Introducing EPS into secondary care

It’s about time that electronic prescriptions are available across all healthcare settings

By Michael Williams, NHS clinical pharmacist and Clinical Solutions Consultant at Civica

The journey towards a fully electronic healthcare system has been an ambitious one, with benefits of greater efficiency, improved patient safety and cost savings. A major milestone came in 2019 when the UK government announced the national roll-out of the electronic prescription service (EPS) to primary care in England. The goal was to save the NHS money, streamline prescription management, reduce paperwork and reduce prescribing errors.

In many ways, the EPS rollout to primary care has been successful. Today, nearly all General Practitioners (GPs) are equipped to use electronic prescriptions directly to community pharmacies, and the benefits are being felt, especially by patients.

EPS in secondary care

In the years since, focus has turned towards secondary care. Developments are now starting to appear under NHS England's First of Type scheme, an initiative to shepherd in the integration of technology partners to test and iterate wider interoperable digital services with the aim of becoming a paperless NHS. As part of the scheme, suppliers of EPS systems are working to deliver safe and timely management of outpatient and secondary care FP10 prescriptions – those that are used for patients in the community – but it continues to be challenging.

Some GPs are finding themselves still involved in the process where it could be better served elsewhere. For example, Dr Helen Salisbury touched on the frustrations with the current situation in a paper published in The British Medical Journal¹. Dr. Salisbury said: “From our perspective, it would save a lot of work if our colleagues in hospital outpatients could just prescribe the medicine they think is needed and send it to the patient’s community pharmacy, rather than writing to us with a request to prescribe it on their behalf. As well as making us grumble about being treated like “community house officers,” it’s inconvenient and time consuming for the patient, as they have to liaise with the GP to get their medicine.”

Thankfully there are efforts to push forward the wider adoption of EPS in hospitals, especially with the shift towards Integrated Care Systems in which allocating prescribing budgets will no longer be an issue. In May 2024, NHS England said it expected that at least half of NHS hospital trusts could have access to an EPS solution by 2026. While ownership of the project will move with the restructuring that saw NHS England dissolved in early 2025, nevertheless, we should expect to see work continue on this essential initiative.

Getting there is going to require a collaborative approach between suppliers and trusts. Smart technology will be needed to deliver the EPS requirements to suit secondary workflows and envelope these with the wealth of safety features and decision support that electronic Prescribing and Administration (ePMA) systems provide. Negating the need for staff to travel to deliver or post prescriptions will save travel time, fuel payments and carbon emissions. FP10 stationary will also no longer be required, so there are significant financial gains to be had with EPS. The development will also support interoperability with the NHS Spine, enabling both outpatient and secondary care services to share their FP10 data with partner healthcare providers and pharmacies. This will allow full visibility of patient prescriptions that would otherwise be hidden.

Beyond acute healthcare, this will be particularly impactful for services like mental health, specialist clinics and child and adolescent services where, through EPS, patient experience can be transformed with steps forward in utilising technology to enhance medicines’ safety and auditing.

EPS in the community

EPS will provide the functionality to outsource the dispensing of discharge prescriptions from secondary care. Whilst this is beneficial for facilitating discharges and potentially reducing wait times, it will have an impact on community pharmacies, a sector that is already facing increased workload and demand. On the other hand, one of the vital requirements of this new technology is that it will connect secondary care clinicians to primary care in the same way GPs are connected to community pharmacies. Not only will EPS improve the secure transition and onward management of patient prescription records, it will also introduce clinician contact details, making the connection between community and hospital clinicians visible and streamlined.

The benefits of EPS in the community will also extend to virtual wards and community teams treating patients in their own homes or in clinics, from palliative care to mental health. The added visibility of acute prescriptions will equip community pharmacists with better insight of the patient's medication, allowing more informed clinical intervention if required. This next step integration also supports the wider care setting where outpatient and acute medications that are prescribed on paper can be easily missed during clerking or medication histories.

In addition to this, the integration could see patients having access to treatment quicker as it’s sent directly to pharmacy, potentially improving outcomes and reducing wait times. In turn, this initiative could see a relief of pressure on hospitals admissions.

EPS in mental health

According to the Centre for Mental Health, an independent UK charity, the economic costs of mental ill health in England reached £300bn in 2022. There are more than 500,000 patients in England with severe mental illness, such as schizophrenia and bipolar disorder. These patients face well-documented health inequalities, dying an average of 15–20 years earlier than the general population​​. Two thirds of these deaths are from physical comorbidities, such as cardiovascular disease, which could be prevented by access to appropriate treatment and support​.

The issues can be exacerbated by paper-based prescriptions alongside current challenges such as lost prescriptions and tampering which, with EPS, will be problems of the past. With a single source of truth in the EPS tracker, the clinician has full visibility of audited events. They will have real time data as to where the prescription is and its dispensing status, giving valuable insight into the patient’s adherence.

There are also benefits in utilising EPS within the confines of a Mental Health ePMA. Not only does it provide a single record of medication management for point of reference, but it can also facilitate decision support when prescribing under the Mental Health Act Consent to Treatment. Also, for the staff using EPS within their ePMA system, it provides familiarity with the user interface and system logic.

Improvements with interoperability across primary and secondary care provides the opportunity to review practice, such as in the case of shared care agreements, which could take a very different form as EPS workflows are adopted.

Final thoughts

As we have seen, there are still significant benefits waiting to be realised across secondary care settings with the wider introduction of EPS. Technology is essential in making this happen. The result will be integrated care systems where patient records and prescriptions can travel between different care providers and avoid unnecessary errors, transcribing, duplication of efforts, patient safeguarding issues and pathway inefficiencies.

It’s now only a matter of time, but it is vital to make sure that EPS in secondary care is set up for success.