Repeat Dispensing/electronic Repeat Dispensing (eRD)

Repeat Dispensing/electronic Repeat Dispensing (eRD)

At least two thirds of all prescriptions generated in primary care are for patients needing repeat supplies of regular medicines, and since 2005 repeat dispensing has been an Essential Service within the Community Pharmacy Contractual Framework (CPCF).

Under the repeat dispensing service pharmacy teams will:

  • dispense repeat dispensing prescriptions issued by a GP;
  • ensure that each repeat supply is required; and
  • seek to ascertain that there is no reason why the patient should be referred back to their GP.

Originally this service was mainly carried out using paper prescriptions, but as the Electronic Prescription Service (EPS) has developed, the majority of repeat dispensing is now carried out via EPS release 2 and is termed electronic Repeat Dispensing (eRD). eRD  is much more efficient and convenient for all involved.

Repeat Dispensing Service Specification (Please note, the service specification does not mention eRD as it was published in 2004, which is before eRD was introduced).


Click on a heading below for more information.

Increasing use of the service - Contract changes in England from 1st March 2015

Despite the benefits that the repeat dispensing service can bring to patients and the NHS, uptake of it has been very low, in part due to lack of engagement by GP practices. In order to increase the benefits being gained by patients and the NHS from this service, it was agreed in September 2014 that from 1st March 2015 there would be a new requirement in the CPCF:

Pharmacy contractors must ensure that appropriate advice about the benefits of repeat dispensing is given to any patient who:

(i) has a long term, stable medical condition (that is, a medical condition that is unlikely to change in the short to medium term), and

(ii) requires regular medicine in respect of that medical condition, including, where appropriate, advice that encourages the patient to discuss repeat dispensing of that medicine with a prescriber at the provider of primary medical services whose patient list the patient is on.

This means that pharmacy teams need to identify appropriate patients and provide them with information about the repeat dispensing/eRD service, with the aim that there is a significant increase in the use of the service by patients. NHS England wants this to happen because use of the repeat dispensing/eRD service:

  • frees up time in GP practices so that GPs and their staff can focus on other higher priority work;
  • is more convenient for patients and their carers; and
  • allows community pharmacy teams to offer a better service to their patients, as well as allowing them to schedule their repeat prescription dispensing workload more efficiently.

Appropriate advice can be given to patients in a number of ways such as:

  • verbally explaining about the service and its benefits to patients; and
  • providing patients with a leaflet describing the service when they are collecting a prescription.

This requirement is part of a broader programme to increase use of the service, which will also engage GP practices and other stakeholders such as Clinical Commissioning Groups (CCGs).

Actions for community pharmacy contractors
All pharmacies are encouraged to work with their Local Professional Network (LPN), LPC and other local partners to support activities to increase uptake of repeat dispensing/eRD by prescribers in their area. These could include:

  • identifying and notifying prescribers of suitable patients; and
  • seeking to transfer patients already using managed repeats to repeat dispensing/eRD.

Please note this new contractual requirement only applies to contractors in England, not Wales.

How does eRD work?

eRD is a process that allows a patient to obtain repeated supplies of their medication or appliances without the need for the prescriber to hand sign authorised repeat prescriptions each time. eRD allows the prescriber to authorise and issue a batch of repeat prescriptions electronically until the patient needs to be reviewed. 

When a prescriber issues an eRD prescription using their EPS Release 2 prescribing system, in addition to the information found on a standard EPS Release 2 prescription, this electronic repeatable prescription contains:

  • the intended interval between each issue of the repeatable prescription; and
  • how many times the repeatable prescription can be issued.

The prescriptions are then made available electronically for dispensing at the specified interval by the patient’s nominated pharmacy.

Erd

 

 

 

 

 

 

 

 

 

 

 

 

 

