Despite the benefits that the repeat dispensing service can bring to patients and the NHS, uptake of it has been very low, in part due to lack of engagement by GP practices. In order to increase the benefits being gained by patients and the NHS from this service, it was agreed in September 2014 that from 1st March 2015 there would be a new requirement in the CPCF:

Pharmacy contractors must ensure that appropriate advice about the benefits of repeat dispensing is given to any patient who:

(i) has a long term, stable medical condition (that is, a medical condition that is unlikely to change in the short to medium term), and

(ii) requires regular medicine in respect of that medical condition, including, where appropriate, advice that encourages the patient to discuss repeat dispensing of that medicine with a prescriber at the provider of primary medical services whose patient list the patient is on.

This means that pharmacy teams need to identify appropriate patients and provide them with information about the repeat dispensing/eRD service, with the aim that there is a significant increase in the use of the service by patients. NHS England wants this to happen because use of the repeat dispensing/eRD service:

• frees up time in GP practices so that GPs and their staff can focus on other higher priority work;
• is more convenient for patients and their carers; and
• allows community pharmacy teams to offer a better service to their patients, as well as allowing them to schedule their repeat prescription dispensing workload more efficiently.

Appropriate advice can be given to patients in a number of ways such as:

• verbally explaining about the service and its benefits to patients; and
• providing patients with a leaflet describing the service when they are collecting a prescription.

This requirement is part of a broader programme to increase use of the service, which will also engage GP practices and other stakeholders such as Clinical Commissioning Groups (CCGs).

Actions for community pharmacy contractors
All pharmacies are encouraged to work with their Local Professional Network (LPN), LPC and other local partners to support activities to increase uptake of repeat dispensing/eRD by prescribers in their area. These could include:

• identifying and notifying prescribers of suitable patients; and
• seeking to transfer patients already using managed repeats to repeat dispensing/eRD.

Please note this new contractual requirement only applies to contractors in England, not Wales.

eRD is a process that allows a patient to obtain repeated supplies of their medication or appliances without the need for the prescriber to hand sign authorised repeat prescriptions each time. eRD allows the prescriber to authorise and issue a batch of repeat prescription issues electronically until the patient needs to be reviewed.

When a prescriber issues an eRD prescription series using their EPS Release 2 prescribing system, in addition to the information found on a standard EPS Release 2 prescription, this eRD messages contain:

• the intended interval between each issue; and
• how many batch issues there are.

For example 13 batch issues may be issued to cover 364 days so that the timing may align with the patient’s annual GP practice review.

The prescription issues are then made available electronically for dispensing at the specified interval by the patient’s nominated pharmacy.

Key information about eRD

1. Multiple ‘issues’: When issuing a repeatable prescription batch, the prescriber will authorise a prescription series with a specified number of batch issues; each issue contains the same prescribed items. Each batch issue is its own prescription.
2. Issues are retrieved one-by-one: The Spine then manages the release of each individual batch issue. The first batch issue is available as soon as it is received by the Spine; subsequent issues will be created on the Spine ready to be pulled down later.
3. A new repeatable prescription series requested after the last issue: Once all authorised issues have been dispensed, or if remaining batch issues have expired, the repeatable prescription series is complete and the patient must contact their GP to arrange for another repeatable prescription series to be issued. Pharmacists should advise patients of the need to contact their prescriber when dispensing the last issue of a repeatable prescription series.
4. Automated process for allowing time to prepare medicine for each issue: To allow pharmacists to prepare medicines for dispensing in advance of a patient visiting the pharmacy, the Spine will automatically send the nominated dispensing site a repeat dispensing batch issue seven days before the expected end date of the previous batch issue. The Spine should calculate the expected date of supply in association with the prescriber’s originally intended date. (Please note, previously, the countdown to the next issue of a repeat prescription didn’t begin until a dispense notification had been issued. This could delay the automatic download of future repeat prescriptions from the Spine, resulting in items not being available for patients in time. Since February 2016, a dispense notification must still be sent, but this will not delay the start of the automatic countdown to the next issue.).
5. The workaround for the automated process (e.g. patient going on holiday): It is possible for a pharmacy to pull down issues in advance of them being sent automatically from the Spine, for example where the instalment dispensing interval is flexible and the pharmacist believes that an instalment should be dispensed at an earlier time because the patient is going on holiday. Pharmacy systems suppliers also have flexibility to implement more advanced scheduling functionality in their systems to support work flow in pharmacies.
6. Ability to change nomination between issues: A repeatable prescription series can only be issued electronically where it is being sent to a patient’s nominated pharmacy. Patients can choose to change their nominated pharmacy before the expiry of the repeatable prescription series. In this case, all outstanding issues which have not been downloaded will be transferred to the new nominated pharmacy. This is different from the paper based repeat dispensing system where all issues must be obtained from the same pharmacy.
7. Repeatable Prescription Authorising Token: When issuing eRD, prescribers can issue one of these.

