Electronic Prescription Service Release 2 Nomination Policy

Electronic Prescription Service Release 2 Nomination Policy Reference number: Version: Responsible Committee: Version 1.5 (Final) Clinical Executive, Quality and Improvement. Date approved: 10 th June 2010 Name of author: Name of responsible director/ assistant director: Ruth Buchan/Moira Hall Debbie Graham/Moira Hall Date issued: Next review to be complete by: 10 th June 2011. Target audience: Primary medical services contractors

Contents 1. Introduction... 3 2. Associated Policies, Procedures and Guidance... 4 3. Aims and Objectives... 4 4. Scope of the Policy... 5 4.1 The nomination policy provides the following key principles... 5 4.2 Timing of Nominations... 5 5. Accountabilities & Responsibilities... 6 5.1 Regulations for prescribers... 6 5.2 Regulations for dispensers (Nominated Dispensing Contractor)... 6 5.3 EPS Authorisation Directions 2008... 7 5.4 Sites... 7 5.5 Nomination Procedures for Prescribers and Dispensers... 8 5.5.1 Suitability for patients... 8 5.5.2 Modes of Nomination... 8 5.5.3 Information for patients... 9 5.5.5 Nomination Requests... 10 6. Monitoring Compliance with this Policy... 12 7. Equality and Diversity... 13 8. Complaints... 13 9. Contingency... 15 10. Governance... 15 11. References... 15 12. Questions and Answers... 17 Appendix 1 Key Principles of Nomination... 20 Appendix 2 Equality Impact Assessment Tool... 23 NHS Calderdale EPS2 Policy Final Version 1.5 2

Policy Statement NHS Calderdale will have a robust EPS2 nomination policy to ensure that nomination takes place in a fair and equitable way. 1. Introduction As part of the National Programme for Information Technology (NPfIT) The Electronic Prescription Service (EPS) programme is to create and implement the Electronic Prescription Service (EPS) and then integrate it with NHS Care Records Service (NCRS). The EPS release 1 is now operating throughout England. EPS allows prescriptions generated by GPs to be transferred electronically between prescribers, dispensers and the reimbursement agency, NHS Prescription Services. EPS release 1 delivered the technical foundations necessary to allow GP practices and Pharmacies to take part in the EPS programme. Prescribers can now issue scripts which include a bar code that identifies the FP10 and patients prescription details with its own unique ID. The patient presents the FP10 to the Pharmacist; it is then scanned by the Pharmacy computer system which is able to pick up details from EPS using a unique identifier in the bar code to identify the individual FP10. Electronic repeat dispensing allows the prescriber to authorise several issues of prescription at once. This means the patient doesn t have to go back to their GP each time to collect another prescription issue. Unlike conventional paper-based repeat prescribing, electronic repeat dispensing is possible from a single electronic prescription and does not require a batch of paper issues to be printed. Instead, a single prescription token is printed and given to the patient at the start of the electronic repeat dispensing regime. Nomination is a new process that gives patients the option to choose, or nominate dispensing contractor(s) to which their electronic prescription(s) can be sent automatically, using the Electronic Prescription Service. Nomination could be likened to existing prescription collection services offered by some community pharmacies (particularly useful for repeat prescriptions), as it removes the need for patients to call at their GP practice to collect a paper prescription form. When a nominated electronic prescription is generated, it is sent to the Electronic Prescription Service. It can then be retrieved by the nominated dispensing contractor s system without the need to scan a barcode. NHS Calderdale EPS2 Policy Final Version 1.5 3

