NHS England » Electronic repeat dispensing (eRD)

Electronic repeat dispensing (eRD) is an integral part of the EPS (Electronic Prescription Service) which enables prescribers to send prescriptions electronically to a dispenser (such as a pharmacy) of the patient’s choice.

Two thirds of prescriptions issued in primary care are repeat prescriptions. These account for nearly 80% of NHS medicine costs for primary care, and the management of these prescriptions and the time involved in processing them can be significant.

Up to 410 million repeat prescriptions are generated every year, equivalent to an average of more than 375 per GP per week. It is estimated that up to 330 million, or 80%, of all repeat prescriptions could eventually be replaced by eRD, saving 2.7 million hours of GP and practice time.

Since April 2019, the GP contract has stated that electronic repeat dispensing should be used for all patients for whom it is clinically appropriate.

What is electronic repeat dispensing (eRD)?

Electronic repeat dispensing (eRD) is a process that allows the prescriber to authorise and issue a batch of repeat prescriptions for up to 12 months with just one digital signature.

Different clinical systems may use different wordings, for example ‘electronic repeat dispensing’ and ‘batch prescribing’.

Prescriptions are stored securely on the NHS Spine and are automatically downloaded to the patient’s nominated community pharmacy at intervals set by the prescriber. This reduces calls, and visits, to the surgery.

How switching to eRD benefitted practices in their response to Covid-19

During the Covid‐19 pandemic, in response to the increasing pressure placed on primary care, practices were asked to consider using eRD for all clinically appropriate patients, to ensure safe prescribing whilst maintaining patients’ access to medications.

By including eRD dispensing as part of a practice’s repeat prescribing protocols, the following benefits were demonstrated:

a reduction in footfall to the GP practice and to the community pharmacy, thus supporting social distancing
a reduced workload for prescribers allowing better prioritisation of resources
controlled management of the supply chain reducing the number of temporarily unavailable medicines

Effective communication between patients and/or their carers, GP practices and community pharmacies is essential for all parties to realise the full benefits of the eRD process.

Prescribers are advised to explain the eRD system to patients carefully. The patient should be advised that permission for repeat dispensing is needed in order to share information about their treatment with their chosen pharmacist. This helps the pharmacist to give the prescriber feedback about the treatment and to provide the patient with further information, if necessary. Consent can be given verbally (i.e. formal written consent is not needed) and the form of consent then recorded in the patient’s notes.

Consent can be read coded in the patient’s notes as:

Patient consent given for repeat dispensing information transfer.

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

A number of eRD prescriptions will then be authorised based on the patient’s circumstances and clinical need. These eRD prescriptions are supplied by the patient’s pharmacy at regular intervals. The patient does not have to request repeats each time.

Identifying suitable patients

The NHS Business Services Authority (NHSBSA) can provide practices with a list of NHS numbers for patients that may be suitable for eRD. This list includes patients who have received the same medicines, of up to 9 drugs, dispensed for 10 or more months in the last 12 months. These patients require review before authorising.

This service was initially implemented to increase primary care’s use of eRD as part of the Covid-19 pandemic response and required GP practices to opt in to receive this data. Practices can directly request the NHS numbers by contacting NHSBSA at nhsbsa.epssupport@nhs.net.

A guide has been produced to help practices manage this data: Electronic Repeat Dispensing – Filtering NHS Number Data.

Which patients are suitable for eRD?

An electronic repeat dispensing prescription can contain one single item or up to four items. Multiple electronic repeat dispensing prescriptions can be issued.

Any patient with a repeat prescription could be suitable for electronic repeat dispensing, including, but not limited to patients:

on stable therapy
with long-term conditions
on multiple therapies, e.g. for hypertension, diabetes, asthma etc.
that can appropriately self-manage seasonal conditions

eRD should not be used for patients:

requiring frequent changes to drug therapy
on complex medication regimes
with an unstable medical condition and/or recent history of frequent admissions to hospital
requiring regular review (3 monthly or more frequent)
requiring terminal/palliative care
in residential institutions, e.g. care homes
who decline to consent or nominate a pharmacy
who are drug misusers
on the following medications:
controlled drugs (including temazepam, tramadol, gabapentin and pregabalin)
benzodiazepines
hypnotics
drugs which require close and careful monitoring, e.g. methotrexate
unlicensed medicines

Pharmacies often see patients on a more regular basis than their GP, so are well placed to identify patients who may be suitable for eRD.

How does eRD work?

Pharmacy nomination

Before a patient can be enrolled onto eRD, they must first specify their nominated pharmacy and then consent to the sharing of information about their treatment between the pharmacy and GP practice.

Patients select a convenient pharmacy, or change their nominated pharmacy, through their GP system online account, through the NHS App, or by making a request directly to the GP practice or pharmacy.

A patient can make a temporary change of nomination. They should be made aware, however, that a change of nomination will apply to future prescriptions and may also affect any that they have not yet collected from their pharmacy. Once they have received their medication from the temporary pharmacy, they should ask the pharmacy to change their nomination back to their usual pharmacy.