Key information about eRD

  1. Multiple ‘issues’: When issuing a repeatable prescription, the prescriber will authorise a prescription with a specified number of issues; each issue contains the same prescribed items.
  2. Issues are retrieved one-by-one: The Spine then manages the release of each individual prescription issue. The first issue of the prescription is available as soon as the prescription is received by the Spine; subsequent issues will be created on the Spine ready to be pulled down later.
  3. A new repeatable prescription requested for after the last issue: Once all authorised issues of the prescription have been dispensed, or if the prescription has expired, the repeatable prescription is complete and the patient must contact their GP to arrange for another repeatable prescription to be issued. Pharmacists should advise patients of the need to contact their prescriber when dispensing the last issue of a repeatable prescription.
  4. Automated process for allowing time to prepare medicine for each issue: To allow pharmacists to prepare medicines for dispensing in advance of a patient visiting the pharmacy, the Spine will automatically send the nominated dispensing site a repeat dispensing prescription seven days before the expected end date of the previous issue of the prescription. The Spine should calculate the expected date of supply in association with the prescriber’s originally intended date. (Please note, previously, the countdown to the next issue of a repeat prescription didn’t begin until a dispense notification had been issued. This could delay the automatic download of future repeat prescriptions from the Spine, resulting in items not being available for patients in time. Since February 2016, a dispense notification must still be sent, but this will not delay the start of the automatic countdown to the next issue. Details about the change were outlined in a news article on the topic).
  5. The workaround for the automated process (e.g. patient going on holiday): It is possible for a pharmacy to pull down issues in advance of them being sent automatically from the Spine, for example where the instalment dispensing interval is flexible and the pharmacist believes that an instalment should be dispensed at an earlier time because the patient is going on holiday. Pharmacy systems suppliers also have flexibility to implement more advanced scheduling functionality in their systems to support work flow in pharmacies.
  6. Ability to change nomination between issues: A repeatable prescription can only be issued electronically where it is being sent to a patient’s nominated pharmacy. Patients can choose to change their nominated pharmacy before the expiry of the repeatable prescription. In this case, all outstanding issues which have not been downloaded will be transferred to the new nominated pharmacy. This is different from the paper based repeat dispensing system where all issues must be obtained from the same pharmacy.
  7. Repeatable Prescription Authorising Token: When issuing an electronic repeatable prescription, prescribers can issue one of these.

Training and resources for pharmacy teams

Training

The NHS regulations state that ‘a pharmacist shall undertake appropriate training in respect of repeat dispensing’. Successful completion of the CPPE repeat dispensing e-learning and e-assessment is one way to provide evidence of training having been undertaken.

PSNC resources

PSNC Briefing 004/17: eRepeat Dispensing – A factsheet for pharmacy teams (January 2017) – One side of this briefing contains key phrases to help advise patients on the benefits of eRD, whilst the other side provides a list of questions to ask patients collecting a repeat dispensing/eRD prescription.

PSNC Briefing 004/15: Increasing use of the NHS Repeat Dispensing service (February 2015) – This briefing will assist community pharmacy teams both in meeting the requirement in the CPCF for pharmacy teams to give advice to appropriate patients about the benefits of the repeat dispensing/eRD service and ensuring their repeat dispensing/eRD procedures are up to date.

PSNC Briefing 001/14: Repeat Dispensing and EPS (January 2014) – This briefing provides contractors and LPCs with a summary of information on repeat dispensing using the EPS system and the answers to frequently asked questions.

NHS Digital resources

NHS Digital has developed a series of materials to boost the usage of eRD:

Other resources

Helpline

Beyond these materials, if you still require eRD support, the NHS Digital eRD line can be called: 0113 397 3858.

Tips on promoting the service

A pharmacist shares her experience of repeat dispensing

Pharmacy’s experience of the repeat dispensing service (an article written by PSNC which appeared in P3 magazine 

Information for GP practices

Contractors should talk to their local GP practices about the CPCF requirement for pharmacies to highlight the benefits of repeat dispensing/eRD to appropriate patients. 

NHS England published Electronic Repeat Dispensing – Guidance in June 2015. This document clearly describes how eRD works and is aimed at CCGs and GP practice teams. Contractors may want to use the document in discussions with local GP practices about repeat dispensing/eRD.

The joint PSNC/NHS Employers/BMA GP Committee guidance for GP practices on repeat dispensing may also be helpful to use in discussions.

PSNC has developed a repeat dispensing/eRD template letter which can be used by contractors to increase a GP practice team’s awareness of repeat dispensing/eRD.

The following presentation can also be used in discussions with GP practices in order to demonstrate the similarity of repeat prescribing and EPS repeat dispensing and the additional benefits of using repeat dispensing:

Comparison of repeat dispensing and repeat prescribing (PowerPoint)

Comparison of repeat dispensing and repeat prescribing (PDF)

NHS Digital has also developed a series of materials to boost the usage of eRD which contractors could highlight to GP practice teams:

Clinical codes for GP practices

GP practices can use the following clinical codes to record patient consent for information sharing for the repeat dispensing/eRD service:

Patient consent given for repeat dispensing information transfer:

  • CTV3 code: XaKRX    
  • V2 code: 9Nd3.      
  • SNOMED CT code: 416224003 

Patient communication materials

The following poster and patient leaflet have been developed by PSNC to be consistent with the repeat dispensing contractual requirements which have a particular focus on eRD.