It is likely that the dispensing contractor will retrieve the electronic prescription prior to the patient arriving to collect their prescription items. This will give them chance to prepare the prescription in anticipation of the patient s arrival. 2. Associated Policies, Procedures and Guidance Department of health guidance on implementation of EPS (see section11) NHS Calderdale Complaints Policy Definitions Nomination Contractors Dispensing Contractors Dispensing Appliance Contractor Prescription Token This is a new process that gives patients the option to choose or nominate a dispensing contractor (s) to which their prescriptions can be sent automatically through the Electronic Prescription Service. This term is used generically to refer to GP, community pharmacies, dispensing GP contractors or appliance contractors. These contractors supply medicines and the term is used synonymously with community pharmacies Whilst not able to dispense medicines, these contractors supply various appliances such as incontinence and stoma products These tokens are printed at the GP using the green FP10 prescription form The difference between a token and a bar coded FP10 prescription is that the token is not hand signed by the prescriber as the electronic message has already been signed electronically. Dispensing Token These tokens are printed at the dispensing contractor and are identical to the prescription token but printed on white paper. Personal Demographics Service (PDS) This is the master index of patient records contained within the NHS Care Records Service. It holds data such as name, address, date of birth, etc. 3. Aims and Objectives The purpose of the nomination policy is to provide all stakeholders with information and clear localised protocols on how nomination will be managed and monitored by the PCT to ensure that nomination takes place in a fair and equitable way. NHS Calderdale EPS2 Policy Final Version 1.5 4

4. Scope of the Policy The nomination policy includes the PCT s recommendations for their contractors (both prescribing and dispensing contractors) about how to collect and set a nomination from a patient. The policy considers the impact on the existing business processes, a complaint procedure and monitoring process. By complying with this policy, contractors will ensure that they are adhering to best practice and can easily demonstrate that nominations have been captured in a fair and equitable way should there be an investigation or complaint. The policy does not cover prescriptions that are not produced under EPS 2, such as traditional paper prescriptions that require the presence of the prescriber s signature. The key stakeholders involved are: Contractors (This term encompasses prescribers and dispensing contractors) Patients NHS Calderdale 4.1 The nomination policy provides the following key principles: 1) Patients must be provided with sufficient clear information about EPS before nomination is captured. 2) Dispensing contractors must not offer any type of inducement to encourage patients to nominate them. 3) Dispensing contractors must not offer any type of inducement to prescribers to influence the nominated contractor. 4) Contractors will need to capture, record and act on patients nomination requests in a timely manner. 5) Prescribers and dispensing contractors must establish Standard Operating Procedures (SOPs) for nomination. 6) Prescribers should not seek to persuade patients to nominate any specific dispensing contractor. The Standard Operating Procedure (SOP) should provide a basis for ensuring that the nomination process and principles are communicated consistently to patients and patient consent is captured in an auditable way. (Further relevant details around these key principles can be found in Appendix 1) 4.2 Timing of Nominations Nomination requests should be collected no earlier than 4-6 weeks before deployment of the Release 2 pharmacy system. If nomination requests are collected NHS Calderdale EPS2 Policy Final Version 1.5 5

prior to going live with the EPS then these requests should be re-confirmed once the system is in place. This principle is also relevant in scenarios where the nomination will be entered onto the system at a later time, as opposed to when the patient is still present. Contractors should ensure this principle is upheld and contained within the Standard Operating Procedures. These general principles will be applied by NHS Calderdale throughout the rollout of compliant systems. 5. Accountabilities & Responsibilities NHS Calderdale will ensure that the provision of relevant legislation will be adhered to by all key stakeholders. 5.1 Regulations for prescribers Section 39B of the National Health Service (Primary Medical Services) (Miscellaneous Amendments) Regulations 2005 provide the following: (4) A contractor - (a) shall not seek to persuade a patient to nominate a dispenser recommended by the prescriber or the contractor; and (b) shall, if asked by the patient to recommend a chemist whom he might nominate as his dispenser, provide the patient with the list of all the chemists in the area who provide an ETP service as given to the contractor by the Primary Care Trust." 5.2 Regulations for dispensers (Nominated Dispensing Contractor) Section 28 of The NHS (Pharmaceutical Services) Regulations 2005 (Schedule 1, Part 4) specifically provides the following: (1) A pharmacist or his staff shall not give, promise or offer to any person any gift or reward (whether by way of a share of or dividend on the profits of the business or by way of discount or rebate or otherwise) as an inducement to or in consideration of his - (a) Presenting an order for drugs or appliances on a non-electronic prescription form or non-electronic repeatable prescription; or (b) nominating the pharmacist as his dispensing contractor (or one of them) in his NHS Care Record. (2) Promising, offering or providing an auxiliary aid in relation to the supply of drugs or a home delivery service is not a gift or reward for the purposes of sub-paragraph (1). NHS Calderdale EPS2 Policy Final Version 1.5 6

