Electronic Repeat Dispensing (eRD) Presentation to South Staffordshire LPC – 13 September Claire Powell / Mike Jones Your NHS partner for improving health and integrating care midlandsandlancashirecsu.nhs.uk
NHS Midlands and Lancashire Commissioning Support Unit 2
eRD - Overview What is eRD? • eRD allows the prescriber to authorise and issue a batch of prescriptions for up to 12 months with just one • digital signature. Once the service is set up, the patient’s nominated dispenser receives the issues at intervals specified by the prescriber. eRD stores all issues of the eRD prescriptions securely on the NHS Spine and delivers them to the patient's • nominated community pharmacy at the intervals set by the prescriber. The prescriber retains the ability to change or cancel the prescription at any time. The first issue is available on the NHS Spine as soon as it is signed and the subsequent issues are • automatically downloaded to the nominated dispenser 7 days before their due date to allow time to order items which are out of stock and prepare the prescription. NHS Midlands and Lancashire Commissioning Support Unit 3
Benefits for dispensers The benefits of eRD for dispensers are: dispensers use their clinical skills to manage eRD prescriptions, which helps to enhance their professional • long-term relationship with patients and prescribers improved stock control - the issues of an eRD prescription are downloaded 7 days before they are due, • allowing time to order any items which are out of stock and to prepare the prescription in advance of the patient arriving to collect it increased efficiency and more predictable workload • reduced time spent collecting paper prescriptions from prescribing sites • subsequent issues of an eRD prescription are automatically cancelled when the Personal Demographics • Service (PDS) is updated with notification of a death NHS Midlands and Lancashire Commissioning Support Unit 4
Questions to patients Before dispensing the electronic repeat dispensing prescription the dispensing site must establish that the patient is taking or using their medication appropriately and that there are no reasons why the medication in question should not be supplied. They should ask the following questions each time an issue of the eRD prescription is dispensed: 1. Have you seen any health professional (GP, nurse or hospital doctor) since your last repeat was supplied? 2. Have you recently started taking any new medicines - either on prescription or that you have bought over the counter? 3. Have you been having any problems with your medication or experiencing any side effects? 4. Are there any items on your repeat prescription that you don’t need this month? (NHS Community Pharmacy Contractual Framework) NHS Midlands and Lancashire Commissioning Support Unit 5
eRD support to Practices / Pharmacies - Phase 1 The MLCSU have worked with the CCGs, NHS England and LPCs to develop a pilot project to deploy eRD into 22 practices across Staffordshire. ❖ East Staffs x 2 ❖ Stafford and Surrounds x 3 ❖ Cannock Chase x 3 ❖ South East & Seisdon x 4 ❖ Stoke x 5 ❖ North Staffs x 5 Following the recommended NHS Digital model, we included a ‘Business Change’ session at each practice • and invited Community Pharmacies to attend. eRD Pharmacy packs have been provided to those that attended, and also to the LPC to host on the • website Working alongside the ‘Medicines Matter’ initiative • NHS Midlands and Lancashire Commissioning Support Unit 6
eRD approach / patient selection We asked Community Pharmacies not to proactively sign up patients as potential eRD candidates, but to • liaise with the practice. Practices have a more detailed knowledge of medical history and will seek the appropriate consent. We recommended that practices only enrol patients who fit the following criteria: • Aged 18 or over. • Prescribed medication that is suitable for eRD. ie not controlled drugs, benzodiazepines, drugs • that require close and careful monitoring (eg methotrexate), hypnotics Stable Medication: - no significant changes to repeat medications within the last 6 months, • with no changes to medication planned for the duration of the first set of prescriptions to be issued by eRD. Stable Condition(s)- Patients’ condition should be stable and they should not have had any • hospital admissions within the last 6 months. Medication reviews and monitoring should be up to date. • Encourage ‘all or nothing’’ in regards to patients repeats. • NHS Midlands and Lancashire Commissioning Support Unit 7
Feedback – Lessons learnt #1 Practices initially focused on patients who received medication for • • Levothyroxine • Anti diabetic medication • Anti hypertension medication Patients will be asked by the practice, for their consent before moved onto an eRD regime. • Practices will inform pharmacies once patients have been enrolled • Pharmacies need to understand that the next issue can only be downloaded once the previous issue has • been dispensed. Instalment Reminder cards may be useful, so that patients know when to collect the next issue and when • to reorder. Examples in handouts, but may need local customisation. Although 12 issue eRD is possible, there is a risk that the 12 th issue may expire before it can be claimed, • and so the guidance is to issue 6 months supply per regime – 6 x 28, 3 x 56 etc NHS Midlands and Lancashire Commissioning Support Unit 8
Feedback – Lessons Learnt #2 During this phase, we received favourable feedback from those pharmacies who attended the Business • Change meetings. Some Community Pharmacies were unable to attend, as the meetings were held at lunchtime. We had a • 38% attendance in South, compared to 60% attendance in North. The LPC fed back details of issues around ‘inappropriate patients’ being set up with eRD at non beacon • practices. • Communications are improved when both practice and pharmacy have a named ‘eRD Champion’ ‘When Required’ drugs (PRN) can be issues as eRD, but practices are advised to set them up as a separate • individual prescription. Community Pharmacy will be asked to remind the patient to re-order when the penultimate issue is • dispensed to allow time for any review appointment to be made with practice. NHS Midlands and Lancashire Commissioning Support Unit 9
Phase 2 Extending the scope of the project to 100 practices • Revised support model but retaining ‘Business Change’ joint meeting • Timescales • • Revised patient groups – Statins Initial 22 beacon practices to extend the scope of eRD patients • NHS Midlands and Lancashire Commissioning Support Unit 10
eRD Resources for Pharmacies The MLCSU Project Team have devised a number of resources including : Community Pharmacy Support guidance: Electronic Repeat Dispensing (June 2018) • EPS – FAQs for Community Pharmacy (July 2018) • In addition: NHS Digital – eRD dispensers guide (Oct 2016) • PSNC Briefing 004/17: eRepeat Dispensing – A factsheet for pharmacy teams (January 2017) • Copies of these documents are available from the LPC Website NHS Midlands and Lancashire Commissioning Support Unit 11
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