eRD top tips
- Be prepared to invest some ‘set–up’ time at the practice. This is an ‘invest to save’ process.
- Start small – increase numbers and expand the selection criteria as the confidence of the prescriber and practice increases.
- Improve communication between the practice and dispenser – maximum benefits will be gained with good working relationships.
- Identify a named lead in both the practice and pharmacy to take implementation forward and ensure regular two–way communication. Practices and dispensers must be responsive to changes in a patient’s medication requirements and have the appropriate communication channels in place to notify each other of changes, cancellations or make referrals back to a GP.
- Utilise a patient’s birth month when placing them on eRD. If a new batch of eRD starts in the patient’s birth month, this can act as a reminder to both patient and practice staff that appointments will be needed for tests and a medicine review. This can help to stagger the need to complete medicine reviews more evenly, preventing eRD drop off when tests cannot be completed in time.
- Setting the total duration of the eRD batch to coincide with reviews. Any functions that have Quality and Outcomes Framework (QOF) points attached can be used to reinforce patient compliance with periodic reviews.
- Make sure all staff at the practice and dispensary are aware of the service and fully understand the processes involved.
- Effective communication with the patient is essential. The service will fail if patients continue to reorder their prescriptions as before or become confused.
Safeguards of eRD
- Each issue of an eRD prescription can only be dispensed once.
- The prescriber can cancel the prescription or prescription items at any time and will know whether the prescription is ‘with dispenser’ or ‘dispensed to patient’.
- The original prescriber is responsible for the duration of the repeatable prescription.
- There is a full end-to-end audit trail from prescribing to dispensing and eRD provides eRD provides a continuous medical record, including reasons for item cancellations.
- The patient can receive their eRD from any Release 2 enabled dispensing site in England.
- The patient can change their nomination at any time. Subsequent issues will be available to the newly nominated dispensing site.
- Automatic cancellation of all outstanding prescriptions will occur when the Personal Demographics Service is updated with notification of death. This prevents relatives and carers being notified of or given prescription items for the deceased.
Further eRD information
Patient consent requirements
Amendments to the GP contract from 1 October 2021 allow practices in England to transfer any clinically suitable patient onto eRD without individual consent if they are already receiving, or have agreed to receive, electronic prescriptions.
Change of practice for patient or prescribing GP
If a prescriber leaves the GP practice before expiry of all issues, the practice must cancel all outstanding issues of eRD for which that GP is an authoriser via their prescribing system. Practices should consider not having the authorising GP as someone who is about to retire or likely to leave.
If a patient leaves the practice, the practice must electronically cancel all outstanding issues of eRD prescriptions. If this is done correctly, all future issues on the Spine will be cancelled.
Alternatively, if a patient dies, once the Patient Demographic Service (PDS) is notified all outstanding eRD future issues will be automatically cancelled. Be aware any issues already ‘with dispenser’ will not be cancelled and a manual notification to the nominated pharmacy is required.
Patient suitability for eRD
The NHS numbers report provides GP practices with NHS Numbers for patients who might potentially be suitable for eRD. A clinical review of the patient and their medications should still be carried out to determine if eRD is appropriate for the patient.
Because it may be difficult to accurately predict when “PRN” medications, such as salbutamol and analgesics, will be needed, eRD works best if all “when required” items are put onto a separate eRD batch.
Changing and one-off nominations
Patients can change their nomination before the end of the repeat dispensing period and all outstanding issues which have not been downloaded will be available to download at the new nominated pharmacy. If the nomination is removed and not replaced, the eRD prescriptions will remain on the NHS Spine until the expiry date of the prescription.
A one-off nomination allows patients with an EPS nomination to request a one-off prescription to be sent to a different pharmacy or appliance contractor, without the need to change their primary nomination. It is designed to be used in scenarios where the patient will not be able to collect their prescription from their usual pharmacy, for example, if they are on holiday in a different part of the country and they may have forgotten to take their medication with them.
If one-off nomination functionality is not available within your prescribing system, and the patient wishes or needs to make a temporary change of nomination, it is important to note that the change of nomination will apply to future prescriptions and any that they have not yet collected from their pharmacy.
Once the temporary nomination is no longer required, the patient should ask the pharmacy or practice to change their nomination back to their usual pharmacy.
If the prescriber or practice change the nomination back or remove it too soon, before the intended pharmacy has downloaded the prescription for example, that pharmacy will not receive the prescription in their routine download.
Stopping a medicine mid-regime or changing the dose
If changes are needed either the individual item or the whole prescription must be cancelled and the new (amended) items or prescription reissued.
Cancelling an item on an eRD prescription will also cancel that item from all future issues of the prescription that remain on the Spine. The prescribing system will be notified that these cancellations have been successful or if not, why any cancellation has failed.
If a prescription has been downloaded by the pharmacy, but has not yet been issued to the patient, it cannot be cancelled automatically. In this case, the prescribing system will show all the prescriptions on the Spine that have had items cancelled successfully and show one prescription that has not had items cancelled as being ‘With Dispenser’.
The GP practice should then contact the pharmacy and request that the prescription is returned to the Spine for the cancellation to take effect. The amended eRD prescription can then be manually downloaded again by the pharmacy.
For patients with multiple items on eRD there are 2 options:
- Cancel all outstanding items on the Spine and replace with a new batch of all items including the new item.
- Cancel the individual item(s) – check when the next issue of the existing eRD batch is due and generate a one-off prescription to cover until the date of the next issue. Then 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.
Availability of repeat dispensing prescriptions
After the first issue has been dispensed and the dispensed notification sent, the next issues are ready to download from the Spine 21 days after the DN notice has been sent.