NHS Calderdale will work with key stakeholders such as the LPC and LMC to ensure compliance with regulations monitoring nominations by the PCT. 5.3 EPS Authorisation Directions 2008 PCTs need to be listed in the Primary Medical Services (Electronic Prescription Service Authorisation) Directions 2008 as amended ( the EPS Authorisation Directions 2008 ) before authorising that their GP practices can use an EPS Release 2 compliant system. Only PCTs listed in these Directions can authorise the use of Release 2 of EPS by their primary medical services contractors or any practice established by the PCT. Thus whilst dispensing contractors can deploy Release 2 as soon as they have a compliant system, prescribers within NHS Calderdale cannot send electronic prescriptions signed with an advanced electronic signature, using a Release 2 compliant system until their PCT has been specified as a PCT that can authorise the use of the ETP service in Amending Directions made by the Secretary of State. 5.4 Sites Patients can choose to nominate up to three dispensing contractors including: One community pharmacy One dispensing appliance contractor One dispensing GP practice Only patients who are eligible to have their prescription dispensed by their GP practice will be able to have the practice dispensary as a third option. A nomination for a dispensing GP practice can only be set up by a member of staff working at that GP practice. Nominations can be set, changed or removed at the following: Any pharmacy or dispensing appliance contractor that offers the service (it doesn t have to be the one that is being nominated). The patient s GP practice as long as they are Release 2 compliant. Over time patients will also be able to use the secure website Healthspace www.healthspace.nhs.uk to set, amend and cancel their nomination on line. Compliant sites will be listed on the NHS Choices website. NHS Calderdale does not intend to duplicate the information that is available and will provide a link to this site on its public facing web site. The NHS Choices website will be updated weekly with the list of dispensing contractors enabled for Nomination from NHS BSA Prescription Services. NHS Calderdale EPS2 Policy Final Version 1.5 7

5.5 Nomination Procedures for Prescribers and Dispensers 5.5.1 Suitability for patients Nomination is both flexible and optional. It is more suitable for some patients than others, depending upon individual circumstances. Some examples to consider are listed in the table below: Patients likely to benefit from Nomination Patients receiving regular medication Patients who collect their medication from the same pharmacy most of the time Patients using a prescription collection service Patients less likely to benefit from Nomination Patients who receive prescriptions infrequently Patients who collect their medicines from a number of pharmacies Patients who work away or travel regularly 5.5.2 Modes of Nomination It is up to contractors to decide how nominations will be captured. Whichever method is used the capturing of nomination must be auditable. Best practice would include written consent from the patient or their carer to include a date and signature. A combination of the following methods may be used: Face to face (at reception/during consultation/in the pharmacy). Telephone (followed up with written consent within 48 hours) Fax Letter E-mail It is expected that at the initial stage, nominations will be mainly captured through face to face meetings with the patient or carer giving their written consent. Alternatively, consideration may be given to recording consent on a GP clinical or pharmacy system, so long as it is auditable. All contractors will need to ensure consent is gained and that the information itemised in section 5.5.3 is provided for each of the above methods. If the contractor is unable to deal with the nomination, the reason(s) will need to be explained to the patient or carer. For example, patient nominations should not exceed the maximum allowed by the service (see Section 5.5.5 below). Another instance involves a patient who is eligible to collect medications from a dispensing GP practice. Here the nomination can only be recorded through that practice and cannot be recorded remotely through other contractors or Healthspace. NHS Calderdale EPS2 Policy Final Version 1.5 8

