Cancellation and Not Dispensed (ND) in EPS

At present when the pharmacy cancels an item by marking an item ND – Not Dispensed, this is not communicated back to the GP practice.

The pharmacy team should still communicate to the practice that the patient has not received the medication, as there is no automated notification process for the practice.

Pharmacy teams and prescribing staff have reported since the start of EPS that a helpful future EPS development would be for a feedback loop so that prescribing staff and the pharmacy team can more easily have oversight within their own system about prescription statuses including ND. Pharmacy teams also wish for updating statuses to be recordable in an easy manner for prescribers and dispensers to keep burden low. This item is referenced within Community Pharmacy IT Group’s Views on Next Generation of EPS.

If the pharmacy has already downloaded the prescription but has not yet processed the prescription, the prescriber may ask whether the pharmacy is able to add the ‘Not Dispensed’ status to an item or prescription and submit this to NHSBSA if the pharmacy agrees this is appropriate.

Community Pharmacy England has received feedback that a benefit with this cancellation method is that the prescription cannot be dispensed inadvertently by another dispenser.

Electronic prescriptions can be ‘cleanly’ cancelled by the prescriber (but not after they have been downloaded by the patient’s nominated pharmacy).

The prescribing system will provide information to the prescriber on which dispensing site has pulled down the prescription, together with the site’s contact details.

Cancel reasons code: In cancelling a prescription, the prescribing system will prompt the user to provide a reason code, for example ‘prescribing error’, ‘change to medication treatment regimen’, ‘at the patient’s request’ or ‘at the pharmacist’s request’. If multiple items are being cancelled, the prescriber can choose to give different cancellation reasons for different items.

Electronic prescriptions, that have not been downloaded to a local dispensing site, can be cancelled on an individual item basis without invalidating the whole prescription however, if all items on an electronic prescription are cancelled this will automatically cancel the whole prescription.

The prescriber should normally inform the patient that the electronic prescription has been cancelled however if the patient visits a pharmacy with a prescription token to collect a prescription that has been cancelled, when the barcode is scanned to pull down the cancelled prescription from the spine, a rejection message will be sent to the pharmacy to indicate that the prescription has been cancelled by the prescriber.

Note, the rejection message will not include the reason why the prescription has been cancelled. It is the responsibility of the prescriber to communicate this to the patient.

If the patient has nominated a pharmacy and the patient has not been given a prescription token, if one item on a multi-item electronic prescription has been cancelled, the pharmacy system will be able to retrieve the electronic prescription and it will indicate that one item has been cancelled along with the reason for cancellation. However, if all items on the nominated prescription have been cancelled and the patient has not been given a prescription token, the pharmacy system will not retrieve the cancelled prescription and the pharmacy will not be aware that the electronic prescription existed but has been cancelled.

Prescribers have previously been advised never to assume that a prescription has been cancelled unless a positive cancellation response has been received from their system. If a response is not received within 5 minutes the prescriber should assume that the prescription has not been cancelled and follow existing procedures (e.g. phone calls).

Cancellation requests cannot themselves be cancelled so to reinstate a prescription, a new prescription must be generated by the prescriber using a new prescription ID. An NHS electronic prescription cannot be amended once sent to the spine. If amendment is required, the prescriber would need to cancel the prescription and then regenerate it in amended form.

System suppliers may allow optional selection of a reason why the item was marked ND. Reasons in systems have inlcluded:“Not required as instructed by the patient”

• “Clinically unsuitable”
• “Prescription cancellation”
• “Prescription cancellation due to death”
• “Illegal NHS Prescription”
• “Prescribed Out of Scope item”
• “Not allowed on FP10”
• “Patient did not collect medication <also – “Patient non-attendance”
• “Patient purchased medication over the counter <also – “Item purchased over the counter” >
• “Not dispensed as instructed by the prescriber”
• “Unable to dispense medication on prescriptions”
• “Patient requested release”
• “Another dispenser requested release on behalf of the patient”
• “Invalid digital signature”
• “Rejected due to version problem”
• “Prescription otherwise invalid or unreadable”
• “Prescription expired”

Some of these options are more suited to paper prescriptions instead of electronic ones.

Electronic prescriptions can only be ‘cleanly’ cancelled by the prescriber (until they are downloaded by the patient’s nominated pharmacy).

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.

ND may also be an option. See section ‘Marking a prescription as not dispensed’

Q. Can an EPS item be cancelled (e.g. if an error has been made)?

A. Prescribers have the ability to ‘cleanly’ cancel an electronic prescription if they cancel it before a pharmacy has downloaded it. Pharmacy contractors also have the ability to mark an EPS item ‘ND’ or ‘Not Dispensed’. When marking a prescription item as ‘not dispensed’ the pharmacy team should still communicate to the prescriber that the patient has not received the medication, as there is no automated notification process for the practice. If necessary a replacement prescription item may need to be requested on a separate EPS prescription.

Q. Can an electronic prescription be amended by the prescriber?

A. No. An electronic NHS prescription cannot be amended once sent to the Spine by the prescriber. If amendment is required, either:

• the pharmacy would need to mark the item ND, and a new item would need to be prescribed; or
• the prescriber would need to cancel the prescription (cleanly e.g. prior to a pharmacy downloading it) and then the prescriber could regenerate it in amended form.

Q. In EPS Release 2, will a prescriber be able to cancel a prescription that has already been dispensed by a pharmacist?

A. Release 2 of the Electronic Prescription Service will support the cancellation of electronic prescriptions. It will not be possible for a prescription to be electronically cancelled in the usual way by a prescriber, where it has the following status:

• “Prescription/item not cancelled as with dispenser”
• “Prescription/item not cancelled as with dispenser (active)”
• “Prescription/item was not cancelled – dispensed to patient”
• “Prescription/item cancellation requested by another prescriber”
• “Prescription/item expired”
• “Prescription/item not found”
• “Prescription/Item had already been cancelled”

Where a prescription cannot be electronically cancelled, a prescriber can follow manual processes, as now, and call the pharmacist to explain that there is a problem with the prescription. To facilitate this, the prescribing system will provide information to the prescriber on which dispensing site has retrieved the prescription. This is an advance on paper prescription processes where the GP may not know which pharmacy the patient has gone to.