Non-nominated prescription information for GP practices

All GP practices using TPP SystmOne and EMIS Web are now able to issue non-nominated prescriptions.

For most practices, the move requires minimal action, but support materials and a checklist are available on this page.

Your system supplier can provide information specific to your prescribing system, and you can contact your local EPS lead for further support if required.

Non-nominated prescriptions are not yet available for national roll-out with Vision and Microtest.

Benefits for prescribers include:

• almost all prescriptions will be processed and signed electronically - in most cases, over 95% of your prescriptions will be processed this way and only a small proportion will be hand-signed
• one main process for prescriptions will lead to a more efficient, faster and secure service
• if a patient without a nomination loses their token, it can be easily reprinted - there is no need to re-issue the electronic prescription
• it is also possible to track more prescriptions using the EPS Prescription Tracker

Millions of patients already have a nomination. Their nomination will remain valid and their prescriptions will still be sent electronically to their nominated dispenser.

If a patient does not have a nomination, their prescription can still be sent electronically. You will need to print a token which should be given to the patient, the patient’s representative or their prescription collection service.

The token contains a unique barcode and you should advise patients to take it to a pharmacy or Dispensing Appliance Contractor (DAC) of their choice in England. The electronic prescription will remain on the NHS Spine until dispensing staff scan the token to retrieve it and begin the dispensing process.

Non-nominated prescriptions are not affected if a patient sets or changes an EPS nomination after they have been issued.

Patients without an EPS nomination will automatically have their prescriptions sent electronically.

Patients with a nomination may also choose to have a non-nominated prescription if they don’t wish to use their nomination for that prescription. 

A token (patients may refer to this as a ‘paper copy’) should be printed for all non-nominated prescriptions. 

In exceptional circumstances, where it is not possible for the patient to collect a token – see guidance for using EPS in remote consultations.

Tokens contain the same information as an FP10 such as the medications prescribed, quantity, dosage and instructions. However, as this is not the legal prescription, you do not sign this by hand.

The token is used by the dispenser, such as a community pharmacy or DAC, to scan the barcode to retrieve the prescription from the NHS Spine. 

Repeat dispensing or batch prescribing 

If a patient is part way through a paper-based repeat dispensing batch when non-nominated prescriptions are switched on, that will continue on paper until the batch is complete and the final issue dispensed. If a new batch is prescribed after this, it will be issued using electronic repeat dispensing (eRD).

With non-nominated eRD, prescriptions for patients are issued in the same way as eRD for those with a nomination. Guidance on how to cancel items on eRD prescriptions is available from your prescribing system supplier.

Unlike a paper-based repeat dispensing batch, patients without a nomination will receive just one token which will cover the entire regime. They will need to present this to a dispenser at each issue.

Dispensers have access to the EPS Prescription Tracker and can use this to check the dispensing intervals of any previous issue and that these are appropriate for the prescribed dose and quantity. Patients can also speak to their local pharmacy or DAC about leaving their token with them if they would like them to dispense future issues in the batch.

If an eRD regime has been issued whilst a patient does not have a nomination, then all issues will remain non-nominated, even if a nomination is set during the regime. 

If a prescription is not able to be sent via EPS, please check the following:

• is the patient’s record synchronised to the PDS?
• is an item marked ‘personally administered’ (PA)? To send the item via EPS, remove the tick from the PA box
• are the prescribed items matched to the dm+d? - The NHS Dictionary of Medicines and Devices (dm+d) provides a standardised reference for medicines and medical devices for use by different clinical systems - use the dm+d factsheet to assist with mapping common items 
• does the patient have an exception code in their record which is no longer relevant?
• is the user logged in with appropriate smartcard rights, and is your system configured correctly to enable users to generate and sign EPS prescriptions according to their roles.

There are only a few scenarios where a prescription won’t be sent electronically and a paper hand-signed prescription will need to be produced, such as:

• private prescriptions
• instalment dispensed CD (FP10MDA) prescriptions
• if the patient is a dispensing patient and there is no EPS system available in the dispensary
• if the patient has their prescriptions dispensed in Scotland, Wales or Northern Ireland
• if, in the professional judgement of the prescriber, the welfare of the patient is likely to be in jeopardy unless a paper prescription is issued.

Check your system supplier guidance for how to revert a prescription to FP10 if required. 

Dispensing practices

If you are a dispensing practice and do not use EPS in your dispensary, you may need to check your system configuration to ensure your dispensing patients continue to receive FP10s that you are able to dispense. Guidance is available from your system supplier.

Exception codes and further guidance 

The following exception codes will prevent EPS being used for a patient, meaning all prescriptions for that patient will need to be hand-signed. 

Cross-border – if a patient regularly uses a pharmacy outside of England, the following code can be added to ensure all their prescriptions will be issued as FP10.

Dispensing patient – if you are a dispensing practice and your dispensary does not yet use EPS, your GP system supplier will advise how prescriptions for dispensing patients are issued in non-nominated prescriptions. You may not need to use this code as your system may manage this differently.

 All practices should check for these codes when receiving GP2GP records for newly registered patients. If an exception is no longer applicable, add the retraction code to enable EPS. See your system supplier’s guidance for how to manage these codes.

All existing paper prescriptions that have not been dispensed will still be valid until their normal expiry date. These prescriptions do not need to be reissued electronically.

Your practice will need to consider your processes for printing and how you will sort and file paper tokens. You may want to re-consider how your printers are routed and where paper tokens for patients without a nomination are printed.

For example, it may be better for some tokens to be printed in a consultation room and other tokens to be printed in the reception area.

Printer guidance specific to your prescribing system is available from your system supplier. 

When printing a non-nominated prescription token it must be of an appropriate quality to ensure pharmacies can scan the barcode to retrieve the prescription from the NHS Spine. To avoid delays in dispensing a patient’s prescription, pharmacies can use the 18-digit Prescription ID to download the prescription manually. However, this is a time-consuming process and should be avoided.

If you encounter any issues with your prescribing system following non-nominated prescription switch-on, a query should be raised according to your existing process for other EPS-related issues with your supplier.

If you encounter any business process issues, you should first raise them with your commissioner.