Controlled drugs in the Electronic Prescription Service

The first GP practices using the Vision and EMIS systems can now send Schedule 2 and 3 Controlled Drugs (CDs) electronically via the EPS. This includes all Schedule 2 and 3 CDs, except for instalment FP10MDA prescriptions.

Vision and EMIS began piloting at 10 GP practices in Yorkshire, the north west and London from 2 October 2018. Although the pilot sites are concentrated in the north and London areas, patients can choose to have their electronic prescriptions dispensed anywhere in England. 

This means that all dispensers will need to be aware that they could receive an electronic prescription for a Schedule 2 or 3 CD.

Following successful testing, the functionality to prescribe Schedule 2 and 3 CDs by EPS will be deployed to all Vision and EMIS sites. Other GP system suppliers are developing the capability and NHS Digital will manage the deployment on a supplier by supplier basis. Further details will be provided closer to the time. 

More information will be published on this website and in the GP and Pharmacy bulletins.

• fewer patients with both paper and electronic prescriptions, making it easier for them as all their prescriptions can be sent electronically to their nominated pharmacy
• sending more prescriptions electronically will reduce the administrative burden on both GP practice and pharmacy staff 
• prescriptions will be sent securely and electronically, and so can’t be lost or misplaced
• being able to see everything that has been prescribed helps pharmacists make the right decisions to safely and effectively dispense the right drugs for patients
• patients who had chosen not to use EPS because they still had paper prescriptions for controlled drugs can now benefit
• patient safety is increased as errors are less likely

Best practice in prescribing CDs

Prescribers are reminded that face-to-face consultations are considered best practice when prescribing controlled drugs. Although the introduction of EPS may result in opportunities for remote consulting and prescribing, particularly in urgent and emergency care, this should be a last resort for controlled drugs, particularly without access to the primary care record or personal knowledge of the patient. Local processes should be updated to reflect the need to consider face-to-face consultations where controlled drugs are requested

Prescribing CDs using EPS

You will prescribe Schedule 2 and 3 CDs electronically via EPS in the same way you prescribe other prescriptions now. However, there are some exceptions. Because it isn’t possible yet for all dispensing systems to endorse electronic prescriptions for oral liquid methadone with a packaged dose endorsement (PDn), a paper FP10 prescription will still need to be generated for this drug to allow the pharmacy to claim the correct fees.

You won’t be able to use EPS for prescribing in instalments (FP10MDA prescribing), as this requires additional changes to be made to EPS to support this.

Words and figures

In order to meet legislative requirements requiring quantities of CDs to be expressed in both words and figures, the system will automatically populate this information in both formats in the prescription message. This will display the details on both the prescriber and dispenser screens.

Nominations

Patients who already have a nomination should be advised that most of their items, including Schedule 2 or 3 CDs, can now be sent via EPS to their nominated pharmacy like their other medication. These patients won’t receive a separate paper prescription for Schedule 2 or 3 CDs anymore, except for oral liquid methadone or instalment FP10MDA prescriptions

Patients who previously didn’t have a nomination because they received Schedule 2 or 3 CDs and didn’t want split prescriptions can be advised to consider setting a nomination.

Introducing CDs by EPS in your practice

Although the controlled drugs function may appear to be available in your GP system, it is important that you do not attempt to switch it on yourself. Deployment during and after the pilot is being managed on a site by site basis.

Patients can nominate any EPS Release 2 enabled pharmacy in England, so you need to be aware that you could receive an electronic prescription for a Schedule 2 or 3 CD and should understand the following points.

Words and figures

In order to meet legislative requirements requiring quantities of CDs to be expressed in words and figures, the prescribing system will automatically populate this information in both formats in the prescription message. This will display the details on the prescriber and dispenser screens. The quantity in words and figures will be included in the ‘message to pharmacy’ field of the prescription message.

Exclusions

Because not all dispensing systems are able to endorse electronic prescriptions for oral liquid methadone with a packaged dose endorsement (PDn), a paper FP10 prescription will still need to be generated for this drug. Prescribers are being asked not to prescribe oral liquid methadone using EPS. If you receive an EPS prescription for oral liquid methadone and do not need (or want) to claim the PD fee for each ‘separate’ container, you can submit a claim. If you want to claim the fee, you will need to ask the prescriber to issue a paper FP10 prescription.

Prescribers won’t be able to use EPS for prescribing in instalments (FP10MDA prescribing), as this requires additional changes to be made to EPS to support this.

Nominations for patients at pilot practices

You should advise patients who already have a nomination that most of their items, including Schedule 2 and 3 CDs, will now be sent automatically to their nominated pharmacy. These patients won’t receive a separate paper prescription for Schedule 2 or 3 CDs anymore (except for oral liquid methadone or any instalment FP10MDA prescriptions).

You should advise patients who previously didn’t have a nomination because they received Schedule 2 or 3 CDs and didn’t want split prescriptions to consider setting a nomination.

Dispense notifications

A method of ‘marking’ the prescription ‘at the time of supply’ should be decided to ensure compliance with the Misuse of Drug Regulations. The dispense notification is suitable for this but, depending on local system configuration, another patient medication record (PMR) process that records a date and leaves an electronic audit trail may be more suitable.

Physically marking the EPS dispensing token (FP10DT) is not a suitable method as it is not the legal prescription. Dispense notifications should be sent as close as possible to the time the patient was given the medication.

Capturing a signature for the collection of Schedule 2 and 3 CDs

You will be aware of the best practice guidance regarding the capture of a signature on the back of an FP10 from the person collecting a Schedule 2 or 3 CD. This guidance also applies to EPS prescriptions and the signature can be captured on the back of a dispensing or prescription token, with these tokens being sent to the NHSBSA in the same month the claim is submitted.

For age exempt patients (under 16 years of age or 60 years of age and over), there is no requirement to capture a signature for exemption from prescription charges and so only age exempt tokens that also capture a signature for collection of a Schedule 2 or 3 item should be sent to the NHSBSA. 

All other tokens (non-age exempt and charge paid) must be sent to the NHSBSA as normal.