5.5.3 Information for patients Relevant information is available to prescribers, dispensing contractors and patients through the connecting for health website: http://www.connectingforhealth.nhs.uk/systemsandservices/eps/staff/communication s/release2/resources/eps-release-2.pdf Contractors who record nominations are required to present the following information to patients or carers to ensure that they could make informed decisions on whether or not nomination applies to them: The EPS involves the electronic transmission of prescriptions safely and securely. Paper is not always required. Any dispensing contractor operating Release 2 can be nominated (Patients are not restricted to nominating a dispensing contractor located close to their GP practice.) Where patients use their nominated dispensing contractor, their prescription will be sent automatically to that dispensing contractor. If the patient chooses not to use their nominated dispenser for a particular prescription, they must make that clear at the time of requesting the prescription. Patients can change their nominated dispensing contractor at the GP practice or any dispensing contractor who is Release 2 enabled at any time with patient consent. This can also be done by the patient themselves using the secure Healthspace website when available. This includes when they are part way through a repeat dispensing cycle. Any prescriptions which have not been downloaded before the change of dispensing contractor will be accessed by the newly nominated dispensing contractor. Where a patient has nominated a dispensing contractor, the dispensing contractor will usually be able to access the electronic prescription in advance of the patient arriving, allowing them to prepare the prescription in advance. Where a patient wishes to use another dispensing contractor as a one-off it is not necessary to undertake the full nomination process. A prescription token can be produced by the prescriber in this instance. If the patient goes to a dispensing contractor other than the one they have nominated, there may be delays before the dispensary is able to access the electronic prescription if a prescription token is not available from the patient. Patients do not have to receive their prescriptions via the Electronic Prescription Service. However, if it is not used, services associated with it (such as nomination) cannot be used. NHS Calderdale EPS2 Policy Final Version 1.5 9

Patients or their carers should be aware that nominating a dispensing contractor means that the details normally recorded on a prescription form (FP10) will be transmitted electronically between the prescriber and the dispensing contractor and between the dispensing contractor and the reimbursement agency. The above information may be provided verbally to the patient and/or carer and must be supported by issuing the NHS CFH patient leaflet Explaining the Electronic Prescription Service Information for patients and carers in England. The leaflet can be obtained from the following website http://www.connectingforhealth.nhs.uk/systemsandservices/eps/staff/communication s/release2/resources/eps-release-2.pdf 5.5.4 Capturing Nominations Any contractor capturing a nomination will need to ensure that they have the necessary procedures in place to manage nominations. NHS Calderdale will not issue a nomination form to contractors. All prescribers, dispensing and appliance contractors will need to keep an audit trail of patient consent to nominate a specific contractor. In the event of a dispute or complaint the PCT will request that a contractor demonstrates the process used for nomination. 5.5.5 Nomination Requests There are four possible nomination actions: New Amend/Replace Cancellation Query This refers to a patient or carer who is making a nomination for the first time This refers to a request to change the existing nominated contractor with another one This refers to the patient or carer going back to hand signed paper FP10 prescriptions This refers to a query from the patient or carer who wishes to confirm/check their current nomination New Nominations A patient may have up to three nominations: One community pharmacy. One dispensing appliance contractor. NHS Calderdale EPS2 Policy Final Version 1.5 10

Dispensing GP (only for registered dispensing patients). For dispensing contractors with multiple sites, it is not possible to nominate an organisation. A specific dispensing premise will need to be nominated. Amend or Replace Nominations Any amendments to an existing nomination will need to consider the following: Implications to downloaded but un-issued prescriptions from the previously nominated contractor. Impact to repeat dispensing arrangements. The timing when the change will take effect. Once a nomination has been amended or replaced, any prescriptions that have not been downloaded will flow to the new contractor. It is therefore important that any request to replace an existing nomination is dealt with in a timely manner by contractors. Dispensing contractors will not be informed of changes to their existing nominations. Cancellations of Nominations Cancellation to enable replacement nomination can be carried out by any contractor provided cancellation does not relate to a dispensing GP practice (see 5.4 and 5.5.2). Alternative arrangements must be put in place to enable continuation of supply, which may be done by nominating a new dispensing contractor or issuing a paper prescription. If a patient or carer wishes to cancel a nomination and return to paper prescriptions, there are 4 circumstances possible; the first of which is the most preferable route. Cancellation made at the GP practice; the GP will need to ensure that there are no outstanding un-issued medications and that if a repeat dispensing arrangement is in place any future issues are cancelled. Alternative arrangements must be put in place to enable supply. This may be done via provision of a signed paper prescription. Cancellation made at nominated site; the dispensing contractor will need to ensure that there are no outstanding un-issued medications and that if a repeat dispensing arrangement is in place the patient or carer is aware of the implications and what they need to do to ensure continuity of supply and that they would have to collect a new signed prescription from the GP. Cancellation made at a non-nominated dispensing contractor site; if the patient is under a repeat dispensing arrangement the contractor needs to advise the patient or carer to inform their GP if they have not done so already. NHS Calderdale EPS2 Policy Final Version 1.5 11

