EPS Flashcards
what is the aim of EPS
To develop a paperless system that:
Enables prescriptions to be sent electronically from GP surgeries to a pharmacy or dispensing contractor or the patient’s choice.
Send prescriptions to the NHS Business Services Authority (NHSBSA) electronically to claim for payment.
Make the process of prescribing and dispensing medications more efficient.
what are the advantages of EPS
Future-proofing the prescription pricing system
More accurate payments to contractors (pharmacies)
Less risk on loss of paper prescriptions (Data Security and Protection/financial implications)
More powerful analysis of data possible
Part of a huge NHS project to allow greater patient data sharing amongst healthcare professionals
Fewer dispensing errors
Saves money
what is NHS spine
NHS spine
A national secure central server of patient and NHS service information / programs
what is dm+D
dm+d
Dictionary of Medicines + Devices
The spine was developed based on dm+d coding for drug and medical device data.
Each dm+d code enables the electronic transmission of prescriptions (ETP) and the accurate population of patient recDords.
The same dm+d code is used throughout the NHS.
what is the function of NHS spine
Stores:
- Patient data (Personal Demographics Service PDS)
- Patient clinical information (Personal Spine Information Service PSIS), summarised as the Summary Care Record SCR
Supports programmes including:
- SCR/ PSIS access (access limitation programs)
- Choose and Book/Electronic Referrals
- GP2GP
- Secondary Uses Service (SUS)
- Electronic Prescription Service (EPS)
what is NHS smart cards
workers specific
NHS smartcards are required by all staff to access the NHS Spine and EPS.
Allows access to NHS spine
Personal property – The pin should not be shared, and the smartcard should not be left for others to use.
Issued by NHS (NHSE)
Different levels of access to NHS patient information for different staff.
Specific to one or more pharmacies (uses ODS codes)
Electronic certificate renewed every 2 years
Locums?
what is the development of EPS
1999 onwards- development of the dm+d 2002 onwards NHS Spine and EPS release 1 2014 EPS release 2-full rollout 2014-15 NHS Spine 2 2019 Schedule 2 and 3 CDs and EPS4 2021 rollout of Phase 4
what is EPS - release 1
FP10 prescriptions with:
barcode down the righthand side
signed by prescriber
Need NHS smartcard, Spine access, barcode reader
Read the barcode: patient, prescriber and medication details inserted into PMR.
Rx representation on screen.
Agree or change details (especially dosage)
Endorse and send for pricing as with paper Rx
Can be dispensed like a normal FP10 Rx (not using barcode)
what is the advantage and disadvantage of EPS release 1
Useful as:
Reduces data input error (?)
Adds accurate patient data record with NHS number
Used to test the Smartcard system/move to EPS2
Drawbacks
More complex PMR entry needed
Data input error not reduced
Have to send off paper prescriptions for pricing at month end
Still used but reducing in numbers (especially with the national roll of of phase 4)
EPS-R2 and Nominations
The patient chooses a dispensing site for their GP practice to send a prescription electronically for EPS2
Patients can nominate:
A pharmacy (including an internet pharmacy)
A dispensing appliance contractor
A dispensing GP practice (if eligible)
Nomination process requires access to the Spine
GP practices/ pharmacies can set up the nomination.
Patients can change their nominated dispenser at any time.
Written permission not required but nomination must be auditable.
Does not expire
Full electronic system-prescriber digitally signs prescriptions formatted like FP10
Prescriptions sent electronically from GP to nominated pharmacy
Nominated pharmacy:
Prints off electronic Rx on a Dispensing Token and accesses electronic Rx by scanning barcode OR scans Prescribing Token barcode to access electronic prescription
Dispenses and checks medication and endorses electronically (Drug Tariff rules apply)
Supplies medication to patient
Sends notification of dispensing to Spine
Check endorsements/claim for fees/medication cost electronically from NHSBSA
what are the types of NHS electronic prescriptions
Repeat prescriptions including Schedule 2 and 3 CDs
Acute prescriptions (urgent care often on Prescription Token or EPS4)
Electronic repeat dispensing service – eRD (batch prescriptions)
what types of prescriptions are not on EPS
Not on EPS
Non dm+d coded items
FP10MDA (yet)
Private prescriptions – Non NHS private prescriptions can be signed electronically but not sent to the pharmacy using the NHS spine.