eRD template poster

eRD leaflet (PDF)

eRD leaflet (Word)

Repeat Dispensing/eRD referral form

If pharmacy teams identify patients who are suitable for repeat dispensing/eRD, with the patient’s consent, they could refer the patient to their GP practice. The following referral form can be used to make such a referral:

Repeat dispensing/eRD referral form (Word eForm for electronic completion)

Repeat dispensing/eRD referral form (for completion by hand) (Word)

Repeat dispensing/eRD referral form (for completion by hand) (PDF) 

The referral form should be used alongside the patient consent form:

Repeat Dispensing/eRD Consent Form for the Public (RD1)

Clinical codes for GP practices

GP practices can use the following clinical codes to record patient consent for information sharing for the repeat dispensing/eRD service:

Patient consent given for repeat dispensing information transfer:

  • CTV3 code: XaKRX    
  • V2 code: 9Nd3.      
  • SNOMED CT code: 416224003

Endorsing, submission and reconciliation of eRD prescriptions

Further information on this topic can be found on the endorsing, submission and reconciliation (EPS) page as the process is the same as for EPS prescriptions.

LPC resources

PSNC has developed the following template letters which can be used by LPCs to increase awareness of repeat dispensing/eRD amongst the relevant stakeholders.

Repeat dispensing/eRD template wording – from LPC to pharmacy

Repeat dispensing/eRD template wording – from LPC to LMC 

FAQs

General

Q. Can pharmacies provide a repeat dispensing service to patients from other Clinical Commissioning Group (CCG) areas?
Yes, as part of the new Terms of Service, community pharmacies must provide the repeat dispensing service to any patients who present repeat dispensing prescriptions at their pharmacy, whether the prescriber is in the same CCG as the pharmacy, or another CCG.

Q. Do I need to let my local NHS England team know that I have completed training to provide repeat dispensing and that my pharmacy is starting to provide repeat dispensing services?
No.

Q. What are the training requirements for repeat dispensing?
The service specification requires the contractor to ensure that he and his pharmacists are competent to provide repeat dispensing services. Pharmacists should also undergo appropriate training, which may, for example, be the CPPE programme and assessment, but could also be a local training pack or a pack produced, for example, by the head office of a multiple. Local workshops are of value, particularly from the perspective of developing relationships between pharmacies and GP surgeries, but attendance cannot be mandated.

Q. How long does a repeat dispensing prescription remain legally valid?
A Repeat Dispensing/eRD prescription for a non-Controlled Drug has to be dispensed for the first time within six months of the ‘appropriate date’, with subsequent issues valid for 12 months from the signed date. The ‘appropriate date’ is the later of either the date the prescription was signed or the date indicated as the start date.

For example consider a prescription for Salbutamol 100micrograms/dose inhaler requesting 12 months supply, split amongst twelve batch issues (RD forms). If the signed date on the prescription (RA form) is 1st January 2013, then if the patient is to obtain all of their medicine, the pharmacy must have dispensed  fully within one year, and therefore by 31st December 2013.

Schedule 2 and 3 Controlled Drugs cannot be prescribed on repeat dispensing prescriptions.

Repeat dispensing prescriptions for Schedule 4 Controlled Drugs must be dispensed for the first time within 28 days of the appropriate date with subsequent issues valid for 12 months from the signed date. Repeat prescriptions for Schedule 5 Controlled Drugs are treated the same as non-Controlled Drugs and must therefore be dispensed for the first time within six months of the appropriate date with subsequent issues valid for 12 months from the signed date.

eRD

Q. The prescriber has not identified a dispensing interval on the prescription and the patient has told me that they are going on holiday for 6 weeks. Can I dispense two issues at the same time for the patient?
 Yes, where a prescriber has not indicated the interval, the pharmacist should use his professional judgement to dispense instalments at an appropriate interval. From a process perspective, the issues must be pulled down and dispensed in order, so the pharmacy would be required to pull down the first issue, update the Spine to indicate that the issue had been dispensed and then repeat the process with the second issue. When processing electronic repeatable prescriptions, the pharmacy system will record the Prescription ID to facilitate requesting subsequent issues of the prescription.

To further improve the efficiency of processing repeat dispensing prescriptions, PSNC would like to see a change to the model to allow multiple issues to be pulled down and prepared at the same time without the Spine having to be updated before the next issue can be retrieved.

Q. Are Repeat Authorisation (RA) forms required for electronic repeat prescriptions in the same way that they are for paper repeat prescriptions?
There is not an EPS ‘RA form’, but the patient may present the ‘repeatable prescription authorising token’ (see next question) which is not required to be seen by the pharmacy.

