EPS and Controlled Drugs

EPS and Controlled Drugs

National roll-out for EPS CDs took place for three GP practice systems: Vision / EMIS / SystmOne. EPS CDs is also being rolled out for some urgent care prescribers subject to the prescribing system supplier.

Read PSNC’s EPS CDs FAQs factsheet 

Dispensing processes

Standard Operating Procedures (SOPs) can reflect that Schedule 2 and 3 CDs can be prescribed by EPS as well as by FP10 paper.

Consider that:

  1. CDs and non-CDs could arrive on the same EPS prescription and any processes that rely on CDs being handled in isolation may need to be changed from the pre-EPS CDs process.
  2. Best practice guidance to capture the details of the person collecting the CD prescription remains in place: an EPS dispensing token (FP10DT) can be used for this purpose and such tokens can be sent to the Pricing Authority.
  3. A method of “marking” the prescription “at the time of supply” should be decided to ensure compliance with the Misuse of Drug Regulations. The dispense notification may be suitable for this, but depending on local system configuration another patient medication record (PMR) process that records a date and leaves an electronic audit trail may be more suitable. Physically marking the EPS dispensing token (FP10DT) is not a suitable method as this is not the legal prescription.

Read more in the section below about instalment dispensing and liquid methadone issues

Instalment dispensing and liquid methadone issues

EPS instalment dispensing (FP10MDA forms) won’t be possible because this requires additional changes to be made to EPS to support this. Because not all dispensing systems are able to endorse electronic prescriptions for oral liquid methadone with a packaged dose endorsement (PDn), a paper FP10 prescription will still need to be generated for this medicine. Prescribers are being asked not to prescribe oral liquid methadone using EPS.

There will be no changes to the process of Instalment Dispensing on paper FP10MDA forms.

EPS has been deployed to Vision / EMIS / SystmOne  sites. The other GP IT Futures system, Microtest is developing CD prescribing capability and NHS Digital will support the deployment.

Technical, regulatory and preparatory background

Changes in legislation

From 1 July 2015, legislation came into force allowing Schedule 2 and 3 controlled drugs to be prescribed and dispensed using the electronic prescription service (EPS) release 2 messages.

EPS release 2 prescriptions for Schedule 2 and 3 controlled drugs will need to satisfy the usual prescription writing requirements (see below) including the need to express the total quantity in words and figures. In PSNC’s response to the consultation on allowing Schedule 2 and 3 controlled drugs to be prescribed via EPS we suggested that this requirement should not apply to electronic prescriptions, but the Home Office concluded that the requirement should remain.

Technical changes

The NHS Digital issued all GP and community pharmacy system suppliers with the technical requirements to implement Controlled Drugs prescribing via EPS.

All dispensing systems have capability to receive and process EPS CDs.

GP system ‘tactical fix’ to include words and figures

The change in legislation to allow CDs to be sent via EPS included the requirement for the quantity in words to be included in the electronic prescription; NHS Digital said in May 2016 that the anticipated timescale for all pharmacy system suppliers to develop this functionality may be as late as December 2018. Due to these extended timescales, a new tactical fix has been developed by NHS Digital which will not require the pharmacy system suppliers to upgrade their systems immediately, instead the fix would rely on the prescribing system suppliers. The tactical fix will be to put the quantity in words into the additional instructions field of the EPS message. A notification has now been submitted to the prescribing suppliers about the need for this fix, and when they are able to make the necessary changes, NHS Digital assurance will take place, with the aim to make the functionality available as soon as possible.

Piloting

EPS CD piloting for EMIS and Vision GP systems is completed. Microtest piloting is not yet completed. See the table:

System  Notes about piloting
EMIS and Vision GP systems

NHS Digital began to pilot the prescribing and dispensing of EPS Schedule 2 and 3 Controlled Drugs (CDs) in England. From early October 2018, ten GP practices initially were granted ability to prescribe CDs with the project aiming to demonstrate that EPS CD prescribing capability is safe and appropriate to be rolled out more widely.

The first pilot GP practices were some of those using the Vision and EMIS GP systems in the North and London. However, because patients can get their prescriptions dispensed from any community pharmacy in the country, community pharmacy teams outside of these areas should also take note of these developments. Pharmacies near the pilot GP practices were notified ahead of time. SystmOne prescribing system begun piloting the prescribing of Controlled Drugs (CDs) via EPS during early 2019. The practices were in Newcastle, South Yorkshire and Southend-on-Sea.

Microtest GP system Piloting for those GP practices using Microtest is to be announced and may occur in 2020 if Microtest is able to complete relevant work.

Changes to GP systems: Pregabalin & gabapentin (2019)

Changes to general practice clinical systems were made ahead of 1st April 2019, because pregabalin and gabapentin were classified as Schedule 3 Controlled Drugs (CDs).

PSNC was informed by NHS England that the EMIS general practice clinical system  started to make this change at GP practices and the software in all EMIS practices was updated in February 2019. Repeat prescriptions for pregabalin and gabapentin should be issued via paper FP10 prescriptions. NHS England issued the following briefing note on Rescheduling of Gabapentin and Pregabalin as Schedule 3 Controlled Drugs.

