Controlled drugs in the Electronic Prescription Service

Benefits include: 

• 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

Once you have checked the roll out schedule for your go live date, you should make sure all staff in your practice, including locums, understand what the changes mean for them.

When controlled drugs have been enabled in your practice, EPS will be used for all eligible prescriptions. This change will happen as per your system supplier’s schedule and you do not need to manually enable the feature.

Once enabled, all prescriptions for Schedule 2 and 3 Controlled Drugs (excluding instalment FP10MDAs) will automatically be processed electronically for patients who use EPS for their existing prescriptions.

If you are a GP practice piloting Phase 4, this change will apply to all patients receiving Phase 4 tokens. 

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 and exclusions 

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.

Oral liquid methadone: Because it isn’t possible 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.

Instalment prescribing: EPS cannot be used for prescribing in instalments (FP10MDA prescribing).

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 for both prescribers and dispensers.  

EPS 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 will not receive a separate paper prescription for Schedule 2 or 3 CDs anymore, except for oral liquid methadone or instalment FP10MDA prescriptions (see exclusions above). 

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

Informing local pharmacies 

You should consider informing your local and frequently used community pharmacies about your controlled drugs go live date. This will help ensure they are prepared for the change. Download an email/letter template.

You should be aware that the number of CD prescriptions sent via EPS will increase significantly as more GP practices have the functionality switched on.

It is important that all staff working in your pharmacy, including locums, are aware of the roll out.

As patients can nominate any EPS Release 2 enabled pharmacy in England, you could receive an electronic CD prescription at any time, even if there are no GP practices close to you currently live with CD functionality. GP practices taking part in the EPS Phase 4 pilot will prescribe CDs electronically both for patients with nominations and for those without (on Phase 4 tokens).

If you receive a prescription for a Schedule 2 or 3 CD via EPS, you should dispense it as you would any other electronic prescription.

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 for both prescribers and dispensers.  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). 

EPS Nominations 

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 will not 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 did not have a nomination because they received Schedule 2 or 3 CDs and did not 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.