EPS use in urgent and other care settings

NHS England announced that from September 2024, the Electronic Prescription Service (EPS) will be extended to Detained Estate services in England.

This extension will allow prison prescribers to issue EPS ‘To Take Out’ (TTO) and urgent prescriptions electronically to community pharmacies, removing the need for paper FP10 forms.

Most patients will be released with a supply of their current medications, so they may not collect their EPS prescription immediately upon release. They might collect their prescription from a pharmacy far from the prison, as many are detained faraway from their usual homes.

Handling These Prescriptions

These prescriptions are expected to be relatively rare. According to NHSBSA, there are about 6,000 HJIS prescriptions annually, and Health and Justice statistics indicate that around 40,000 people are released from prison each year. However, any pharmacy might receive these prescriptions. Here are the key points for pharmacy teams to consider when handling these prescriptions.

Non-nominated prescriptions

These prescriptions might be non-nominated EPS prescriptions that need to be retrieved from the NHS Spine. Due to the uncertainty of where individuals will live after release, prescribers may choose to issue non-nominated prescriptions instead of using one-off or standard nominated prescriptions.

Tokens

Some individuals might have a token or prescription barcode/number for their prescription, either provided to them by the prescriber, or accessible via the NHS App or their online NHS website account. However, many patients may not have a token due to difficulties faced by prison prescribers in providing this, and because patients may not have access to phones or computers to download their EPS token to present it to the pharmacy. In such cases, the prescription will need to be located by the pharmacy team using patient identifiable information, such as the prison address from which they were released, their name, and date of birth.

Free-of-charge status

The prescriber address will confirm that the prescription is exempt from charges, as those with the practice address of HMP are exempt. The prescription must have ‘HMP’ printed in the practice address box on the front of the form. In these instances, the patient does not need to complete a signed declaration on the back of the form. EPS exemption category 0015 is used for processing HMP prisoners on release.

Note: Be aware that some dispensing systems may currently label this category in a misleading way, such as ‘patient does not have to pay a prescription charge’. Exemption category 0015 should be used exclusively for processing HMP prisoners upon their release.

Pharmacy queries to the prescriber

If a pharmacy team member needs to contact the prison prescriber, they should look-up the prison, contact the main switchboard, and request to be connected to the healthcare team. These teams generally operate during core hours from 08:00 to 17:00, Monday to Friday, with some availability outside these hours.

Dispensing for the patient

Community pharmacies will need to dispense the medication for the individual while they wait (if it is in stock), as there will not be an opportunity to prepare the medication in advance for non-nominated EPS prescriptions.

Rollout plans

The roll-outs will be phased. Insights from early users will help shape the further rollout and guidance.

The plans and dates may be subject to change.

Benefits

This rollout improves access to urgent and necessary medicines for released patients by:

• Enabling the prescribing of discharge medicines in advance as part of release planning, resolving the issue of safely retaining a paper prescription.
• Streamlining the discharge medicines prescribing process, allowing for more remote prescribing and reducing reliance on on-site prescribers to issue paper FP10s.
• Replacing the need for dispensing discharge medicines that are often left behind or cannot be supplied before the patient leaves.
• Avoiding the need for patients to return to prison post-release to collect discharge medicines, which often remain uncollected.
• Addressing issues related to the destruction of paper FP10s if a detainee returns to custody after a court appearance, as EPS prescriptions can be digitally cancelled.

Support and escalations

Queries can be sent to: necsu.hjis@nhs.net. If there is a technical issue or a concern with an EPS prescription, use the usual EPS escalation route factsheet to ensure a proper resolution.

Further information

NHS England notice about Rollout of the Electronic Prescription Service (EPS) to Detained Estate services

EPS is rolling out across some trusts, and this is anticipated to continue.

Following a successful pilot, NHS England’s Transformation Directorate including the EPS team rolled out the EPS to urgent care providers using the Advanced Adastra prescribing system from 2018. Integrated urgent care providers include: NHS 111, GP out of hours, Clinical Assessment Services (CAS), Walk-in Centres, Minor Injuries Units and Urgent Care Centres.

EPS is available within the following relevant prescribing systems:

• Advanced Adastra prescribing system
• IC24
• EMIS Web
• TPP systems

Prescribers with EPS can use EPS to prescribe medicines in the same way that GP practices do.

How does this work?

Prescribers identify a pharmacy that is open and accessible for the patient using similar processes to those used for paper FP10s.

EPS alone is unable to guarantee the pharmacy:

• will be made aware of the urgency of the prescription;
• has medication in stock; and
• has the ability to dispense the prescription.

Due to the nature of prescriptions issued in urgent care, prescribers have been advised to consider whether it is necessary to contact dispensers to notify them they are issuing an EPS prescription to advise it needs to be dispensed promptly.

The EPS system will use a type of ‘one-off nomination’ to send the prescription to the pharmacy that the patient has selected. This will not affect existing nominations for the patient’s ‘regular’ prescriptions.

The prescriptions will be downloaded by the pharmacy team’s PMR system in the normal way. Pharmacies that are open out of hours and that regularly receive paper prescriptions written by prescribers from urgent care providers may want to consider reviewing how frequently they download prescriptions from the central NHS Spine, so that any prescriptions sent by urgent care services are downloaded promptly. The prescription message will contain the contact details of the prescribing site in case there are any queries for the prescriber. The existing EPS dispense/claim message sending processes are unaffected.

You can use the prescription ID number to locate and download prescriptions manually if you would like to delay a full download of all EPS prescriptions in order to help you to manage your EPS prescription workload.

It is possible that a patient may present at a pharmacy different to the one originally selected by them and the urgent care prescriber. In this case, the pharmacist at the pharmacy where the patient has presented, should obtain the patient’s NHS number through a Personal Demographic Service search and use this with the Prescription ID (which may be obtained from the patient or from EPS Tracker) to manually download the prescription from the Spine, or contact the pharmacy originally selected by the urgent care prescriber. Patients may be given their prescription ID either verbally or via text message.

What happens if there is a problem using EPS for urgent care?

In the event of either a prescribing, dispensing or national system failure and the patient is not present to receive an FP10, the urgent care provider could send an FP10 prescription via NHSmail scanned attachment (ideally following up with a phone call) to the patient’s chosen pharmacy. This will initiate the emergency supply process, with the FP10 subsequently being posted to the pharmacy.

EPS has not yet rolled out to dentistry. The overall volume of forms prescribed by dentists is low, and EPS has not yet been tested within dentistry. If dentistry EPS is to be rolled out in the future, there will be some challenges to overcome – regulatory and technical.

National COVID-19 Clinical Assessment Service electronic prescriptions: From 1st September 2020, the COVID-19 Clinical Assessment Service (CCAS), hosted by the South Central Ambulance Service, added the functionality for GPs within the service to prescribe, using EPS. This was intended to improve the patient journey and allow the CCAS GPs to complete an episode of care. The scope of prescribing was for acute prescriptions only and was only to include controlled drug medicines where clinically appropriate. EPS prescriptions that came from the CCAS were not restricted to patients in the South East Region as the service manages patient enquiries from across England. Pharmacy teams were able to use the contact details on the EPS token to telephone the service to contact the prescriber in the event of queries.

The EPS team continues to work to make EPS an option for prescribers to use in extended access hubs, community, out of hours and urgent care settings.

Updates will be published by Community Pharmacy England and NHS England.

If there is a technical issue or a concern with an EPS prescription from a pilot or other setting use EPS escalation route factsheet to escalate the issue appropriately and ensure a proper resolution.