Prior to the pandemic, explicit patient consent had been required for eRD.

After the COVID-19 pandemic began, patient consent requirements for eRD were suspended to encourage wider use of the system. From October 2021 the changes were confirmed to be permenent.

There is no longer a requirement for individual patient consent when moving a patient with an electronic repeatable prescription on to eRD.

NHS England and NHS Improvement (NHSE&I) have written to community pharmacies and GP practices to highlight the ongoing opportunity for eRD to be further utilised to benefit more patients.

GP practices have been advised by NHSE&I that they should utilise eRD by:

• requesting from NHSBSA the list of their patients that are most suitable for eRD, by emailing nhsbsa.epssupport@nhs.net (this can be be requested more than once and ‘recent changes’ can be highlighted within);
• screening the list of patients to adjust it as needed;
• contacting relevant patients that use EPS that items are being converted to eRD (making use of NHSBSA contact templates); and
• adjusting privacy notices to explain that relevant patients may have their prescriptions converted to eRD.

PSNC encourages pharmacy teams and LPCs to support their GP practice colleagues with helping patients to benefit from the advantages of eRD use.

Resources

You may wish to help explain the benefits of eRD to patients via animation, letter, flyer or poster. Alternatively, there are direct contact templates available in the form of email, text message, and social media.

GP practices could be directed to the Wessex eRD handbook, NECS e-learning and the eRD readiness checklist.

Read more and find further resources at: eRD.

Training

CPPE repeat dispensing e-learning and e-assessment

PSNC resources

Claiming for EPS prescriptions on time factsheet (March 2019)
In this factsheet we explain how to reduce the risk of delays to payment caused by timing issues with electronic prescriptions.

PSNC Briefing 004/17: eRepeat Dispensing – A factsheet for pharmacy teams (January 2017)
One side of this briefing contains key phrases to help advise patients on the benefits of eRD, whilst the other side provides a list of questions to ask patients collecting a repeat dispensing/eRD prescription.

PSNC Briefing 004/15: Increasing use of the NHS Repeat Dispensing service (February 2015)
This briefing will assist community pharmacy teams both in meeting the requirement in the CPCF for pharmacy teams to give advice to appropriate patients about the benefits of the repeat dispensing/eRD service and ensuring their repeat dispensing/eRD procedures are up to date.

PSNC Briefing 001/14: Repeat Dispensing and EPS (January 2014)
This briefing provides contractors and LPCs with a summary of information on repeat dispensing using the EPS system and the answers to frequently asked questions.

NHS Digital resources

NHS Digital has developed a series of materials to boost the usage of eRD:

• eRD learning module for pharmacy teams and GP practice staff;
• eRD toolkit – This toolkit is suitable for pharmacy teams as well as GP practice staff. The toolkit includes a dispenser quick guide, full dispenser guide, presentation and patient text
• eRD webinar video

NHSBSA resources

• eRD page
• EPS and eRD resources page
• NHSBSA eRD video (without audio narration)

See the ‘Information for GP practices’ section of this page: NHSBSA can identify suitable patients for eRD for specific GP practices that make a request to NHSBSA.

Other resources

• Wessex AHSN eRD website section has support materials regarding eRD this includes videos, handbooks and numerous other resources including: Managing the eRD transition report, and eRD digital handbook.
• NHSBSA – Hints & Tips, Issue 25 (October 2016)
• NHS PrescQIPP – Repeat prescribing in primary care (March 2016)
• NHS England – Electronic Repeat Dispensing – Guidance (June 2015)

Tips on promoting the service

A pharmacist shares her experience of repeat dispensing

Pharmacy’s experience of the repeat dispensing service – an article written by PSNC which appeared in P3 magazine 

Contractors should talk to their local GP practices about the CPCF requirement for pharmacies to highlight the benefits of repeat dispensing/eRD to appropriate patients.

