Maximising electronic repeat dispensing

Two thirds of prescriptions issued in primary care are repeat prescriptions. These repeat prescriptions account for nearly 80 per cent of NHS medicine costs for primary care. The management of these prescriptions and the time involved in ordering them can be significant.

It is estimated that up to 330 million, or 80 per cent, of all repeat prescriptions could eventually be replaced with eRD; this could save 2.7 million hours of GP and practice time which is worth approximately £90m to the NHS.

Electronic Repeat Dispensing (eRD) is an integral part of EPS, which offers many extra benefits over paper repeat dispensing and repeat prescribing. eRD allows regular medicines to be prescribed for suitable patients in batches of up to a year and stores the prescriptions securely on the Spine.

The Spine delivers the prescriptions to the patient’s nominated community pharmacy or dispensing appliance contractor at regular intervals, specified by the prescriber. This removes the need for the patient to contact their prescriber to request another repeat prescription and consequently saves the patient and prescriber time.

The prescriber retains the ability to cancel a single item or whole prescription at any time. The nominated dispenser receives the first issue on the effective date for which it is signed, and subsequent issues automatically download at the nominated dispenser seven days in advance of the due date, which helps to manage stock control and preparation in advance of the patient attending. 

This toolkit has been developed by the EPS team at NHS England to help prescribers and dispensers make the most of eRD. Throughout the toolkit you will find downloadable information which you can share.

What is eRD?

eRD simplifies the repeat prescribing process and offers a range of benefits. eRD:

• allows the prescriber to authorise and issue a batch of repeatable prescriptions for up to 12 months with just one digital signature
• means patients don’t need to contact the surgery to reorder at regular intervals, unless their condition changes
• means dispensers are mandated to ask patients if they require all items on their prescription before every issue, to avoid medicines wastage
• puts the prescriber in control rather than allowing the patient or dispenser to continue re-ordering unnecessary items - which leads to oversupply and stockpiling

How eRD works

eRD stores all the issues of the eRD prescriptions securely on the NHS Spine and automatically downloads them to the patient’s nominated dispenser at the intervals set by the prescriber.

The prescriber retains the ability to cancel an item or whole prescription at any time. 

PRN or 'When required' medication can be prescribed using eRD. The prescriber can set the specified intervals based on the predicted number of uses/doses.

If the patient runs out, the next issue can be requested in advance - based upon clinical assessment by the dispenser. 

This may mean an extra prescription is needed to ensure the patient has enough medication to last until their next review. In some prescribing systems a variable prescription type is available which assists with this.

Patient consent

Patients are required to give their consent for repeat dispensing. However, this can be verbal and formal written consent is not required.

Consent can be read coded in the patient’s notes as:

Setting up a patient on eRD

When a prescriber issues an eRD, it will contain:

• the total quantity per issue
• the intended duration of each issue of the prescription
• how many times the eRD prescription can be issued before the patient/medication should be reviewed or re-ordered

Cancellation and prescription synching

eRD allows the cancellation at item or whole prescription level, which will cancel all subsequent issues on the Spine.

If the prescription is already with the dispenser, the prescribing system will receive a message to contact the dispenser. The dispenser must return the issue to the Spine for the cancellation to take place. The amended eRD prescription can then be manually downloaded by the pharmacy.

Individual prescription items can’t be amended. Therefore, if a dose change is required, the item needs to be cancelled and re-prescribed.

There are two options for patients with multiple items on eRD where an item requires cancellation:

1. Cancel all outstanding items within the prescription form and replace with a new eRD, including the new item/amended dosage change.
2. Cancel the individual item(s) – check when the next issue of the existing eRD prescription is due and generate a one-off prescription to cover until the date of the next issue of the original eRD. Create a new eRD prescription to start at the same time as the next issue of the existing eRD prescription with enough issues so that all prescriptions end at the same time. 'Synching' prescriptions in this way ensures that all the patient’s prescriptions are received by the dispenser on the same day and support interaction checking.

It is always good practice to communicate with the patient’s nominated pharmacy about any changes made to eRD prescriptions; this can be done with the electronic note to dispenser within the new eRD prescription.

NHS England has commissioned an e-learning module for prescribers. This covers system specific training for prescribers on all aspects of eRD.

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.

Patients will benefit from regular contact with their dispenser, who will be responsible for checking that their circumstances haven’t changed since the previous issue of the prescription was collected. Dispensers will also ask whether the patient needs all of the items on their prescription, in order to avoid medicine wastage.

eRD requires the dispenser to 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?

Based on the patient’s answers to these questions, the pharmacist will make a clinical decision to either dispense the medication or refer the patient back to their prescriber. If a patient does not require an item, the pharmacist will mark it as 'Not Dispensed'.

The benefits of eRD for dispensers

1. Improved stock control – the issues of an eRD prescription are downloaded 7 days before they are due, allowing time to order and prepare the prescription.
2. Increased efficiency and more predictable workload.
3. Reduced time spent collecting paper prescriptions from prescribing sites.
4. Dispensers use their clinical skills to manage eRD prescriptions, which helps to enhance their professional long-term relationship with patients and prescribers.
5. No need to retain and store paper issues.
6. Electronic reimbursement reduces the workload at the end of the month.
7. Prescriptions are automatically cancelled when the Personal Demographics Service (PDS) is updated with notification of a death.

*Throughout this toolkit, the term ‘dispenser’ or 'dispensary' refers to dispensing appliance contractors, pharmacies and dispensing staff.

How eRD works

eRD stores all of the issues of the eRD prescriptions securely on the NHS Spine and delivers them to the patient’s nominated community pharmacy at the regular 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 delivered to the pharmacy 7 days before their due date (providing the dispense notification for the previous issue has been sent), to allow time to order in stock and prepare the prescription. 

Cancellation and prescription synching

eRD allows the cancellation of the whole prescription or individual items. Cancelling an item will also cancel the items from all future issues of that prescription. If the prescription is already with the dispenser, it must be returned to the Spine for the cancellation to take place. The amended eRD prescription can then be manually downloaded by the dispenser.

eRD is an essential service and is part of the NHS Community Pharmacy Contractual Framework. The service specification requires a contractor to ensure that pharmacists are competent to provide repeat dispensing services. Pharmacists should also undergo appropriate training, for example, The Centre for Postgraduate Pharmacy Education (CPPE) programme and assessment. The CPPE produces an open learning pack on repeat dispensing.