Q. What is the ‘repeatable prescription authorising token’? Are pharmacy teams required to see it for EPS repeat dispensing?
It is a type of prescription token. Prescribers can provide the patient with this so the patient knows how many prescription batch issues have been authorised. Prescription tokens are printed on prescription form stationary by the prescriber to accompany the electronic prescriptions. For standard prescriptions these are occasionally printed at the patient request or to pass on clinical information. With electronic repeat dispensing, prescribers may pass a token to the patient.

Pharmacy teams are not required to see this repeat token to process repeat prescriptions, and where it is presented, there is no need to send it to the Pricing Authority – unless it has been used as an alternative to a dispensing token for one of the dispensing episodes to capture a patient signature.

Q. Why does paper repeat dispensing involve a paper (RA) form, whilst there is no (RA) form for electronic prescriptions?
With paper prescriptions the legal instruction on a pharmacy to dispense, comes from the hand-written signature. Paper repeat dispensing therefore involves a paper RA form being issued by the prescriber which includes the legal instruction to dispense against the paper RD forms.

Electronic prescriptions use electronic signatures and repeat dispensing is therefore simpler for electronic prescriptions. When issuing a repeatable prescription, the prescriber will electronically authorise a specified number of issues and the patient’s nominated pharmacy can pull these down from the spine, as required.

A patient may present a ‘repeatable prescription authorising token’ (see question above).

Q. How is exemption information captured for electronic repeat dispensing?
As with standard electronic prescriptions, you must enter the correct payment/exempt category on the electronic prescription using the pharmacy system, to ensure reimbursement is correct.

In addition where a patient signature is required for electronic repeat prescriptions, this must be captured separately for each dispensing issue. If the patient pays for their prescription or is non-age exempt, the pharmacy can print a dispensing token to capture the patient signature. The only tokens required to be sent to the Pricing Authority are those relating to paid prescriptions and those used to collect the patient’s exemption declaration (for a reason other than age) will be required to be sent to NHS Prescription Services each month for audit purposes.

Electronic repeatable prescriptions are electronically authorised and sent to the patient’s nominated pharmacy so that they can pull them down from the spine, as required.

Q. Are patients required to consent to be issued with electronic repeatable prescriptions?
Patients must give informed consent to the sharing of information between the dispenser and prescriber before participating in the repeat dispensing service, both for the paper based and electronic repeat dispensing arrangements. Normally consent is obtained from patients by prescribers.

If a patient has already given his consent for the paper-based arrangements, there is no requirement to collect his consent again before issuing an electronic repeat dispensing prescription. If the patient has not already nominated a pharmacy, informed consent would be required before changing the patient’s nomination settings. 

Q. How is the dispensing site determined?
A repeatable prescription can only be issued electronically where it is being sent to a patient’s nominated pharmacy. Patients can choose to change their nominated pharmacy before the expiry of the repeatable prescription. In this case, all outstanding issues which have not been downloaded will be transferred to the new nominated pharmacy. This is different to the procedure for paper based repeat dispensing, where all issues must be obtained from the same pharmacy. When issuing an electronic repeatable prescription, prescribers are required to always issue a ‘Repeatable Prescription Authorising Token’.

Q. Can issues be cancelled by the GP?
Yes, if the patient’s circumstances do change, the GP can cancel and reissue a repeat prescription for a patient. An electronic prescription can only be cancelled electronically where it has not been pulled down to a local dispensing system. If an electronic prescription has already been pulled down by a dispensing site, prescribers should use local arrangements to request that the prescription is not dispensed, for example, telephoning the dispensing site. The ability to cancel an electronic prescription is one of the main advantages of eRD over the paper based system

Repeat dispensing (paper) 

Q. Does a repeat dispensing batch issue form have to be an exact duplicate of the repeat dispensing authorising form, e.g. if there are 4 items listed on the authorising form, does the batch issue have to be printed with the same four items on one form, or can two batch issues be printed with two of the items on each form?
Regulations do not require this to be the case so long as the pharmacist is content that the batch issues do relate to the authorising form.

Q. I have dispensed the final batch from a patient’s repeat prescription. How do I submit the authorising (RA) form to the Pricing Authority?
Repeat authorisation (RA) forms should be submitted to the Pricing Authority at the end of the month in which all batch issue forms have either been dispensed or expired or the medication is no longer required.

It is important that forms are sorted for submission in the correct order as detailed on the reverse of Form FP34C. In months where repeat authorisation forms are being submitted, tick the appropriate box on the FP34C Submission Form to indicate this. There is no need to declare the number of repeat authorisation forms submitted.