Alternatively, they can contact the practice or their usual pharmacy when they wish to re-set their nomination. They can also change it themselves if this functionality is available to them via their patient-facing service or app.

Prescriber batch authorisation

eRD allows the prescriber to authorise and issue a batch of repeat prescriptions for up to 12 months with just one digital signature. The prescriber authorises a number of repeat prescriptions for a defined period, for example for 6 months. These are issued as a batch (e.g. 6 prescriptions, each with 28 days’ supply). The maximum number of repeat batches that can be issued is 13 batches each with a 28-day interval to cover a total of 364 days.

The GP clinical system alerts the practice before the issue of the last batch. The doctor, practice nurse or pharmacist may want to review the medication before authorising a further batch of prescriptions. Patients should be aware that they may need a clinical review, examination, or investigation, etc., before it is considered safe to continue with a prescription.

All issues of eRD prescriptions are held securely on the NHS Spine and are made available for download by the patient’s nominated community pharmacy according to the schedule set by the prescriber.

If the patient or prescriber moves

The prescriber retains the ability to cancel an item or whole prescription at any time.

A repeat dispensing batch must be cancelled when a patient changes practice.

Until recently, when a prescriber moved to a different practice, the electronic repeat dispensing prescriptions issued by that prescriber had to be cancelled. Changes put in place by the NHSBSA now mean that when a prescriber moves practice, any of their outstanding eRD prescriptions from the original practice will still be charged back to the lead partner of the original practice. There is, therefore, no need to cancel as the costs will not be incorrectly attributed the new practice.

If the Personal Demographics Service (PDS) is notified of a death, the Spine will automatically cancel outstanding prescriptions.

Amendments and cancellations

eRD allows the cancellation of an item or the whole prescription, cancelling all the remaining prescriptions on the Spine, for that item or the full prescription.

Individual items on an eRD cannot be amended or new items added to the original eRD once they have been sent to the Spine. This is why we use eRD mostly for ‘stable’ patients. If a dose change is required, the item needs to be cancelled and a new prescription generated.

If the prescription is already with the dispenser, the prescribing system will receive a message to contact the dispenser and request them to return the prescription to the spine for that item to be cancelled. The dispenser must return the issue to the Spine for the cancellation to take place. The amended eRD prescription can then be manually downloaded by the pharmacy.

Alternatively, the prescriber can ask the pharmacy to mark that item as ‘Not Dispensed’ for that issue. Any future issues will have that item cancelled.

There are two options for patients with multiple items on eRD where an item requires cancellation:

Option 1 | Cancel all outstanding items within the prescription form and replace with a new eRD, including the new item/amended dosage change.
Option 2 | Cancel the individual item(s), check when the next issue of the existing eRD prescription is due and generate a one-off prescription to cover until the date of the next issue of the original eRD. 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. Synchronising prescriptions in this way ensures that all the patient’s prescriptions are received by the dispenser on the same day and support interaction checking.

It is always good practice to communicate with the patient’s nominated pharmacy about any changes made to eRD prescriptions. You can do this with an electronic note to the dispenser on the new eRD prescription.

When a patient goes on holiday in England and leaves medication behind

If a patient goes on holiday in England and leaves their medication behind, the patient can nominate a different pharmacy where the next batch issue can be drawn down and dispensed.

If the next due prescription in the batch has not already been drawn down, it remains on the Spine with the status of ‘to be dispensed’ and can be located on the EPS prescription tracker. The temporary pharmacy can then manually download the next batch issue by using the prescription ID. This will leave the patient nomination for future batch issues at their regular pharmacy.

If, however, the next due prescription in the batch has already been drawn down by the patient’s regular (nominated) pharmacy, this will prevent any further prescriptions from being released. In such cases, the ‘holiday’ pharmacy should contact the nominated pharmacy and agree a process for transferring the prescription(s).

Ideally, the prescription that has already been drawn down should be returned to the Spine from where it can be drawn down again by any pharmacy and without needing to change the patient’s nomination. The temporary pharmacy will need to know either the Prescription ID (GUID) number or the patient’s NHS number to be able to do so. If the usual (nominated) pharmacy is unwilling to return the prescription to the Spine, the patient’s nomination will need to be temporarily changed to the ‘holiday’ pharmacy and a dispense notification (DN) sent by the original pharmacy for the existing prescription. Sending the DN unlocks the next prescription in the series, enabling the ‘holiday’ pharmacy to search for and download the next prescription.

‘When required’ or PRN medication

‘When required’ or pro re nata (PRN) medication can also be prescribed using eRD. It is recommended that PRN items are set up as a separate eRD batch as they may have a different interval to the patient’s other eRD repeat medication batches.

The prescriber can set the intervals for these prescriptions, based on the patient’s medication history to predict the number of uses/doses. If the patient runs out, the next issue can be downloaded in advance, based on a clinical assessment by the dispenser.