The NHSBSA can provide eRD candidates lists to GP practices

NHS Business Services Authority (NHSBSA) can support eRD by providing relevant lists of patients’ NHS numbers to GP practices – where patients are potentially suitable for eRD. The data can only be requested by a clinician registered at the practice using the Request form for eRD candidates from the GP Practice (PDF document). The process is further set out at eRD candidate list process guide (Microsoft Word document). The request form is sent from the GP practice to nhsbsa.epssupport@nhs.net

Guidance

NHS England published Electronic Repeat Dispensing – Guidance in June 2015. This document clearly describes how eRD works and is aimed at CCGs and GP practice teams. Contractors may want to use the document in discussions with local GP practices about repeat dispensing/eRD.

The joint PSNC/NHS Employers/BMA GP Committee guidance for GP practices on repeat dispensing may also be helpful to use in discussions.

PSNC has developed a repeat dispensing/eRD template letter which can be used by contractors to increase a GP practice team’s awareness of repeat dispensing/eRD.

The following presentation can also be used in discussions with GP practices in order to demonstrate the similarity of repeat prescribing and EPS repeat dispensing and the additional benefits of using repeat dispensing:

Comparison of repeat dispensing and repeat prescribing (PowerPoint)

Comparison of repeat dispensing and repeat prescribing (PDF)

NHS Digital has also developed a series of materials to boost the usage of eRD which contractors could highlight to GP practice teams:

• eRD webinars: A recorded eRD webinar;
• eRD learning module for pharmacy teams and GP practice staff; and
• eRD toolkit – This toolkit is suitable for pharmacy teams as well as GP practice staff. The toolkit includes a dispenser quick guide, full dispenser guide, presentation and patient text.

Clinical codes for GP practices

GP practices can use the following clinical codes if recording patient consent for information sharing for the repeat dispensing/eRD service:

• CTV3 code: XaKRX
• V2 code: 9Nd3.
• SNOMED CT code: 416224003

The following poster and patient leaflet have been developed by PSNC to be consistent with the repeat dispensing contractual requirements which have a particular focus on eRD.

eRD template poster (PDF) or (Word)

eRD leaflet (PDF) or  (Word)

Patient materials from NHSBSA include:  an animation, a letter, a flyer, a poster and direct contact templates (email, text message, and social media).

Pharmacies can order copies of a flyer via Primary Care Support England (PCSE).

If pharmacy teams identify patients who are suitable for repeat dispensing/eRD, with the patient’s consent, they could refer the patient to their GP practice. The following referral form can be used to make such a referral:

Repeat dispensing/eRD referral form (Word eForm for electronic completion)

Repeat dispensing/eRD referral form (for completion by hand) (Word)

Repeat dispensing/eRD referral form (for completion by hand) (PDF)

The referral form should be used alongside the patient consent form:

Repeat Dispensing/eRD Consent Form for the Public (RD1)

Read more at: endorsing, submission and reconciliation (EPS) hub. including the Submitting EPS messages within time webpage which advises to ensure that all eRD prescription issues are claimed within 365 days of the prescriber’s original signature date because eRD issues cannot be submitted beyond this point.

PSNC has developed the following template letters which can be used by LPCs to increase awareness of repeat dispensing/eRD amongst the relevant stakeholders.

Repeat dispensing/eRD template wording – from LPC to pharmacy

Repeat dispensing/eRD template wording – from LPC to LMC

General

Q. Can pharmacies provide a repeat dispensing service to patients from other Clinical Commissioning Group (CCG) areas?
Yes, as part of the new Terms of Service, community pharmacies must provide the repeat dispensing service to any patients who present repeat dispensing prescriptions at their pharmacy, whether the prescriber is in the same CCG as the pharmacy, or another CCG.

Q. Do I need to let my local NHS England and NHS Improvement team know that I have completed training to provide repeat dispensing and that my pharmacy is starting to provide repeat dispensing services?
No.

Q. How long does a repeat dispensing prescription remain legally valid?
A Repeat Dispensing/eRD prescription for a non-Controlled Drug has to be dispensed for the first time within six months of the ‘appropriate date’, with subsequent issues valid for 12 months from the signed date. The ‘appropriate date’ is the later of either the date the prescription was signed or the date indicated as the start date.

For example consider a prescription for Salbutamol 100micrograms/dose inhaler requesting 12 months supply, split amongst twelve batch issues (RD forms). If the signed date on the prescription (RA form) is 1st January 2013, then if the patient is to obtain all of their medicine, the pharmacy must have dispensed  fully within one year, and therefore by 31st December 2013.

Schedule 2 and 3 Controlled Drugs cannot be prescribed on repeat dispensing prescriptions.

