Home Electronic Prescriptions
In preparation for the roll-out of Release 2 of the Electronic Prescription Service, changes were made to the relevant legislation, the Medicines for Human Use (Prescription Only) Order 1997 (the ‘POM Order’), the NHS (General Medical Service Contracts) Regulations 2004 and the NHS (Pharmaceutical Services) Regulations 2005, to enable the prescribing and dispensing of electronic prescriptions and to put in place controls to support the managed roll out of the service.
What is an electronic prescription?
ETP Release 1 enabled GP Systems are able to send prescription details electronically to the spine. Each electronic message has a unique identifier code which is contained within the barcode printed on prescription forms by Release 1 systems. The electronic message generated by Release 1 systems is not a legal electronic prescription.
An electronic message becomes a legal electronic prescription where the prescription has been created in electronic form, is signed with an electronic signature and is then transferred to the dispensing site as an electronic communication. This applies, with exceptions, to both NHS and private prescriptions. It is not yet possible to issue an electronic prescription for a drug specified in Schedule 1, 2 or 3 of the Misuse of Drugs Regulations 2005 and prescribers remain free to continue to issue paper prescriptions.
Electronic NHS Prescriptions
EPS Release 2 enabled systems will support prescribers in digitally signing prescription messages to convert them into legal electronic prescriptions.
NHS prescribers are limited to when they can issue electronic prescriptions by the NHS (General Medical Service Contracts) Regulations 2004. Only PCTs that have been authorised through Secretary of State Directions can direct their GPs to start issuing electronic NHS prescriptions. At least 3 months notice will be given of a particular PCT being granted this authority.
In autumn 2007, the Department of Health issued notice that EPS Release 2 would initially be implemented in 5 ‘Wave 1’ PCT areas and 12 ‘Wave 2’ PCT areas. Table A provides the details of the selected PCTs. Guidance on whether an individual GP is Release 2 enabled and has started issuing electronic prescriptions can be obtained from the relevant PCT.
Table: Wave 1 & Wave 2 Initial Implementer Sites
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Wave 1 Initial Implementer Sites
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Wave 2 Initial Implementer Sites
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A copy of the Directions ("the Primary Medical Services (Electronic Prescription Service Authorisation) Directions 2008") which provide the legal authority for the PCTs listed in the Directions to direct their GPs to start issuing electronic NHS prescriptions can be found in XVIIID of the Drug Tariff. In guidance, the Department of Health have emphasised to PCTs the need to involve local stakeholders, for example in agreeing the timing and phasing of deployment of Release 2 in a locality.
As the relevant notice period has now passed for the Wave 2 sites as well as the Wave 1 sites, it is possible that the first initial implementer sites will be established in a Wave 2 area.
On 1st February 2010, the Department announced that a further 10 sites will be added to the Secretary of State Directions. This will bring the total number of authorised PCTs to 27, from 1 May 2010.
Table: PCTs to be added to the Secretary of State Directions with effect 1st May 2010
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PCT Sites Authorised from 1st May 2010
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Which prescribers can use the service?
Any prescriber with access to a prescribing system with the necessary functionality and who has a Smartcard and PIN number with the necessary access rights could use the Electronic Prescription Service.
At present, the focus is on rolling out the Service to GP surgeries and pharmacies so initially the bulk of the prescriptions received via the service will be from General Practitioners and other prescribers based in GP surgeries such as Nurse Independent Prescribers. In time, it is anticipated that other practitioners including dentists and hospital doctors will also be able to issue prescriptions via the service.
Who can receive an electronic NHS prescription?
The NHS (General Medical Service Contracts) Regulations 2004 put in place controls around which patients can be issued with electronic prescriptions. Initially, it will only be possible to issue an electronic NHS prescription where the patient has nominated their dispensing site.
These restrictions were put in place to support the phased implementation of the Electronic Prescription Service.
Once the majority of dispensing sites are operating Release 2, and following further regulatory change, it is anticipated that it will also be possible for electronic prescriptions to be issued where the patient does not want to nominate a pharmacy.
What can be prescribed on an electronic NHS prescription?
Each electronic NHS prescription may contain up to 4 items. Prescribers are able to issue acute prescriptions, repeat prescriptions (repeat prescribing) and repeatable prescriptions (repeat dispensing) via the service but it will not be possible for a prescriber to use the service to request a bulk prescription (Drug Tariff Part VIII note 9) for a school or institution.
There are some prescription items that cannot be transmitted electronically, for example:
It is currently not permitted to issue an electronic prescription for a Controlled Drug specified in Schedule 1, 2 or 3 of the Misuse of Drugs Regulations, however this is currently under review and is expected to change in the future.
And there will be occasions where a product cannot be prescribed electronically for technical reasons. For example, this could occur if the product is not listed on the NHS Dictionary of Medicines & Devices or if the prescribing system is not able to issue a prescription for the item because the supplier hasn’t ‘mapped’ the appropriate codes. This is likely to affect less commonly prescribed items including products to be specially manufactured or extemporaneously dispensed products.
Frequently Asked Questions
1. Could an electronic NHS prescription be received by a community pharmacy other than via the NHS Electronic Prescription Service?
No. The NHS (Pharmaceutical Services) Regulations 2005 are clear that for an electronic prescription to be dispensed as an NHS prescription, it must be sent via the NHS Electronic Prescription Service and no other messaging system.
2. Can a prescriber issue an FP10MDA Instalment Dispensing prescription electronically via the Electronic Prescription Service?
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 are currently outside of the scope of the Electronic Prescription Service however as a result of the Shipman Inquiry, consideration is currently being given to allowing the electronic transmission of prescriptions for Schedule 2 & 3 Controlled Drugs in the future.
Although there is no FP10MDA concept in the Electronic Prescription Service, prescribers could use the repeat dispensing arrangements to authorise multiple dispensing of diazepam to a patient. Schedule 2 and 3 Controlled Drugs cannot be prescribed within the NHS repeat dispensing arrangements.
3. Will I continue to receive paper prescriptions as well as electronic prescriptions?
Yes. The mix of paper versus electronic prescriptions will vary greatly depending on the location of a pharmacy and patient preferences. Initially only patients who have nominated a dispensing site will be able to receive their prescriptions electronically. There will also be occasions where the prescriber cannot issue an electronic prescription, for example if the prescription is issued during a home visit and the prescriber does not have access to the service or where a particular product cannot be prescribed electronically.
4. Could a private prescription be sent via the Electronic Prescription Service?
No, private prescriptions are currently out of scope of the Electronic Prescription Service. This may change in future.
5. Can electronic NHS prescriptions be post dated?
Yes. A post dated electronic prescription will be held locally within the clinical system and is not sent to the EPS until the specified date.
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