How EPS Phase 4 works?

Previously, it was only possible to issue an EPS prescription where the patient nominated a pharmacy or another dispenser. EPS had been most advantageous for patients who received regular medication and who tended to get their prescriptions dispensed at the same pharmacy most of the time.

Under Phase 4 of EPS, prescriptions would be sent via EPS by default, whether a patient has an EPS nomination in place or not. However, where certain criteria are met, a paper prescription would still be used, for example:

• when a patient explicitly asks their GP for a paper prescription; or
• when the medicine being prescribed is not listed in the NHS list of medicines (dm+d).

However, many of the benefits associated with EPS are associated with nomination, therefore as EPS progresses with more GP practices being ‘Phase 4’ ready, it is important that appropriate patients continue to be given the opportunity to benefit from using nomination. All existing nominations will remain valid and further nominations for appropriate patients should continue to be set.

What happens if a patient has not set a nomination?

A patient who has not set a nomination or does not wish to do so would be issued with an EPS Phase 4 green prescription token so that they may visit the pharmacy of their choice. Pharmacy teams would scan the bar code on the token to access the EPS script.

NHS Digital identified several opportunities to progress EPS matters leading up to and during the Phase 4 wider rollouts:

• the EPS service model was reviewed and the highest priority recommendations were implemented;
• pharmacy training events (PMR system-specific) were held across the country; and
• EPS Controlled Drugs (CDs) (Schedule 2 and 3) was widely rolled out across almost every GP practice.

PSNC continues to work with NHS England and NHS Digital to address issues with EPS which are detailed in PSNC’s EPS log. Community Pharmacy IT Group (CP ITG) also feed into the log.

The Phase 4 pilot

NHS Digital piloted EPS Phase 4 from late 2018 at around 60 GP practices. A successful outcome was reached.

EPS Phase 4 prescriptions within cross border areas

GP practices close to the border may issue paper prescriptions instead of Phase 4 prescriptions, for those patients near the border which wish to use community pharmacies within Wales or Scotland.

NHS Digital have provided some guidance for GP practices relating to the matter.

From 18th November 2019 and across 2020 EPS Phase 4 began rolling out to more GP practices. Full rollout for TPP SystmOne and EMIS GP system practices took place in September 2020.

All community pharmacy teams should therefore be aware that they may continue to more EPS Phase 4 tokens to process.

During the COVID-19 pandemic NHS Digital is continuing to support prescribing system suppliers with their roll-out of EPS Phase 4:

• Microtest and Vision are currently piloting Phase 4 with some of their general practice users.

Specific dates for many GP practices were previously made available as to when they would plan to go live with Phase 4 on NHS Digital’s Phase 4 deployment schedule during the earlier stage of the Phase 4 rollout.  NHS Digital are no longer publishing data about which GP practices will go live because most GP practices are now Phase 4 live. More than 90% GP practices were live with Phase 4 (October 2020 and after).

Under EPS Phase 4, patients can choose to take their token to any pharmacy in England. If you receive a Phase 4 token, simply scan the barcode and dispense it as you would any other electronic prescription. As with all EPS prescriptions, dispense notifications and endorsements need to be added to the electronic prescription using your pharmacy system. Endorsements written or printed onto any type of EPS token will not be processed by the NHS Business Services Authority (NHSBSA).

One-off nomination is another option available within some prescribing systems. Some patient may benefit from using one-off nomination instead of Phase 4 if it is an option for those patients. Read more about this at: Nomination.

For scenarios in which patients have lost their Phase 4 non-nominated token see: ‘Locating EPS prescriptions‘ and the section below.

NHS Digital has updated its guidance for use of EPS within remote consultations, which has been used more widely during the ongoing COVID-19 pandemic.

The guidance about remote EPS is for prescribers and pharmacy teams. The advice includes that:

• Nomination should still continue to be used wherever possible.
• You should only use Phase 4 (non-nominated) prescriptions if other options are not suitable.

One-off nomination is an extra alternative to use instead of Phase 4, where available. It is currently only available within the TPP SystmOne GP system, but EMIS plans to add this functionality to their EPS prescribing systems in the future.

For EPS Phase 4 prescribing, if the patient cannot receive their required Phase 4 token, other information should be provided instead. Ideally the Prescription ID should be provided where possible. Some GP practices can copy this and send it by email or text message to the patient using their clinical system.

If pharmacy teams receive the ID from the patient electronically, it can be used or ‘pasted’ to pull down the prescription onto the pharmacy PMR system. Pharmacy teams can also type the code into their systems.