Cancellation is being made by the patient or carer through Healthspace; the patient or carer would be responsible for confirming continuation of supplies with their GP as above. Query If the patient has received a prescription token, it will be printed with the name of the nominated dispenser contractor. A patient or carer may wish to confirm or check the identity of their nominated dispensing contractor at any point in time. The request for a query may be done in any release 2 compliant site. Over time, patients will be able to check for themselves on the secure website HealthSpace (www.healthspace.nhs.uk). Using the Nomination Once a nomination is set, all electronic prescriptions from the GP practice will automatically be sent to the nominated contractor. The patient must be informed of this. GP practices will be expected to establish local processes to manage nomination. Two particular issues which these processes will need to address are: Ensuring that on each occasion the patient wishes to use the EPS. Patients should be encouraged to inform the prescriber if they do not wish to use their nominated dispensing contractor for a particular prescription. They are free to do this at any time, providing they make it clear to the prescriber at the time of requesting the prescription. Where a patient has more than one nomination e.g. a community pharmacy and an appliance contractor, prescribers should have procedures in place which detail management of the distribution of prescriptions to the correct nominated dispenser. 6. Monitoring Compliance with this Policy It is NHS Calderdale s responsibility to monitor the way in which nomination is captured, so that no one dispensing contractor is commercially advantaged or disadvantaged in any way. The PCT may have information available to them either through their own internal monitoring or through externally-sourced routes. The PCT may wish to consider and make use of the following sources of information: Nomination reports, which will provide both summary and detailed information about nominations made; access to which will be held within the Secondary Uses Service (SUS), which PCTs will access via the NHS portal with a smartcard. More information on this will be available at www.cfh.nhs.uk/eps Concerns raised by, or complaints made by, patients, dispensers or prescribers. (See section 8) NHS Calderdale EPS2 Policy Final Version 1.5 12

Where a PCT considers that it has identified some unusual or unexpected distribution of nominations, which may suggest a failure to comply with this policy, the directions require it to consider whether any further investigation or action is appropriate. Such action may, of course, include action for breach of contract if the PCT considers that appropriate. Further details can be found at the following web link: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationslegislatio n/dh_091267 Contractors should note that in the event of a concern relating to nomination, evidence of written consent (signed and dated) from patients/ carers will make it easier for a contractor to both protect and defend themselves against accusations of misuse of nomination. 7. Equality and Diversity The PCT is committed to: Eliminating discrimination and promoting equality and diversity in its Policies, Procedures and Guidelines, and Designing and implementing services, policies and measures that meet the diverse needs of its population and workforce, ensuring that no individual or group is disadvantaged. 8. Complaints NHS Calderdale will ensure that all stakeholders adhere to current legislation with regards to nomination and encourage the use of available escalation routes to deal with complaints. Standard operating procedures need to be established locally to ensure that: nomination is communicated consistently to patients, and Is captured in an auditable way so that, if challenged, processes are in place to back up information following on from a customer complaint or from an audit perspective. Examples of potential issues are as follows: Source Patient Issue Contractor refuses to record/capture nomination Conflict with regards to which dispensing contractor has been nominated Timeliness of nomination recording NHS Calderdale EPS2 Policy Final Version 1.5 13