Repeat dispensing prescriptions for Schedule 4 Controlled Drugs must be dispensed for the first time within 28 days of the appropriate date with subsequent issues valid for 12 months from the signed date. Repeat prescriptions for Schedule 5 Controlled Drugs are treated the same as non-Controlled Drugs and must therefore be dispensed for the first time within six months of the appropriate date with subsequent issues valid for 12 months from the signed date.

eRD

Q. The prescriber has not identified a dispensing interval on the prescription and the patient has told me that they are going on holiday for 6 weeks. Can I dispense two issues at the same time for the patient?
 Yes, where a prescriber has not indicated the interval, the pharmacist should use his professional judgement to dispense instalments at an appropriate interval. From a process perspective, the issues must be pulled down and dispensed in order, so the pharmacy would be required to pull down the first issue, update the Spine to indicate that the issue had been dispensed and then repeat the process with the second issue. When processing electronic repeatable prescriptions, the pharmacy system will record the Prescription ID to facilitate requesting subsequent issues of the prescription.

To further improve the efficiency of processing repeat dispensing prescriptions, PSNC would like to see a change to the model to allow multiple issues to be pulled down and prepared at the same time without the Spine having to be updated before the next issue can be retrieved.

Q. Are Repeat Authorisation (RA) forms required for electronic repeat prescriptions in the same way that they are for paper repeat prescriptions?
There is not an EPS ‘RA form’, but the patient may present the ‘repeatable prescription authorising token’ (see next question) which is not required to be seen by the pharmacy.

Q. What is the ‘repeatable prescription authorising token’? Are pharmacy teams required to see it for EPS repeat dispensing?
It is a type of prescription token. Prescribers can provide the patient with this so the patient knows how many prescription batch issues have been authorised. Prescription tokens are printed on prescription form stationary by the prescriber to accompany the electronic prescriptions. For standard prescriptions these are occasionally printed at the patient request or to pass on clinical information. With electronic repeat dispensing, prescribers may pass a token to the patient.

Pharmacy teams are not required to see this repeat token to process repeat prescriptions, and where it is presented, there is no need to send it to the Pricing Authority – unless it has been used as an alternative to a dispensing token for one of the dispensing episodes to capture a patient signature.

Q. Why does paper repeat dispensing involve a paper (RA) form, whilst there is no (RA) form for electronic prescriptions?
With paper prescriptions the legal instruction on a pharmacy to dispense, comes from the hand-written signature. Paper repeat dispensing therefore involves a paper RA form being issued by the prescriber which includes the legal instruction to dispense against the paper RD forms.

Electronic prescriptions use electronic signatures and repeat dispensing is therefore simpler for electronic prescriptions. When issuing a repeatable prescription, the prescriber will electronically authorise a specified number of issues and the patient’s nominated pharmacy can pull these down from the spine, as required.

A patient may present a ‘repeatable prescription authorising token’ (see question above).

Q. How is exemption information captured for electronic repeat dispensing?
As with standard electronic prescriptions, you must enter the correct payment/exempt category on the electronic prescription using the pharmacy system, to ensure reimbursement is correct.

In addition where a patient signature is required for electronic repeat prescriptions, this must be captured separately for each dispensing issue. If the patient pays for their prescription or is non-age exempt, the pharmacy can print a dispensing token to capture the patient signature. The only tokens required to be sent to the Pricing Authority are those relating to paid prescriptions and those used to collect the patient’s exemption declaration (for a reason other than age) will be required to be sent to NHS Prescription Services each month for audit purposes.

Electronic repeatable prescriptions are electronically authorised and sent to the patient’s nominated pharmacy so that they can pull them down from the spine, as required.

Q. How is the dispensing site determined?
A repeatable prescription can only be issued electronically where it is being sent to a patient’s nominated pharmacy. Patients can choose to change their nominated pharmacy before the expiry of the repeatable prescription. In this case, all outstanding issues which have not been downloaded will be transferred to the new nominated pharmacy. This is different to the procedure for paper based repeat dispensing, where all issues must be obtained from the same pharmacy. When issuing an electronic repeatable prescription, prescribers are required to always issue a ‘Repeatable Prescription Authorising Token’.

Q. Can issues be cancelled by the GP and/or pharmacy?
Yes, if the patient’s circumstances do change, the GP can cancel and reissue a repeat prescription for a patient.

The ability to cancel an electronic prescription is one of the main advantages of eRD compared with the the paper-based repeat dispensing system method.