Private Schedule 2 or 3 controlled drugs – must be printed on FP10PCD
how does eRD work?
day 1 - Gp signs eRD and uploads onto spine
pharmacy downloads and prepare medication
patient collects
pharmacy sends dispense medication
day 21 - second issue is downloaded automatically and have 7 days to prepare
day 28- patient collects
pharmacy sends dispense notification
day 49 - third issue is downloaded and automatically and have 7 days to prepare
day 56- patient collects
pharmacy sends dispense notification
…..
what happens to patients without a nomination
How can a GP write prescriptions for patients without a nominated pharmacy?
Get a patient to nominate a pharmacy, which they can change later (one off repeat)
Paper FP10 or EPS-R1
Use EPS4
what is EPS phase 4 and how does it work?
- GP issues a prescription
- non nominated EPS R2 prescription can be issued if no nomination is present and a paper prescription is not requested by patient
- X medication is added to the NHS spine
- the spine holds the rx ready for pulling down once the patient presents tehir paper to their chosen pharmacy
- patient takes their token to the pharmacy
- pharmacy scans token =dispenses = discuss if nomination needs to be set
- patient collects Rx from pharmacy
what is EPS tracker
Used to find the status of an EPS prescription
Enter a barcode or search by patient NHS number/date range, to find where a prescription is in the process:
left the prescribing site (been signed off)
reached the Spine
reached a dispensing site
been fully processed and claimed
Is the prescription at another nominated pharmacy?
Which prescription type the prescription has been written in i.e. phase 1 - 4?
You cannot see what items have been prescribed at this point.
what is the benefits of EPS tracker
GP Practice and pharmacy can check the current status of an Rx
Pharmacies can ‘copy and paste’ a barcode into their system to retrieve a prescription
Pharmacies can double check claiming
Pharmacies can check if the following prescriptions have been written:
- EPS1 barcoded paper prescription
- EPS2 electronic prescription
EPS4 electronic prescription and can download electronic Rx (not EPS1)
EPS2 vs EPS4
Scanning an EPS4 token may cause the PMR to print an identical token on FP10DT (white)
EPSR2 sent to the nominated pharmacy automatically – the prescription is usually already being processed or ready!
If a patient/representative cannot collect the EPS4 token, will they know all the appropriate information for the pharmacy to find that patient?
If the patient can not collect a prescription from their surgery the pharmacy team can find and dispense and EPS4:
GP sends email to patient with barcode of Rx or Rx ID number
Search the EPS tracker e.g. using NHS number of patient
Can be done for an EPSR2 if the nominated pharmacy can return it to the spine
what are problems with EPS
Drug field details in instructions field
Instructions for use in Latin code
Multiple copies of eRD prescriptions generated concurrently
what are the advantage and disadvantage of using EPS for patient
A:
Faster service-goes straight to pharmacy
Convenience-only visit GP surgery for medical appointments, not to collect Rx e.g. via ordering online and/or using eRD
Freedom of choice-can collect Rx anywhere, even if on holiday in a different part of England
D:
Timescale expectations not met
Sometimes Rx hard to find at the pharmacy as so many different systems in operation (complaints)
EPS2-renomination on receipt of Rx by distant pharmacy
Patient unaware of Rx if on eRD
what are the advantage and disadvantage of using EPS for GP surgery staff
A:
Less work
Less staff needed to process Rx= cost savings=more profit
Greater control (Rx cancellation)
D: Not all items allowed (non dm+d), FP10MDA Training staff Problems with writing correctly Difficult for locum doctors
what are the advantage and disadvantage of using EPS for pharmacy
A:
Streamlined workflow-staff can download prescriptions when they have free time
Fewer collections of Rx from GP surgeries
Aids development of new dispensing models e.g. internet/ distance selling
Easier month end processing
Reduced errors?
More accurate claims and fewer Rx lost in transit
D:
Extra work: printing DTs, sending dispense notifications, electronic endorsements, claims for payment, searching for Rx on the tracker
Interact less with GPs
Threat of internet pharmacies to community pharmacies
Paper Rx and DTs (non-age exempt) still submitted
Technical issues- wrongly written prescriptions, ‘quick dispense’ and ‘batch’ submissions problematical.
No flagging system for urgent Rx
Most errors are picking errors
Prescription switching/payment exemptions, electronic Rx out of date prior to claim esp 28 day expiry Rx (Schedule 2, 3 and 4 CDs)
Paper FP10 (signed in ink)
EPS1 (barcoded FP10 signed in ink)
EPS2 (signed, sent and claimed electronically) linked to nominated dispenser site
Prescription Tokens (printed by GP) and Dispensing Tokens (printed by pharmacy)
eRD
CDs Schedule 2 and 3
EPS4 (signed, sent and claimed electronically) NOT linked to nominations