Contractor Abuse of the nomination process (e.g. registering nominations without patient or carer consent) Directing patients to specific sites (as prohibited by legislation) Offering inducements (as prohibited by legislation) Improper use of NHS promotional materials Misuse of patient list for purposes other than what they are intended for Inadequate support or Smartcard service Poor response times to update Choices website Any activities such as complaints or suspicions around nomination recommendations, inducements, gifts, rewards, dividends as an inducement or in consideration of a named nomination will be considered as a serious matter by NHS Calderdale and we reserve the right to initiate proceedings under breach of terms of service (NHS Pharmaceutical Services), or breach of medical contract or to contact the NHS Counterfraud service. Complaints from Patients Patients should try to speak to the contractor in the first instance. If they feel they are unable to do this or if they are dissatisfied with the response they should direct any complaints to NHS Calderdale s Customer Service team. The Customer Services team can be contacted on 0800 183 0912 NHS Calderdale, F Mill, Dean Clough Halifax, HX3 5AX or email PALS@calderdale-pct.nhs.uk This information is also available on the PCT website or via the following link: http://www.calderdale.nhs.uk/get-involved/compliments-and-complaints Reference should be made to the NHS Calderdale Complaints Policy and Procedure, available on the PCT website or via the following link: http://www.calderdale.nhs.uk/fileadmin/files/public_information/publication_scheme/ Policies_and_Procedures/RMC2_-_Complaints_Policy_and_Procedure.pdf Complaints from Contractors NHS Calderdale EPS2 Policy Final Version 1.5 14

Complaints from contractors cannot be dealt with under the NHS Complaints regulations. These should be dealt with as contracting issues and referred to the appropriate contract manager. 9. Contingency If a contactor is unable to record a new nomination, amend or cancel an existing one or a deal with a query, the contractor may implement their own approach by either asking the patient or carer to return at another convenient time or for their details to be captured and then recorded electronically as soon as possible. Roll out of the first phase of EPS2 across NHS Calderdale will inform if the above approach causes any confusion, particularly if the updates are not done on a timely manner or if the inability to deal with the nomination persists (e.g. prolonged system downtime or PDS unavailability). The PCT will prepare a separate document on contingency arrangements for EPS Release 2. 10. Governance The policy will be ratified by the NHS Calderdale Board, and reviewed by the EPS2 Project Board (which will include local representative committees). The policy will be discussed with various stakeholders including LMC, LPC via EPS2 Project Board, who will be given the opportunity to feedback any comments to authors of the document. Following any phased roll out of EPS Release2 amongst prescribers within the PCT the nomination policy will be reviewed to ensure it remains fit for purpose. The document has been produced in line with NHS Calderdale guidance on producing a policy using the template provided by the organisation and available through the NHS Calderdale intranet. 11. References Electronic Prescription Service available at: http://www.connectingforhealth.nhs.uk/systemsandservices/eps http://www.connectingforhealth.nhs.uk/systemsandservices/eps/staff/communications/releas e2/resources/eps-release-2.pdf EPS Authorisation Directions 2008 Department of Health Gateway no. 10877 NHS Calderdale EPS2 Policy Final Version 1.5 15

The Primary Medical Services (Electronic Prescription Service Authorisation) Directions 2008 and supplementary guidance Department of Health Gateway no 8990 Nomination policy Checklist at http://www.connectingforhealth.nhs.uk/systemsandservices/eps/staff/implementation/toolkit/n omination NHS Calderdale EPS2 Policy Final Version 1.5 16

12. Questions and Answers Do all patients have to nominate? No. Nomination is more suitable for some patients than others. It depends on the patient s individual circumstances. Nomination is most suitable for patients who: receive regular repeat prescriptions tend to collect their prescriptions from the same place each time currently use a prescription collection service. How many dispensing contractors can a patient choose to nominate? Patients can choose to nominate up to three dispensing contractors, including: one community pharmacy one dispensing appliance contractor one dispensing GP practice (subject to local system configuration). Can nomination be used for all types of electronic prescriptions? Yes. Acute, repeat and repeat dispensing prescriptions can be sent to the patient s nominated dispensing contractor. How is a patient identified at the nominated dispensary if they do not have a prescription token? Pharmacies will need local processes (as they do now, where they have collected the prescription on behalf of the patient from the prescriber) to authenticate the person collecting the prescription, taking into account professional guidance. Who can register a patient s nomination? Anyone who has an individually registered Smartcard and a User Role Profile which allows them to update the patient s PDS record can set the patient s nomination. Over time patients will also be able to set their own nomination using the secure website HealthSpace (www.healthspace.nhs.uk). Does the patient have to be a minimum age to be able to request a nomination? No. Professional judgment should be used to determine whether it is appropriate for the patient s nomination to be set. NHS Calderdale EPS2 Policy Final Version 1.5 17

