriber is asked to enter their NHS smartcard pin code and the electronic prescription is sent to the nominated Pharmacy. There is an option to nominate an alternative “one off” Pharmacy in specific circumstances and to print off a prescription token as noted below. Note that a prescription token does not require a manual prescriber signature – the electronic signature to the smart care and pin code suffice.
Phase 4 of EPS (recently implemented) allows prescriptions for patients without an EPS nomination to be signed, sent and processed electronically.
Patients without an EPS nomination will be given a token (patients may refer to this as a paper copy of their prescription) to present at a community pharmacy or Dispensing Appliance Contractor (DAC) to obtain their medication. This token will contain a unique barcode which can be scanned at any community pharmacy or DAC in England to download the prescription from the NHS Spine and retrieve the medication details.
Paper prescriptions will continue to be available in special circumstances, but almost all prescriptions will be processed electronically.
Prescribers will have the ability to cancel electronic prescriptions at any point up until they are dispensed and record the reason why they were cancelled. Also, prescriptions for nominated dispensing contractors will no longer need to be sent by post in situations where this was previously necessary.
Phase 4 – Information for GP Practices contains details on how it works in practice along with resources and templates.
Sign up to receive NHS Digital bulletins to your inbox.
Prescribing in Remote Consultations
GMC updated guidance (Feb 2021)
With more and more remote consultations the GPC thought it important to highlight that the GMC have published updated guidance on prescribing, to support doctors who are increasingly seeing patients via remote and virtual consultations.
Key updates include:
- New advice for doctors not to prescribe controlled drugs unless they have access to patient records, except in emergencies.
- Stronger advice on information sharing, making it clear that if a patient refuses consent to share information with other relevant health professionals it may be unsafe to prescribe.
- Alignment with the GMC’s updated Decision making and consent guidance, highlighting the importance of good two-way dialogue between patients and doctors in all settings.
Electronic Prescription Service in Remote Consultations
NHS Digital Guidance on safe EPS use
Guidance has been published by NHS Digital and the key points to note are:
If the patient has an EPS nomination in place already, the prescribing system will automatically default to send the prescription to that dispenser.
- You should check whether a patient’s nominated pharmacy is suitable for the prescription before prescribing. If not, for example if the nominated pharmacy is closed or the patient is not able to get there, then consider changing the nomination or using a one-off nomination (if this is available in your prescribing system) – see below.
- If the patient does not have a nomination in place, encourage them to choose a pharmacy that is convenient to them and set the nomination on their record.
Changing a Nomination
If a patient wishes to make a temporary change of nomination, it is important to tell the patient that:
The change of nomination will apply to future prescriptions and may also affect any that they have not yet collected from their pharmacy.
Once they have received their medication from the ‘temporary’ pharmacy, they should ask the pharmacy to change their nomination back to their usual pharmacy. Alternatively, they can contact the practice or their usual pharmacy when they wish to re-set their nomination. They can also change it themselves if this functionality is available to them via their patient-facing service or app.
If the prescriber changes the nomination back or removes it too soon (i.e. before the intended pharmacy has downloaded the prescription), then that pharmacy will not receive the prescription in their routine download.
This is available in most prescribing systems and, if available, can be used to override the patient’s regular pharmacy for this prescription without affecting future prescriptions which will continue to be sent to the patient’s regular nominated dispenser. The one-off prescription would be affected if the regular nomination is changed before it is collected.
EPS Phase 4 (non-nominated) Prescriptions
If an EPS nomination is not a suitable option and if EPS phase 4 is enabled, send the prescription as a non-nominated EPS prescription. The prescription will be signed electronically and sent to the Spine. The prescribing system will default to print a token, which would be given to the patient if they were present, to take to a pharmacy of their choice.
In scenarios where the patient is not present to collect the token, they can still go to a pharmacy to ask them to download and dispense the prescription.
It is important to:
- Provide the patient with the prescription ID, if possible.
- If this is not possible, ensure the patient knows their NHS number or knows where to find it.
- Advise the patient to give the pharmacy their Prescription ID or NHS number.
Nominations – Consent and Recording
Patients must be informed and given their consent before a nomination is recorded. The consent doesn’t have to be in writing but you do need to have an auditable process.
The patient’s nomination should be recorded in the Pharmacy Medicine Record (PMR) system or GP system, and it is then updated on the NHS Spine.
Once updated, the nomination will be visible to both the patient’s GP practice and their pharmacy. The patient’s prescriptions will then be sent via EPS to their nominated pharmacy, unless they request otherwise.
Increasing Electronic Repeat Dispensing
The NHS Business Services Authority has launched a service to help GP practices increase electronic repeat dispensing (eRD). You can request the NHS numbers of patients who may find the service useful, based on their prescribing data.
The whole repeatable prescription can be set up for as long as a year but each repeat should not be for longer than the patient has now.
For example, if the patient has prescriptions for a month’s supply now, then the repeat dispensing should be set up as up to 13 x 28 days’ supply.
Guidance for Practices
The NHSBA will:
- contact GP practices to confirm whether they have an active nhs.net email address.
- once confirmed, send the practice an email with a password-protected ZIP file. This will contain the NHS Number and the name of item prescribed for every patient that is potentially eligible for eRD.
- A clinician should then review the patient records of those patients to ensure that they are appropriate for eRD.
The practice can then arrange for verified patients to be moved to eRD. All requests for NHS Numbers as part of the COVID-19 response should be made to firstname.lastname@example.org .
Information for Patients
To help explain eRD to your patients, the NHSBSA and Wessex AHSN have created a poster for practices’ entrances. To download the poster, visit the NHSBSA website .