Note: An electronic prescription can only be cleanly cancelled electronically where it has not been pulled down to a local dispensing system. If an electronic prescription has already been pulled down by a dispensing site, prescribers should use local arrangements to request that the prescription is not dispensed, for example, telephoning the dispensing site.

One method of cancellation of a batch issue is that if the pharmacy and their system is able and not yet processed an item or prescription, an item or form may be marked  ‘not dispensed’ and submitted to NHSBSA and a new alternative eRD issue or cycle used as/if required. This method of cancellation has a benefit that the prescription will not require being returned to the NHS Spine (reducing the risk it could inadvertently be dispensed by another pharmacy.

Read more within the ‘Cancelling prescriptions’ section of the EPS dispensing webpage.

Repeat dispensing (paper) 

Q. Does a repeat dispensing batch issue form have to be an exact duplicate of the repeat dispensing authorising form, e.g. if there are 4 items listed on the authorising form, does the batch issue have to be printed with the same four items on one form, or can two batch issues be printed with two of the items on each form?
Regulations do not require this to be the case so long as the pharmacist is content that the batch issues do relate to the authorising form.

Q. I have dispensed the final batch from a patient’s repeat prescription. How do I submit the authorising (RA) form to the Pricing Authority?
Repeat authorisation (RA) forms should be submitted to the Pricing Authority at the end of the month in which all batch issue forms have either been dispensed or expired or the medication is no longer required.

It is important that forms are sorted for submission in the correct order as detailed on the reverse of Form FP34C. In months where repeat authorisation forms are being submitted, tick the appropriate box on the FP34C Submission Form to indicate this. There is no need to declare the number of repeat authorisation forms submitted.

Originally repeat dispensing was mainly carried out using paper prescriptions but as the Electronic Prescription Service (EPS) has developed, the majority of repeat dispensing is now carried out as eRD. However, some contractors may still receive paper repeat dispensing prescriptions.

How does repeat dispensing involving paper prescriptions work?

Repeat dispensing involves the use of a repeatable paper prescription (authorising) form and a number of batch issue paper forms. These forms will be generated by prescribers through their GP practice systems.

The repeat authorising form (RA) associated with paper prescriptions should contain prescriber, patient and prescribed medicine details and include the number of issues required and the dispensing interval (e.g. weekly, monthly, quarterly). The form should contain the letters “RA” on the right-hand side of the form. This form must be signed by the prescriber.

The maximum number of batch issue forms (RD) that can be issued is equivalent to one year’s duration of prescribing of an individual item. These forms should contain the same prescriber, patient and prescribed medicine details as the authorising forms and indicate in the prescribing area that the form is being used for repeat dispensing. These forms should include the letters “RD” on the right-hand side.

Batch issue forms should not be signed; however, the prescriber’s signature box should be annotated with text displaying the words Repeat Dispensing: XX of YY, where XX is the number of the batch issue form and YY is the total number of batch issues covered by the repeatable prescription (e.g. 1 of 6, 3 of 12 etc). The date on all of the batch issues and the repeat authorising form will be the same.

Endorsing requirements for paper repeat dispensing prescriptions

Each batch issue form (RD) should be endorsed as required in the Drug Tariff Part II Clause 9. In addition, each RD should be stamped with the pharmacy’s stamp and dated with the date on which the items were dispensed.

There is no requirement to endorse the repeat authorisation form (RA) but community pharmacies are required to maintain records of the dispensing of repeatable prescriptions in order that there is a clear audit trail in place.

Submission process for paper repeat dispensing prescriptions

Batch Issue (RD) forms 

Dispensed batch issue forms should be submitted to the Pricing Authority at the end of each month in their correct groups, i.e. exempt or charged groups, within each monthly batch of prescriptions. The order in which these forms are to be submitted within a batch is detailed on the FP34c submission document. Initial batch issue forms (ie 1 of x) need to be sorted separately from subsequent batch issue forms (ie 2 of x, 3 of x etc), both sorted by doctor surname in alphabetical order.

Batch issue forms which have not been dispensed should not be submitted to the Pricing Authority. Any forms that become time expired should be destroyed.

Repeat Authorising (RA) forms

Authorising forms should be submitted to the Pricing Authority at the end of the month in which all batch issue forms have either been dispensed or expired or the medication is no longer required. It is important that forms are sorted in the correct order as detailed on the reverse of updated form FP34c, when submitted. In any month, if any repeat authorisation forms have been submitted, tick the appropriate box on the FP34c Submission Form. There is no need to declare the number of repeat authorisation forms submitted.