This may mean an extra prescription is needed to ensure the patient has enough medication to last until their next review. Some prescribing systems have a variable prescription type, which helps with this.

eRD in dispensing practices

A dispensing doctor is only permitted to issue paper and electronic repeat dispensing for non-dispensing patients. The NHS (General Medical Services Contracts) Regulations dictate that a dispensing doctor may not provide electronic repeatable prescribing services to any person to whom they provide pharmaceutical services.

Safeguards in eRD

eRD has several inbuilt safeguards:

each issue of an electronic repeat dispensing prescription cannot be dispensed more than once
the prescriber can cancel the prescription or prescription items at any time and the prescriber will know whether the prescription is ‘with dispenser’ or ‘dispensed to patient’
there is a full, end-to-end audit trail from prescribing to dispensing to the patient
it provides a contemporaneous, medico-legal record, including the reason for prescription (item) cancellation
the original prescriber is responsible for the duration of the repeatable prescription unless the original prescriber leaves the GP practice, in this case the lead GP will take over responsibility
once a patient has nominated a dispenser this preference will be stored (on the NHS Spine) and the patient’s prescriptions are sent via EPS to their nominated pharmacy until the patient chooses to change or remove their nomination. If a patient decides part way through a course that they wish to use a different pharmacy, they can simply make a new nomination.
automatic cancellation of all outstanding prescriptions will occur when the PDS is updated with notification of death, preventing carers being notified of or given prescription items for deceased individuals

Benefits of eRD

Administrative benefits to primary care

The administrative benefits to primary care include:

saving staff time and involvement due to reduced footfall at the GP practice and fewer telephone calls as patients don’t need to collect or order repeat prescriptions
the administrative work associated with paper repeat prescribing processes is reduced
fewer paper prescription requests are lost, therefore improving data protection and information governance
less paper is processed and used

Benefits to prescribers

The benefits to prescribers include:

reduction in medicines waste
the prescriber has access to the patient’s nominated dispenser within the prescribing system
less time is spent processing, reauthorising, and signing repeat prescriptions
reduction in the number of times prescriptions require signing as the initial single electronic signature remains valid for each issue
the initiating prescriber remains responsible throughout the lifetime of the repeat dispensing prescription improving the quality of prescription data for clinical governance
the risk of a batch of prescriptions getting lost is reduced, as they are stored digitally, thus improving accountability for prescriptions issued and dispensed
medication can be managed more effectively as the prescriber can cancel part or all prescription items or a batch of undispensed electronic repeat dispensing prescriptions at any time
during cancellation the prescriber knows where the electronic repeat dispensing prescription is within the system and receives messages as to the location of the prescription
a complete record is provided, including the reason for any prescription cancellation
all outstanding prescriptions are automatically cancelled when the PDS is updated with notification of death
fewer patients requesting regular medication from out of hours services, as they will have access to their regular repeat dispensing prescriptions at their nominated dispenser

Benefits for patients

Benefits for patients include:

no need to contact the surgery to re-order medication at regular intervals unless their condition changes
improved safety for patients as the pharmacy checks that the medicines are still safe and appropriate
improved care for patients as a result of greater collaboration between the practice and the pharmacy
the option to change their nominated dispenser at any time during the duration of the eRD prescription
the option to request the next issue early or obtain more than one prescription, for example when going on holiday if clinically appropriate
prescription security with a paperless system
the option to make a local arrangement with their nominated pharmacy for collection or delivery
the service is reliable, secure, and confidential

Benefits to dispensers

Benefits to dispensers include:

improved prescription processing due to automated downloads
reduced waste as dispensers must ask patients if they require all items on their prescription before each issue
improved stock control and subsequent reduction in prescription queries and owed medications
it simplifies the processing of regularly prescribed medicines

Summary

Do:

review all training and information resources in order to understand the service and the processes involved in implementing eRD
identify suitable patients to switch to eRD and understand the process that the practice will use to initiate eRD – each medication to be included in the regime should be checked individually, to ensure that the issue durations and maximum issues/review dates are synchronised so that all medications included will be required at the same time and will all end at the same time
ensure you know the practice’s eRD procedures in terms of how many issues will be given to patients which can depend on the disease review interval and the patient’s next medication review date (up to 12 months allowed) – the maximum number of repeat batches that can be issued is 13 batches each with a 28-day interval to cover a total of 364 days
ensure that you can explain eRD to a patient
ensure that you know how to cancel eRD prescriptions and manage medication changes
work closely with community pharmacies to establish preferred methods of communication regarding eRD processes

Do not’s:

don’t switch large numbers of people over quickly without a plan or discussing with patients
don’t start with people on lots of PRN medicines

Other helpful resources

Essential to getting started with eRD

Wessex Academic Health Science Network (AHSN), eRD handbook (May 2020 second edition)
Wessex AHSN, eRD Readiness checklist/ PDSA cycle
NHSBSA, YouTube video, Electronic Repeat Dispensing – an overview

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