Prescribing Models
Prescribing Models
The EPS supports three prescribing models in addition to existing paper based FP10 prescribing. The prescribing models, depicted in the figure below, are:
- acute (Acute Prescribing)
- continuous (Repeat Prescribing)
- continuous-repeat-dispensing (Repeatable Prescriptions)
The prescriber must still be available to provide a paper FP10 prescription to the patient, if requested by the patient or if desired by the prescriber. Electronic prescriptions will be the default and FP10 prescriptions only produced in exemptional circumstances.
acute
An acute prescription is generated following a consultation between a prescriber and a patient and is a “one-off” prescription.
MedicationRequest and MedicationDispense Notes
continuous
Repeat prescribing (continuous) is valid for an authorised number of repeats or for a defined period. Prescription initiation is controlled by the prescriber. Each prescription issue is separately authorised by a prescribing clinician using their local prescribing system supported by any workflows or rules implemented for the repeat prescribing process.
The prescription authorisation results in an electronic prescription being sent to EPS. The repeat prescription is treated by the EPS in the same way as an acute prescription.
MedicationRequest and MedicationDispense Notes
The concept of MedicationRequest with an intent of plan is described in GP Connect Access Record Structured
The prescriber will add the following information in MedicationRequest resources.
- numberOfRepeatPrescriptionsAllowed in Extension UK Core Medication Repeat Information
- numberOfRepeatPrescriptionsIssued in Extension UK Core Medication Repeat Information
Dispensers should populate the following in MedicationDispense resources.
- numberofRepeatsAllowed in Extension-EPS-RepeatInformation
- numberOfRepeatsIssued in Extension-EPS-RepeatInformation
continuous-repeat-dispensing
Electronic Repeat Dispensing (eRD): An overview Video
One of the key aspects of repeat dispensing is that the EPS manages the re-issue of subsequent authorised issues of the repeat dispensing prescription.
The technical model for repeat dispensing works in the following way:
- The prescriber authorises a prescription with a specified number of issues for which it is valid.
- Each issue is for the same prescribed medication items.
- The prescriber optionally prints a “Repeatable Prescription Authorising Token” to give to the patient. Refer to the document “EPS Prescription Token Specification” (ref. NPFIT-ETP-EDB-0027) for detailed token printing requirements.
- When the EPS receives the electronic repeatable prescription it makes this available as the 1st issue of the prescription for dispensing.
- The next issue of the prescription is created on EPS once the previous issue is deemed “complete” (i.e. all medication items either dispensed or not dispensed) so it can be requested and download by the dispenser. EPS will send nominated repeat dispensing subsequent issues to the nominated dispenser at a time a few days before the next issue is due based on the date of the last dispensing event and the ‘DaysSupply’ attribute from the prescription.
- Once all authorised issues of the prescription have been dispensed, or if the prescription has expired, the repeatable prescription is completed. For more medication, the patient must re-visit their GP and obtain a new Repeatable Prescription Authorising Token for another repeat cycle.
- At any time, the prescriber may submit a prescription cancellation request on the prescription or an item within the prescription. This will cancel the repeat dispensing authorisation, or prescribed item, and prevent any further issues of the prescription, or prescribed item, from being dispensed.
MedicationRequest and MedicationDispense Notes
The MedicationRequests from the prescriber should use the intent of original-order. The intent of the MedicationRequest from EPS to the dispenser should be reflex-order to indicate the order has been generated by EPS.
EPS will maintain/add the following information in MedicationRequest resources.
- numberOfRepeatPrescriptionsAllowed in Extension UK Core Medication Repeat Information
- numberOfRepeatPrescriptionsIssued in Extension UK Core Medication Repeat Information
- lastDispensedDate in Extension-EPS-DispensingInformation
- basedOn an identifier refererence to the original-order.
Dispensers should populate the following in MedicationDispense resources.
- numberofRepeatsAllowed in Extension-EPS-RepeatInformation
- numberOfRepeatsIssued in Extension-EPS-RepeatInformation