Note: The prescription ID (when used for remote EPS) can include the  prescription number and some GP practice systems may additionally have capability to generate the barcode to support pharmacy team work. This number/barcode could be communicated to the pharmacy team by a mixture of methods e.g. the patient could transfer a high-res image to the pharmacy electronically for the pharmacy to use or scan.

As a last resort, the EPS Tracker may be used to locate a missing EPS prescription (e.g. via use of the NHS number).

View NHS Digital’s guidance about this here.

Recommended tips:

Non-nominated paper tokens

• If you receive a Phase 4 token, you should scan the barcode and dispense it as you would any other electronic prescription.
• Pharmacy teams can use the green Phase 4 prescription tokens to capture any patient exemption-related or charge-related signatures.
• Green Phase 4 tokens should be filed with all the other white EPS tokens and not within the main bundle of paper prescriptions before the submission is sent to the NHSBSA.
• Consider your system and print settings. Many PMR systems have settings to customise which types of EPS prescriptions may automatically have a white EPS dispensing token printed.
• Some pharmacy teams that process the Phase 4 token used a highlighter pen or a sticker to highlight the ‘Prescriber signature not required’ wording on the token, to highlight that it is a Phase 4 token rather than a barcoded paper prescription.
• During the earlier stages of the rollout, patients have sometimes filled in the back of the green Phase 4 token before they arrived at the pharmacy. If the pharmacy process involves shredding the green Phase 4 token and replacing it with a newly printed white dispensing token, the patient will have to complete the reverse of the dispensing token. To address this scenario, some pharmacy teams have changed their initial Phase 4 approach so that they use the green Phase 4 token for patient declarations, rather than printing out a new white EPS dispensing token for each Phase 4 script.

Remote use of Phase 4 and EPS

The ‘Remote use of Phase 4 and EPS’ section above deals with remote use of EPS. See that section for tips relevant to that topic

If you have an EPS Phase 4 issue that requires reporting, you should use the usual escalation routes to do this (i.e. raising through the PMR supplier and ensuring they escalate to NHS Digital National Service Desk if they cannot resolve it). In addition you may email PSNC’s Community Pharmacy IT Lead, Daniel Ah-Thion for PSNC’s information. Read more at the one-pager EPS escalation factsheet.

Q. Can EPS Tracker be used to view information relating to a Phase 4 prescription ?

Yes, EPS Phase 4 prescriptions can be identified using the EPS Tracker search (by prescription reference or by patient NHS number). EPS Phase 4 prescriptions will not be included within the ‘my prescriptions’ area until after your pharmacy has downloaded the EPS Phase 4 prescription into your PMR system.

Q. Can patients with a nomination also request a Phase 4 prescription?

Yes. This may done for scenarios such as where an urgent prescription is required and the usual pharmacy is closed but the patient would wish to take a Phase 4 token to an alternative pharmacy.

Q. What do Phase 4 non-nominated tokens look like compared with Release 1 barcoded paper prescriptions?

Both are printed onto green stationery.

Phase 4 non-nominated tokens include wording (“PRESCRIPTION TOKEN – Not to be used as a prescription, even if signed by an authorised prescriber“) within the prescriber box and a shorter 18-character barcode number on the right.

Release 1 barcoded paper prescriptions need to include the prescrber’s ink signature within the signature box, and a longer 36-character barcode number is on the right.

GP practice & pharmacy resources

GP practice resources

Should pharmacy teams receive a question from GP practice colleagues about what EPS Phase 4 is, then pharmacy teams may choose to highlight that there are some materials on the NHS Digital website:

• EPS Phase 4 webpage for GP practice staff (including the factsheet / checklist)

The Phase 4 deployment plan involves a plan so that GP practice staff within GP practices that are about to go live with Phase 4, should be made aware about EPS Phase 4.

Other pharmacy resources

Phase 4 information for NPA members (login required)

Read more at:

• Differences between Release 1 barcoded prescription and Phase 4 token one-pager factsheet

The ‘reporting issues’ section above references that Phase 4 issues should be raised using the EPS service model as set out within the one-pager EPS escalation factsheet (i.e. to the PMR and escalated from them to NHS Digital National Service Desk if the PMR cannot resolve). Additionally if you have queries about this webpage or you require more information please contact Daniel.Ah-Thion@psnc.org.uk or it@psnc.org.uk. To share and hear views about digital developments with like-minded pharmacy team members, join the CP Digital email group today.