Electronic prescriptions

England’s Electronic Prescription Service: taking off now on the implementation runway

March 2006

As about 1.3m prescriptions are now being issued every working day in England — a number expected to rise by over 5% each year — we need to change from a paper-based prescriptions system to an electronic one that is more efficient and consistently accurate.

Most notably, around 70% of prescriptions issued are for repeat medication, which potentially consume a significant proportion of a typical GPs time. Once fully operational, the new Electronic Prescription Service (EPS) will streamline the current time-consuming system used for dealing with repeat prescriptions and will also bring additional benefits for prescribers, dispensers and patients alike.

It is intended that, by the end of 2007, every GP surgery, community pharmacy and many appliance contractors will have access to the Electronic Prescription Service. Any prescriber working from a GP surgery will be able to use the service and, in time, prescribers working from other locations such as walk-in centres or dental practices will also be included.

NHS Connecting for Health, the Department of Health agency responsible for delivering England's National Programme for IT, is responsible for implementing the new electronic transmission of prescriptions service throughout England.

Once fully implemented, the EPS will be integrated with the NHS Care Records Service. As well as automatically recording what has been prescribed on a patients NHS care record, the EPS will, subject to the patients consent, provide GPs and other healthcare professionals with information on what has actually been dispensed, thus improving the care they can provide.

What benefits will the new service bring?

The benefits of introducing the EPS will vary for different stake­holder groups and will depend upon what stage of the service is being implemented. For instance, patients will not notice much change during Release 1 of the service, but will start to experience more benefits once Release 2 is rolled out.

From a pharmacy perspective, the need to collect patients prescriptions physically from surgeries will disappear, as it will be possible for GPs to send prescriptions electronically. Also, accuracy and safety will be improved because prescription information will not need to be typed in first by the prescriber and then again by the dispenser, as the information will simply be downloaded onto the dispensers system.

Receiving prescriptions electronically from the prescriber, rather than waiting for the patient to turn up with a piece of paper, will also assist dispensers to manage their workflow and stock control. Not only will this enable the pharmacist to prepare prescriptions during quiet periods, but it could also reduce waiting times for patients at pharmacies.

Working with users

To ensure that the EPS is robust and fit for purpose, NHS Connecting for Health has sought input from key stakeholders throughout the design and development of the service.

GP, pharmacist and patient 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 helped to ensure that the potential benefits of the new service can be maximised. These groups also inform the development of communication and guidance material.

The user groups will continue to operate throughout the implementation of the service. An Implementation Reference Group is also helping to inform the implementation of the service via strategic health authorities and primary care trusts. In addition, other groups of stakeholders have been brought together on occasion to consider particular issues.

How the service will work

Each GP surgery and community pharmacy will go through two main stages of change, based on two software upgrades known as Release 1 and Release 2.

Figure 1. How the system will work during release 1.

During Release 1, patients will still receive a paper prescription that will be almost identical to the current FP10 prescription form except that it will have a barcode on it. This barcode represents a unique code, identifying the prescription in the EPS system.

When the prescriber issues this prescription, an electronic copy of the information on it will be sent to the Electronic Prescription Service. This copy will have attached to it the same unique code as is represented by the barcode on the paper prescription.

When a patient takes an FP10 form featuring a barcode to a pharmacy that has also implemented Release 1, a scan of the barcode will retrieve the electronic copy of the information and bring it onto the dispensers computer. There will be no need, therefore, for the dispenser to re-enter the information on the pharmacy's system.
The dispenser will then dispense 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 will be processed in the same way as paper prescriptions are now.

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

Patients will be given the option of naming a pharmacy (or other dispenser), if there is one they wish to use on a regular basis. If they do this, their nominated dispenser will be able to receive their prescriptions electronically without the patient having to use a paper prescription at all, thus avoiding visits to the surgery just to collect a prescription and enabling dispensers to prepare patients medicines in advance.

Patients who do not wish to use the nomination facility will receive a barcoded paper copy of their prescription. Any dispenser they take it to will be able to scan this barcode and retrieve the electronic prescription.

The Prescription Pricing Authority (PPA) is responsible for reimbursing community pharmacists for the prescriptions they dispense. At present, the paper prescription forms are sent to the PPA for processing once they have been dispensed. As part of the EPS implementation, the PPA will be connected to the N3 network (as will community pharmacies). Once Release 2 of the service is implemented, digitally signed electronic prescriptions that have been dispensed will be sent to the PPA electronically for reimbursement. Signed, paper prescriptions will continue to be processed manually.

Figure 2. How the system will work during release 2.

The implementation approach

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

ICT-system suppliers will provide and install the necessary hardware and software in order to make current GP and pharmacy systems EPS compliant. Each ICT-system supplier has to go through a number of steps, starting with technical compliance testing by NHS Connecting for Health, then a trial at an initial-implementer site, usually involving a small local community of pharmacies and GP surgeries.

When this has been assessed and the suppliers system has been shown to be of the necessary standard (clinically and technically) and able to communicate with other systems, the supplier is able to start a staged rollout, monitored by NHS Connecting for Health.

Figure 3. Scanning the barcode will retrieve the electronic copy of the
prescription and bring it onto the dispenser’s computer.

Progress to date

Release 1 of the service is now in use at a number of initial-implementer sites. Wider rollout of Release 1 has now begun and over 600 GP practices have now had their systems upgraded.
There are a number of stages that GP practices and pharmacies will go through in preparation for operating the EPS. Typically, these stages may include upgrading current hardware and software (as necessary); installing a suitable network connection; arranging smartcards for users; installing local hardware and software as necessary; and training all prescribing/dispensing staff in how to use the new system.

Further information about the Electronic Prescription Service, including guidance materials on implementation, is available from www.connectingforhealth.nhs.uk/eps

Tim Donohoe, Director, Electronic Prescription Service, Leeds.