England e-Prescription Services

In the 1990s, NHS England recognized the potential for the digital delivery of health information and services. In 2001, the National Programme for Health IT (NPfIT) strategy included an ePrescribing service. Given the size and complexity, national rollout and implementation of ePrescribing was split into two releases. Each release consisted of a first testing phase followed by a general rollout phase. Beginning in 2005, Release 1 added barcodes to prescriptions and established the fundamental technical infrastructure for message transmission.

Release 2, involving the full electronic transfer of prescriptions, is in progress. In January 2018, the Electronic Prescription Service (EPS) was reported to be live in 11,672 (99.4%) community pharmacies and 6,869 (91.3%) GP practices in England. The English experience showed that a phased approach to implementation gave stakeholders time to provide input to the process and to become accustomed to the new systems, while also providing a window within which to identify and resolve any challenges that only become apparent during implementation.

Stakeholders in England e-Prescription services include:

1. the British Medical Association, which represents doctors working in all areas of the UK
2. the General Pharmaceutical Council, which regulates pharmacists in the UK.

The NHS Electronic Prescription Service (EPS) required prescribers and dispensers to register to use the service. Once registered, they were issued with smartcards to control their access to the service. The service was introduced using an incremental approach:

Electronic Prescription Service Release 1 (ETP R1)

Release 1 added barcodes to prescriptions and established the fundamental technical infrastructure for message transmission. The standard paper prescription form, FP10, was changed to include a space for a barcode, which had a universal unique identifier. The unique identifier ensured the correct prescription was retrieved from the NHS Spine. The paper prescription remained the legal entity, while an electronic version of the prescription was uploaded to the NHS Spine. The NHS Spine is a centrally managed reference database that stores the electronic prescription as well as the demographic information.

Community pharmacists could scan the barcode to identify and retrieve the patient’s prescription from the NHS Spine. This phase provided dispensers with a chance to test information retrieval from the NHS Spine and to ensure that every patient had only one record in the NHS Spine.

Implementation of Release 1 was split into two phases:

• Phase 1 Release 1 pilots were set up at specified sites only. A series of pairs of GP practices and community pharmacies tested Electronic Prescription Service Release 1 Phase 1 (EPS R1 P1) modules. Once the modules met acceptable standards for message exchange and were accepted by the test sites, the modules were given to the NHS for deployment.
• Phase 2 National implementation of Release 1 began, with the goal of installing the accepted Electronic Prescription Service for all. Primary care trusts were responsible for applying for Directions from the Secretary of State for Health, authorizing them to implement the service in their respective areas.

Electronic Prescription Service Release 2

In this release, the electronic prescription was sent to the NHS Spine, where it could be downloaded by any pharmacist or the patient’s nominated pharmacist. The electronic prescription, which was signed digitally, was the legal document, and the patient receives a paper notification with barcoded identifier. When the patient presented the notification, the dispenser scanned the barcode to identify the prescription in the NHS Spine then download the prescription to the dispensing system.

The following capabilities were also included:

• Nomination of dispenser, where the patient can nominate the dispenser.
• Cancellation of prescription, which allows for the prescriber (or any authorized staff in their practice) to cancel the prescription up until it is dispensed.
• Repeat prescribing/dispensing, where prescribers can sign a number of prescriptions electronically.

Some provision remains for paper prescriptions—for example, in case of EPS outage. Again, implementation of Release 2 was split into two phases:

• Phase 3 A restricted number of prescribing-dispensing pair sites took part in live testing of prescribing and dispensing using Release 2. Prescriber entry was tightly controlled — prescribers could connect to R2 functionality only if their primary care trusts had been authorized by Secretary of State Directions. Dispensers/pharmacies did not require identification. Any pharmacy could dispense an R2 prescription.
• Phase 4 This phase is the national implementation of Release 2, providing full electronic prescribing capability.