EPS and e RD Great Yarmouth Waveney Agenda

EPS and e. RD Great Yarmouth & Waveney

Agenda • EPS Overview & Update • e. RD & the Benefits • Patient Selection & Synchronisation – How does it work - Animation • e. RD Prescribing and cancelling – basic principles. • Questions & Feedback?

EPS Overview & Update

Local Overview – GY&W • • • 100 successfully deployed Average usage in April 2017 was 74% 120, 133 nominations 51. 7% of registered population 3 rd highest nominated CCG in England (% terms) • 1. 9% e. RD in April 4

National Perspective • • • GMS Contract 2017/18 Local Digital Roadmaps (LDRs) Strategic Transformation Planning (STPs) • • • Universal Capability i GPs and community pharmacists can utilise electronic prescriptions All permitted prescriptions are electronic By the end of 2016/17 80% of repeat prescriptions to be transmitted electronically* (80% of repeat prescriptions target = 56% of all prescriptions) 25% Electronic Repeat Dispensing for all appropriate patients by 31/3/18 • *non-dispensing patients only, until solution available for GP dispensaries 5

e. RD & the Benefits

What is e. RD? • Electronic Repeat Dispensing (e. RD) is an integral part of EPS which offers extra benefits over paper repeat dispensing and regular repeat prescribing. • e. RD allows regular medicines to be prescribed for suitable patients in batches of up to a year and stores the prescriptions securely on the spine. 7

What is e. RD? • Prescriber issues batch of EPS prescriptions in one go for suitable patients with repeat medication, for up to 12 months. • Pharmacy responsible for carrying out checks with patient before dispensing each issue. • Patient liaises regularly with pharmacy and has flexibility throughout the regime.

How does e. RD work at a practice? Prescriber can authorise and issue a batch of repeat prescriptions until the patient needs to be reviewed. Repeat dispensing can be issued for up to 12 months, but can also be issued for shorter periods. Repeat items that have not yet been downloaded by the pharmacy can be cancelled by the GP Practice. An electronic prescription for repeat dispensing this will contain the following information: the intended interval between each issue of the repeatable prescription how many issues the repeatable prescription can be dispensed 9

Benefits for the GP practice • Reduction in workload in re-signing requested repeat prescriptions. • Reduction in the amount of requests/queries coming into the practice. • Cancellation at any point during the regime at item or at prescription level. • New medication can be added to the regime. • Possible reduction in medicines waste.

Benefits for the patient • Reduction in unnecessary visits to the GP practice. • Ability to request multiple issues of medication when necessary e. g. holidays, Christmas, Easter • Potential reduction in out of hours requests for routine medication. • Patient doesn't need to remember to order their prescription. • Patient cannot lose their prescription. • Pharmacy nomination can be changed in the middle of a repeat dispensing regime.

Benefits for the Pharmacy • • • Improved stock control. Increased efficiency. Effective time management. Reduction in managed repeat workload. Less “Emergency Supply” at peak periods

Patient selection & synchronisation

Suitable patients • • Long term condition, stable therapy Medication expected to remain stable between reviews, e. g. 3 m, 6 m, 12 m 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 14

Prescribing e. RD When a prescriber issues an electronic prescription for repeat dispensing this will contain the following information: • the intended duration of each issue of the prescription • how many times the repeatable prescription can be issued before the patient/medication should be reviewed 6 issues x 28 day duration = 6 months supply 15

Preparing repeats for e. RD • Check the issue duration / interval is correct for each repeat template. • Synchronise all items to be issued in the same e. RD batch. • Ensure the number of authorised issues and/or review dates match up. • Consider issuing items in separate batches – eg CD 4 or 5 (28 day expiry) or PRN items (irregular issue duration). • Use the patients’ usage history to calculate PRN intervals e. g. 4 issues in 12 months = 84 days between issues.

How Does e. RD process Work? 17

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Patient going on holiday.

6 28 5 28 28 4 1 3 28 9 23 13 11 8 24 25 26 27 14 15 16 17 18 19 20 21 22 12 10 7 28 2 Patient requests additional medication because they are going on holiday?

6 28 5 28 28 56 4 1 3 28 9 23 13 11 8 24 25 26 27 14 15 16 17 18 19 20 21 22 12 10 7 28 2

6 28 5 28 4 56 9 23 13 11 8 24 25 26 27 14 15 16 17 18 19 20 21 22 12 10 7 28 2 3

How does e. RD Work? In words! • Once the prescription is signed; the 1 st prescription will be available immediately for download by the nominated dispenser (unless postdated). • All other prescriptions will remain on the spine until the previous issue has been completed i. e. ‘Dispensed’ or ‘Not Dispensed’ and a Dispense Notification (DN) sent to the spine. • Subsequent prescriptions will automatically download into the pharmacy system 7 days in advance of its due date. • Where clinically appropriate, a prescription can be downloaded early as long as a DN has been sent for the previous issue. 31

Community Pharmacy – The 4 Questions • Have you seen any health professional (GP, nurse or hospital doctor) since your last repeat was supplied? • Have you recently started taking any new medicines either on prescription or that you have bought over the counter? • Have you been having any problems with your medication or experiencing any side effects? • • Are there any items on your repeat prescription that you don’t need this month? • e. RD and this monthly “review” is part of the Community Pharmacy 32 Contractual Framework

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e. RD Prescribing and cancelling – basic principles.

Do you need an RA token? No, it is no longer mandatory to print an RA token at the start of a repeat dispensing regime, but all systems still do RA Token can be passed to patient, pharmacy or shredder A token can still be printed at the request of the patient or pharmacy.

Can a patient change nomination part way through the regime? Yes. Patients can change their nominated pharmacy before the end of the repeat dispensing period. Any outstanding issues which have not been downloaded will be available to download at the new nominated pharmacy.

Patient changes practice or dies. • Any outstanding repeat dispensing batches should be cancelled. • Make it part of your deduction checks. • If PDS is notified of death the spine will automatically cancel outstanding prescriptions. 38

Prescriber changes practice • Any outstanding repeat dispensing batches should be cancelled and re-issued by another prescriber • e. RD Prescriptions would move with the Prescriber and be charged to their new practice. • Ensure any new e. RD regimes are authorised by a GP least likely to leave 39

How to get started? • Start small! • Identify potential patients – at medication review – opportunistically – by advertising in the surgery. • Target specific conditions/regimes – Hypertension, thyroid #EPSr 2

e. RD Resources and Activities • NHS England e. RD Guidance http: //www. england. nhs. uk/ourwork/tsd/sst/erd-guidance • CPPE e-learning has been updated www. cppe. ac. uk https: //www. cppe. ac. uk/programmes/l/repeat-e-01/ • e. RD Toolkit for Prescribers https: //www. digital. nhs. uk/Electronic-Prescription-Service/Electronic-repeat-dispensing-forprescribers • NHS Digital EPS https: //digital. nhs. uk/eps 41

Questions & Feedback 42