How can the patient check which dispensing contractor they have nominated? If the patient has received a prescription token, it will be printed with the name of the nominated dispenser contractor. Alternatively, they can ask either a member of GP practice or pharmacy staff to check their PDS record for them. Over time, patients will be able to check for themselves on the secure website HealthSpace www.healthspace.nhs.uk Is the dispensing contractor informed that a patient has nominated them? No. The nominated dispenser will only be informed when they have retrieved an electronic prescription for the patient. Is it possible to check which dispensing contractor a patient has nominated? Yes. Patients can ask a member of GP practice or pharmacy staff to check their PDS record for them if they have forgotten which dispenser they have nominated. Will a dispenser be informed when a patient has changed their preferred dispensing contractor? No. A dispensing contractor will not be informed when a patient changes their nomination. Can dispensing GP practices be nominated from other locations such as community pharmacies? No. Only staff within a dispensing practice can set a nomination for that GP practice. Do dispensing GP practice staff need to obtain patient consent before setting their dispensing patients nomination? Yes. The patient must request for the nomination to be set in the same way as other types of dispensing contractor. Can a community pharmacy continue to receive prescriptions for appliances? Yes. A community pharmacy offering such services can receive prescriptions for appliances. Will staff at the GP practice always have to ask whether a patient would like to use their nominated pharmacy when administering a prescription? GP practices will be expected to establish local processes to manage nomination. Two particular issues which these processes will need to address are: where a patient has more than one nomination, prescribers will need to know NHS Calderdale EPS2 Policy Final Version 1.5 18

which nominated dispenser to send which prescription ensuring that on each occasion the patient wishes to use the EPS. Patients should be encouraged to inform the prescriber if they do not wish to use their nominated dispensing contractor for a particular prescription. They are free to do this at any time, providing they make it clear to the prescriber at the time of requesting the prescription. Can a patient choose not to use their nominated dispensing contractor for any prescription? Yes. The patient always has the option not to use their nominated dispensing contractor. When changing a nomination, will all existing nominated prescriptions that have not been retrieved be transferred to the new nominated dispensing contractor? Yes. All nominated prescriptions that have not been retrieved will be transferred to the new dispensing contractor. Patients need to be aware of this if they are considering changing their nomination. Can an internet pharmacy be nominated? Yes. If they wish, patients can choose to nominate an internet pharmacy, as their community pharmacy nomination. As with all pharmacies, they will be listed on www.nhs.uk Does a patient need to fill out a patient consent form to nominate? A patient does not need to fill out a consent form; however locally GP practices and dispensing contractors are advised to introduce a consent form as part of their local processes. Should a prescriber generate separate electronic prescriptions if prescribing both medication and appliances? As now, the prescriber must decide whether it is appropriate to generate two separate prescriptions. This will depend on where the patient wishes to have their medication/appliances dispensed. NHS Calderdale EPS2 Policy Final Version 1.5 19