Repeat Dispensing (Paper)

Originally repeat dispensing was mainly carried out using paper prescriptions but as the Electronic Prescription Service (EPS) has developed, the majority of repeat dispensing is now carried out as eRD. However, some contractors may still receive paper repeat dispensing prescriptions.

How does repeat dispensing involving paper prescriptions work?

Repeat dispensing involves the use of a repeatable paper prescription (authorising) form and a number of batch issue paper forms. These forms will be generated by prescribers through their GP practice systems.

The repeat authorising form (RA) associated with paper prescriptions should contain prescriber, patient and prescribed medicine details and include the number of issues required and the dispensing interval (e.g. weekly, monthly, quarterly). The form should contain the letters “RA” on the right-hand side of the form. This form must be signed by the prescriber.

The maximum number of batch issue forms (RD) that can be issued is equivalent to one year’s duration of prescribing of an individual item. These forms should contain the same prescriber, patient and prescribed medicine details as the authorising forms and indicate in the prescribing area that the form is being used for repeat dispensing. These forms should include the letters “RD” on the right-hand side.

Batch issue forms should not be signed; however, the prescriber’s signature box should be annotated with text displaying the words Repeat Dispensing: XX of YY, where XX is the number of the batch issue form and YY is the total number of batch issues covered by the repeatable prescription (e.g. 1 of 6, 3 of 12 etc). The date on all of the batch issues and the repeat authorising form will be the same.

Endorsing requirements for paper repeat dispensing prescriptions

Each batch issue form (RD) should be endorsed as required in the Drug Tariff Part II Clause 9. In addition, each RD should be stamped with the pharmacy’s stamp and dated with the date on which the items were dispensed.

There is no requirement to endorse the repeat authorisation form (RA) but community pharmacies are required to maintain records of the dispensing of repeatable prescriptions in order that there is a clear audit trail in place.

Submission process for paper repeat dispensing prescriptions

Batch Issue (RD) forms 

Dispensed batch issue forms should be submitted to the Pricing Authority at the end of each month in their correct groups, i.e. exempt or charged groups, within each monthly batch of prescriptions. The order in which these forms are to be submitted within a batch is detailed on the FP34c submission document. Initial batch issue forms (ie 1 of x) need to be sorted separately from subsequent batch issue forms (ie 2 of x, 3 of x etc), both sorted by doctor surname in alphabetical order.

Batch issue forms which have not been dispensed should not be submitted to the Pricing Authority. Any forms that become time expired should be destroyed.

Repeat Authorising (RA) forms

Authorising forms should be submitted to the Pricing Authority at the end of the month in which all batch issue forms have either been dispensed or expired or the medication is no longer required. It is important that forms are sorted in the correct order as detailed on the reverse of updated form FP34c, when submitted. In any month, if any repeat authorisation forms have been submitted, tick the appropriate box on the FP34c Submission Form. There is no need to declare the number of repeat authorisation forms submitted.

Pharmacy management of repeat medication requests

In England, the provision of regular medicines to patients is facilitated by a variety of different mechanisms in addition to the Repeat Dispensing service. Some Clinical Commissioning Groups (CCGs) and general practices have raised concerns about medicines waste and the mismanagement of non-NHS repeat medication services such as “managed repeats”; some have considered the introduction of measures that restrict community pharmacies from supporting patients to request repeat prescriptions. Community pharmacy contractors are concerned about the unintended consequences these changes may have on patients, particularly those who are vulnerable, time poor and/or require assistance.

There is always scope for continuous improvement in systems and processes; improving how repeat medication services operate requires local general practices and community pharmacies to work together, to ensure timely and appropriate patient access to their medicines. To help inform constructive local discussions, PSNC and Pharmacy Voice have written a briefing (presented as Frequently Asked Questions) about repeat medication services, where we outline common queries, shed some light on pharmacy processes and discuss a number of important considerations regarding the most talked about proposals that CCGs have put forward – the “Coventry model” and the “Luton model”.

The briefing should be of interest to pharmacy contractors, general practices, CCGs, Local Medical Committees (LMCs), Local Pharmaceutical Committees (LPCs), local patient groups and Healthwatch.

Pharmacy management of repeat medication requests – Frequently Asked Questions

In early 2017 Healthwatch Kent published a report on work they had undertaken to explore patients’ views on the management of repeat prescriptions; this followed the introduction of changes to repeat ordering processes by one Kent CCG. The report is likely to be of interest to pharmacy contractors, general practices, CCGs, LPCs, LMCs, local patient groups and other Healthwatch organisations.



Latest Services and Commissioning news

View more Services and Commissioning news >