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The Electronic Prescription Service

BMA guidance

July 2007

This note is part of a series of guidance documents on the National Programme for IT. It has been produced by the British Medical Association (BMA). The National Programme for IT will significantly impact upon your working practices and therefore it is important that you are fully aware of developments. It is also very important that you share this knowledge with your patients so that they can make appropriate informed choices. This guidance note provides information on the Electronic Prescription Service in England. Guidance on developments in Scotland, Wales and Northern Ireland will be available shortly. The Electronic Prescription Service is under development so this guidance represents the current position and will be updated to reflect future changes.

Overview – The Electronic Prescription Service
The Electronic Prescription Service (EPS) will enable electronic prescriptions to be sent from the prescriber to the dispenser via the central spine. The dispenser will also be able to submit electronic prescriptions to the Prescription Pricing Division for reimbursement. The Electronic Prescription Service is being rolled out via two releases of software – Release 1 and Release 2.

Scope
The Electronic Prescription Service is initially focusing on GP prescribing (including dispensing doctors), community pharmacies and dispensing appliance contractors. Eventually it is intended to encompass all prescribing currently done via the FP10 prescription including FP10(HP)s however hospital systems would need to be made compatible. Schedule 4 and 5 (Misuse of drugs regulations 2001) Controlled Drugs can be prescribed via EPS. Schedule 2 and 3 controlled drugs cannot be prescribed via EPS and will continue to be prescribed using a paper prescription until there is a change in legislation. The General Practitioners Committee (GPC) has written to the Home Office to press for this change.

Release one
Release 1 is currently being rolled out across England and is expected to complete by the end of 2007. During Release 1 the paper FP10 will include a barcode, which contains a unique code to identify the prescription. The barcode is then scanned by the dispenser to obtain the prescription. The barcode only identifies the prescription, not personal details.

Release two
Release 2 is expected to begin rolling out towards the end of 2007. Prescribers will then be able to sign their prescriptions electronically. If a patient decides to nominate a pharmacy, for example, one they use regularly, their electronic prescriptions will be transmitted via the spine to the pharmacy. If a patient does not wish to nominate a pharmacy he/she can continue to receive a barcoded paper copy of the prescription as described above. A patient can change their nomination at any time and it is intended that this will normally happen at the pharmacy rather than at the GP practice.

Benefits
Release 1 will save dispensers having to re-key information, however, the main benefits for GP practices and patients will be delivered in the Release 2. For example:

• Prescribers will be able to bulk sign prescriptions on their computer
• Prescribers will be able to cancel an electronic prescription up until the point it is recorded in the system as having been dispensed
• There should be an improvement in accuracy due to the dispensers not having to retype the information.
• Patients will not always need to visit the GP practice to pick up their prescriptions especially for repeat prescriptions, which amount to around 70% of FP10 prescriptions.
• When a patient nominates a pharmacy, dispensers can begin preparing the prescription once it has been sent by the GP so that it can be ready for collection by the patient.
• Pharmacists may be able to manage their stock more effectively, which will benefit patients by helping to ensure that their prescription is available.
• Patients can choose to nominate any pharmacy so, for example, they can pick up their prescription from a pharmacy near work. This was not always possible before with repeat prescriptions.

Issues to resolve
A significant number of prescriptions will still involve the use of paper prescription “tokens”, for example, so that patients, who are entitled to free prescriptions, can complete and sign the declaration on the back of the prescription. The current position is that if there was no need to issue a prescription token at the GP surgery, for an exempt patient then the dispenser would have to print a dispensing token to capture the declaration. However, the number of such declarations has reduced significantly given the changes in age related exemption.

Other issues which are being considered by the User Group are:

• managing the information that is currently included on the right hand side of the paper prescription
• only drugs on the NHS Dictionary of Medicine and Devices (dm+d) can be prescribed via EPS (however this includes most drugs)
• the development of internet pharmacies

BMA Involvement
Members of the Joint GP IT Committee of the General Practitioners Committee and the Royal College of General Practitioners have been actively contributing to the design and development of the service via the Electronic Prescription Service GP User Group.

Further information
Visit the Connecting for Health website to find more information on the EPS.

If you would like to contact the BMA about NHS IT issues please email: info.nhs-it@bma.org.uk