Appendix 1 Key principles of Nomination To ensure nomination is used in an appropriate way, four key principles of nomination have been developed. Principle 1 - Patients must be provided with sufficient information about the EPS before nomination is captured The following information should be communicated to the patient: The EPS involves the electronic transmission of prescriptions safely and securely. Paper is not required Any dispensing contractor operating Release 2 of the Electronic Prescription Service can be nominated Patients are not restricted to nominating a dispensing contractor located close to their GP practice Where patients use their nominated dispensing contractor their prescription will be sent automatically to that dispensing contractor If the patient chooses not to use their nominated dispenser for a particular prescription, they must make that clear at the time of requesting the prescription Patients can change their nominated dispensing contractor using the secure website HealthSpace, or at their GP practice or any dispensing contractor at any time; this includes when they are part way through a repeat dispensing cycle any prescriptions which have not been downloaded before the change of contractor will be accessed by the new nominated contractor Where a patient has nominated a dispensing contractor, the dispensing contractor will usually be able to access the electronic prescription in advance of the patient arriving allowing them to prepare the prescription in advance If the patient goes to a dispensing contractor other than the one they have nominated, there may be delays before the dispensary is able to access the prescription Patients do not have to receive their prescriptions via the Electronic Prescription Service, however, if it is not used, services associated with it (such as nomination) can not be used. NHS Calderdale EPS2 Policy Final Version 1.5 20

The NHS Connecting for Health leaflet Explaining the Electronic Prescription Service Information for Patients and Carers in England contains all this information and is available to order from http://information.connectingforhealth.nhs.uk Principle 2 Dispensing contractors must not offer any type of inducement to encourage patients to nominate them Dispensers and dispensing staff shall not give or offer any gift or reward to encourage a patient to nominate them; this also includes the offering of share dividends of profits, discounts and loyalty points. This is supported by the Dispensing Contractor s Terms of Service which underpin this principle. NHS Pharmaceutical Service Regulations 2005, prohibit pharmacists or their staff from offering inducements to encourage patients to nominate them. Prescribers should not seek to persuade a patient to nominate a certain dispenser. Instead, if a patient asks the prescriber to recommend a dispenser, then the prescriber should provide the patient with a list of all the dispensers in the area who provide the Electronic Prescription Service. This is supported by prescribers Terms of Service: The NHS (Primary Medical Services) (Miscellaneous Amendments) Regulations 2005 prohibit contractors from seeking to persuade a patient to nominate a dispenser recommended by the prescriber or the contractor. The contractor shall, if asked by the patient to recommend a *chemist whom he might nominate, provide the patient with a list of all the chemists in the area who provide the EPS, as given to the contractor by the PCT. * chemist means (a) (b) (c) a registered pharmacist a person lawfully conducting a retail pharmacy business in accordance with section 69 of the Medicines Act 1968 or a supplier of appliances, who is included in the list of a Primary Care Trust or a Local Health Board under section 42 of the Act, or who provides local pharmaceutical services in accordance with the LPS arrangements. Principle 3 Dispensing contractors will need to capture, record and act on patient s nomination request in a timely manner A patient s nomination request should be collected no longer than 4-6 weeks prior to deployment of the Release 2 pharmacy system. If nomination requests are collected prior to going live with the EPS then these requests should be re-confirmed once the system is in place. This principle is also relevant in scenarios where the nomination will be entered onto the system at a later time, as opposed to when the patient is still present. Local NHS Calderdale EPS2 Policy Final Version 1.5 21

processes should be established to ensure this principle is upheld. Principle 4 Prescribers and dispensing contractors must establish standard operating procedures for nomination Standard operating procedures need to be established locally to ensure that: nomination is communicated consistently to patients, and is captured in an auditable way so that, if challenged, processes are in place (either written or verbal) to back up information following a customer complaint or from an audit perspective. Any changes made to a patient s nomination settings are recorded by the system and PCTs will have access to audit facilities to monitor this to ensure that the system is being used appropriately. NHS Calderdale EPS2 Policy Final Version 1.5 22

Appendix 2 Equality Impact Assessment Tool. 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Yes/No/ N/A No Comments EPS2 will be implemented throughout Calderdale, and all patients given the option to nominate. Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems The policy and systems should be a positive benefit to older people on repeat prescriptions, as they will be able to collect another prescription issue without having to visit their GP The policy and systems should be a positive benefit to disabled people on repeat prescriptions, as they will be able to collect another prescription issue without having to visit their GP 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are there any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? No N/A No It will be a positive benefit 5. If so can the impact be avoided? N/A 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? N/A N/A NHS Calderdale EPS2 Policy Final Version 1.5 23