Cancellation and Not Dispensed (ND) in EPS

Currently, when a pharmacy marks an item as Not Dispensed (ND), this information is not automatically sent back to the GP practice.

Pharmacy teams should continue to inform the practice if a patient has not received their medication, because there is currently no automated notification process.

Pharmacy teams and prescribing staff have consistently reported that a future EPS enhancement should allow prescription status updates, including ND statuses, to be visible within both prescribing and dispensing systems. This would help improve visibility and reduce the need for manual communication.

There is also strong support for any future solution to be simple to use and minimise additional workload for pharmacy teams and prescribers.

This proposal is included within the Community Pharmacy IT Group (CP ITG) vision for the future development of EPS.

If a pharmacy has already downloaded an EPS prescription but has not yet completed dispensing, the prescriber may ask whether the pharmacy can mark the item or prescription as Not Dispensed (ND).

If the pharmacy agrees this is appropriate, the ND status can be added and submitted to NHS Business Services Authority (NHSBSA).

Community Pharmacy England has received feedback that a key benefit of this approach is that the item cannot later be dispensed accidentally by another dispenser.

An EPS prescription can be cancelled electronically by the prescriber before it has been downloaded by the patient’s nominated pharmacy.

Prescribing systems will show the prescriber whether a dispensing site has already downloaded the prescription. Where available, the dispensing site’s contact details will also be included.

Cancellation reason codes

When cancelling a prescription, the prescribing system will ask the user to select a reason. Examples include:

• Prescribing error;
• Change to medication treatment regimen;
• At the patient’s request; or
• At the pharmacist’s request.

If multiple items are being cancelled, different cancellation reasons can be selected for different items.

Cancelling individual items

Items can be cancelled individually without cancelling the entire prescription, provided the prescription has not yet been downloaded by a dispensing site.

If all items on an electronic prescription are cancelled, the whole prescription will automatically be cancelled.

Informing the patient

The prescriber should normally tell the patient that their prescription has been cancelled.

If a patient presents a prescription token at a pharmacy after the prescription has been cancelled, scanning the barcode will generate a message confirming that the prescription has been cancelled.

The rejection message will not include the reason for cancellation. It remains the prescriber’s responsibility to explain this to the patient.

What pharmacies can see

Where a patient has nominated a pharmacy and one item on a multi-item prescription has been cancelled, the pharmacy system will usually indicate:

• Which item has been cancelled; and
• The reason for the cancellation.

However, if all items on a nominated prescription are cancelled and the patient has not received a prescription token, the pharmacy may not be aware that the prescription ever existed.

Important points for prescribers

Prescribers should not assume a cancellation has been successful unless a positive cancellation response is received from their system.

If confirmation is not received within five minutes, the prescriber should assume the cancellation has not been completed and should follow local procedures, such as contacting the pharmacy directly.

Cancellation requests cannot themselves be cancelled. If a prescription needs to be reinstated, the prescriber must generate a new prescription with a new prescription ID.

An NHS electronic prescription cannot be amended after it has been sent to Spine. If changes are required, the existing prescription must be cancelled and a replacement prescription issued.

Some IT system suppliers allow pharmacy teams to record a reason when marking an item as Not Dispensed (ND).

Examples include:

• 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;
• Patient non-attendance;
• Patient purchased medication over the counter;
• Item purchased over the counter;
• Not dispensed as instructed by the prescriber;
• Unable to dispense medication on prescription;
• 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; and
• Prescription expired.

The options available vary between systems. Some reasons may be more relevant to paper prescriptions than EPS prescriptions.

A prescriber can only cancel an EPS prescription electronically before it has been downloaded by the patient’s nominated pharmacy.

If a dispensing site has already downloaded the prescription, the prescriber should follow local procedures to request that it is not dispensed. This may include contacting the pharmacy by telephone.

Using the Not Dispensed (ND) process may also be appropriate in some circumstances. See the section above titled Marking a prescription as not dispensed.

Q. Can an EPS item be cancelled if an error has been made?

Prescribers can electronically cancel an EPS prescription before it has been downloaded by a pharmacy. Pharmacy teams may also be able to mark an item as Not Dispensed (ND) where appropriate.

If an item is marked ND, pharmacy teams should still inform the prescriber that the patient has not received the medication because there is no automated notification process.

Where needed, a replacement prescription can be issued separately.

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

No. Once an NHS electronic prescription has been sent to Spine, it cannot be amended.

If changes are required:

• The pharmacy may mark the item as ND and request a replacement prescription; or
• The prescriber may cancel the prescription before download and issue a new amended prescription.

Q. Can a prescriber cancel a prescription that has already been dispensed?

No. A prescription cannot be electronically cancelled if it has already reached certain stages in the dispensing process.

Examples include:

• Prescription or item not cancelled as with dispenser;
• Prescription or item not cancelled as with dispenser (active);
• Prescription or item was not cancelled because it has been dispensed to the patient;
• Prescription or item cancellation requested by another prescriber;
• Prescription or item expired;
• Prescription or item not found; or
• Prescription or item had already been cancelled.

In these situations, the prescriber should follow existing manual processes and contact the pharmacy directly.

A benefit of EPS is that prescribing systems can identify which pharmacy downloaded the prescription. This can help prescribers contact the correct pharmacy more quickly than would usually be possible with paper prescriptions.