If a patient’s other prescription items are issued via EPS, there is a risk that the paper script for pregabalin or gabapentin may not be collected from the GP practice; pharmacy teams should be alert to this risk and should advise patients that the paper script will need to be collected from the practice (or the pharmacy could offer to collect the script for the patient if you provide a prescription collection service).

Escalation or feeding back

If you receive an EPS Controlled Drug and have any questions or comments for PSNC please contact PSNC Community Pharmacy IT Lead, Daniel Ah-Thion. The usual EPS escalation routes will also apply for formally raising any EPS questions or issues.

FAQs

Read PSNC’s EPS CDs FAQs factsheet.

Q. Is EPS CD prescribing limited to GP practices?

No. EPS CDs have been allowed since 2015. Prescribers are able to transmit CDs via EPS if they have a prescribing systems that allows this.

Most GP practices already have an EPS system. However, EPS is also moving into some urgent and other care settings.

Additionally, different types of prescribers hold different prescribing rights. For example doctors and nurse independent prescribers are prescriber types which are allowed to prescribe CDs. See our webpage: ‘Who can prescribe what?’.

EPS prescribing systems can be setup so that the prescriber’s type is electronically incorporated to support prescribers prescribing those items which they are allowed to prescribe.

Q. Are ‘words and figures’ required on my PMR screen for paper Release 1 prescriptions?
Words and figures are required on the legal prescription, which in the case of Release 1 barcoded prescriptions is the piece of paper. Some PMR systems may opt to also show words on the PMR screen but there is not a legal requirement that this information needs to be there.

Q. Can a prescriber issue an FP10MDA Instalment Dispensing prescription electronically using EPS?

In England, only Schedule 2 Controlled Drugs plus Buprenorphine, Buprenorphine/Naloxone (Suboxone) and Diazepam can be prescribed in instalments on Form FP10MDA.Schedule 2 and 3 Controlled Drugs may be dispensed when prescribed using EPS. However, there is currently no equivalent to FP10MDA for EPS. Prescribers wanting supplies to be made in instalments will continue to use hard copy FP10MDA form.

Q. Do the dispense and claim notification messages for a Schedule 2 or 3 CD prescribed using EPS need to be submitted within 28 days of the date on the prescription?

Legally, all Schedule 2 and 3 CDs must be dispensed within 28 days of the appropriate date. However, for the purposes of claiming reimbursement, pharmacy systems should allow you to send the dispense and claim notification messages after the validity period of 28 days as it is recognised that scenarios may exist (e.g. technical outages) where it may not be possible to submit a claim before the 28 days even though medicines were supplied within 28 days.

Your system supplier may alert you to any CD prescriptions yet to be dispensed and approaching their end of validity period of 28-days. Further information is available on our Period of validity webpage.

Q. What if I receive an EPS prescription for oral liquid methadone?

GP practices have been informed they should not prescribe oral liquid methadone via EPS.  If this item is prescribed inadvertently the prescriber might be asked by the pharmacy contractor to arrange for a paper prescription.

Note that whilst oral liquid methadone prescriptions can be claimed/reimbursed, not all pharmacy system suppliers have yet enabled the PD endorsement, therefore either standard paper FP10 or paper FP10 MDA may be appropriate instead.

Q. Do the dispense and claim notification messages for a Schedule 2 or 3 CD prescribed using EPS need to be submitted within 28 days of the date on the prescription?

Legally, all Schedule 2 and 3 CDs must be dispensed within 28 days of the appropriate date. However, for the purposes of claiming reimbursement, pharmacy systems should allow you to send the dispense and claim notification messages after the validity period of 28 days as it is recognised that scenarios may exist (e.g. technical/internet outages) where it may not be possible to submit a claim before the 28 days even though medicines were supplied within 28 days.

Your system supplier may alert you to any CD prescriptions yet to be dispensed and approaching their 28-day expiry. Further information is available on our Period of validity webpage.

Q. What is the status with the roll-out of EPS CD pilots across different GP system user bases?

GP system Status with roll-out
Vision (InPS) GP system Nationally rolled out
EMIS Web (EMIS Health) GP system Nationally rolled out
Evolution (Microtest) Pilot expected in future
SystmOne (TPP) Nationally rolled out

 

Further info

Read more within:

If you have queries on this webpage, require more information, or would like to suggest addition of a tip to support efficient dispensing please contact it@psnc.org.uk. The usual EPS escalation routes will also apply for raising any EPS questions or issues (see the ‘Escalation and feeding back’ section above).

 

 

Return to the IT section: EPS home / eRD / SmartcardsSystem suppliers

Return to the EPS sections relating to: Preparing&enhancing EPS / Nomination / Dispensing&Supply EPS / CDs  / Tokens / EPS/IT contingency planning / Submission / Cancelling/changing EPS / RTEC / Future

EPS resources/factsheets also include: EPS essential checklists, EPS CDs FAQs, checking EPS totalsNomination Principles, EPS/IT/ODS change, Phase 4, Reporting EPS issues, EPS studies including tips and lessons, Submitting EPS in time, TokensTracker

Ask a question about pharmacy IT: it@psnc.org.uk

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