The EPS explained Print E-mail
Written by NHS Connecting for Health   
With about 1.3 million prescriptions now being issued every working day in England – and this figure expected to rise by over 5 per cent each year – we need to change from a paper-based prescription system to an electronic one that is more efficient. The Electronic Prescription Service (EPS), being introduced throughout England, will enable electronic prescriptions to be generated, transmitted, received and, once dispensed, sent to the reimbursement agency. It will also allow patients to nominate specific dispensers should they so wish. Eventually, electronic prescriptions will replace most paper ones, bringing improvements in service, convenience and accuracy.

GP surgeries, community pharmacies and appliance contractors will have access to the EPS by the end of 2007. Prescribers working from a GP surgery will be able to use the service and, later, prescribers working from other locations such as walk-in centres or dental practices will also be included.

Why it is being introduced


With the growing number of prescriptions being issued, we need a system that is more efficient, consistently accurate and better able to cope with expected further increases in prescription numbers than the existing paper-based service.

The EPS will also bring a range of benefits to patients, GPs, pharmacists and other people – the extent of which will depend on individual circumstances. In particular, about 70 per cent of prescriptions are now repeats, and the EPS has been designed to streamline the current time-consuming system for dealing with them. For example, fewer patients will need to visit their GP surgery just to collect a repeat prescription, saving time for both patients and surgery staff. For many pharmacists, the need to collect patients’ prescriptions from surgeries will also become obsolete.

In addition, accuracy and safety will be improved because prescription information will be more complete and will not need to be typed in by the GP or other prescriber, and then again by the pharmacist or other dispenser; the information provided by the prescriber will simply be downloaded by the dispenser. Receiving prescriptions electronically from the prescriber, rather than waiting for the patient to arrive with a piece of paper, will also assist dispensers in managing their workflow and stock control.

In the longer-term, it is planned that the EPS will be integrated with the NHS Care Records Service. As well as automatically recording what has been prescribed on a patient’s NHS Care Record, the EPS will, subject to consent, provide the GP and other healthcare professionals with information on what has actually been dispensed to patients – improving the care they can provide.

How it works


Each GP surgery and pharmacy (or other dispenser) is going through two main stages of change – based on two software upgrades known as Release 1 and Release 2. Access to the EPS will be tightly controlled through the use of smartcards issued to individual GPs, pharmacists and other approved users, providing them with different levels of access as appropriate.

Release 1
Patients do not notice much change when their GP surgery implements Release 1 as they still receive a paper prescription, which is almost identical to the previous FP10 paper prescription form except that it has a barcode. This barcode represents a unique code to identify the prescription – it contains no personal information. When the prescriber issues this paper prescription, an electronic copy of the information on it is sent to the EPS. This copy has attached to it the same unique code as is represented by the barcode on the paper prescription.

When a dispenser, who has also implemented Release 1, receives a paper prescription with a barcode on it, scanning the barcode retrieves the electronic copy of the information on to the dispenser’s computer. There is no need to retype the information into the dispenser’s system. The dispenser then dispenses the medicine or appliance as usual, with the same level of safety checks as before. If the patient takes the prescription to a pharmacy that has not yet implemented Release 1, it can be processed in the same way as paper prescriptions are now.

Release 2
When a GP surgery has implemented Release 2, the prescriber will be able to apply an electronic signature to the electronic message, making it the prescription against which drugs etc. can be dispensed. The smartcards, which control access to the EPS, will also control who is allowed to sign a prescription electronically.

Patients will be able to nominate a pharmacy (and/or other type of dispenser) if there is one they wish to use on a regular basis that has also implemented Release 2. If they do this, their nominated dispenser(s) will be able to receive their prescriptions electronically without the patient having to collect anything from the prescriber – avoiding visits to the surgery just to pick up a prescription and enabling dispensers to prepare the patient’s medicine in advance of the patient arriving to collect it.

Patients who do not wish to use the nomination option will receive a barcoded paper copy of their prescription. Any dispenser they take it to will be able to scan this barcode and draw down the electronic prescription as described for the first stage of the service. Patients will be able to change their nominated pharmacy at any time. It is anticipated that nomination will usually take place at the pharmacy or other dispenser.

Once the majority of GP surgeries and pharmacies and other dispensers have implemented Release 2, the need for paper prescriptions will considerably reduce and the default position will become the issue of an electronic prescription.

Implementation


This two-stage approach enables complete validation of all technical, clinical and process aspects of the full-scale system while the paper-based system is still operating. It will allow users to become familiar with the software and processes before any significant changes affecting patients are implemented.

System suppliers are upgrading their current systems to make them EPS-compliant. Following a period of development, each system supplier goes through a process of testing, which is followed by a trial at an ‘initial implementer’ site. When the supplier’s system has been shown to be of the necessary standard (clinically and technically), the supplier is permitted to start a wider rollout, which is monitored by NHS Connecting for Health.

Working with you


To ensure that the EPS is robust and fit for purpose, NHS Connecting for Health has sought input from key stakeholders throughout the service’s design and development. Specially created user groups, meeting on a regular basis, have provided different perspectives on key design issues. This work has included looking at the live operation of the service in the initial implementer sites. Reviewing the early operational experiences at these sites has also helped to ensure that the potential benefits of the new service can be maximised. These groups inform the development of communication and guidance material.

The main user groups are the GP User Group, Pharmacy User Group and Patient User Group, which will continue to operate throughout the implementation of the service. In addition, other groups of stakeholders have been brought together on occasions to consider particular issues.

Further information

Guidance is being published to support those people involved in implementing the changes through each phase of change. Materials to help you explain the changes to patients are available in a range of languages and formats. To order or download these publications and for other fully up-to-date information, please visit www.connectingforhealth.nhs.uk/eps
 
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