EPS nomination: standards that must be followed

To use the Electronic Prescription Service (EPS), patients decide which dispenser will receive their electronic prescriptions. This process is known as making a nomination. Patients can have up to 3 nominations:

1. One pharmacy (must be a specific community or internet pharmacy).
2. One dispensing appliance contractor (DAC).
3. One dispensing GP practice (if applicable).

Patients must be fully informed about EPS before their nomination can be set on the system. 

Nomination is suitable for most patients, and patients on regular repeats and who use the same pharmacy most of the time will see the most benefit.

All staff advising patients about their nominations need to know about EPS. They should be able to explain how EPS and nominations work to patients seeking advice from a GP practice, pharmacy or dispensing appliance contractor whether discussing face to face, communicating digitally or over the phone (including medicine delivery drivers). This includes explaining to patients how they may change their nomination and how many nominations they may have in place at any one time.

Consent for nomination or nomination resets does not have to be in writing, but healthcare providers must have an auditable process (such as standards of practice) in place.

Dispensers

Dispensers must:

• explain EPS and set the nominated dispenser requested by the patient (within the bounds of the list above)
• (if changing pharmacy ownership) inform the patient that the ownership has changed and ask whether they wish to continue with the nomination

Dispensers must not:

• offer inducements or incentives to encourage a patient to nominate them
• attempt to persuade or influence a patient to nominate a certain pharmacy/dispenser, or attempt to challenge the patient’s choice in any way

Nomination changes should be recorded promptly in the patient medication record (PMR) system (some dispenser sites do this at the end of each day or throughout the day).

Secondary care systems cannot record or change a patient's primary care nominated dispenser.

Prescribers

Prescribers must:

• check the nomination when issuing a prescription and confirm it is the patient's current choice - if there is more than one nomination, ask which one they would like to use
• if asked, provide the full list of dispensers - for example, in alignment with NHS Directory of Services (DoS) list of pharmacies or the NHS website ‘Find a pharmacy’ tool

To help find the most suitable pharmacy the DoS can be searched by location and opening times. 

Patients registered with a dispensing practice that uses EPS in their dispensary may also be able to nominate their dispensary.

Prescribers must not:

• persuade or influence a patient to nominate a certain pharmacy

3rd party services

IT developers, app developers, website managers and any other 3rd-party services dealing with aspects of EPS nomination change must align to these nomination principles. This includes ensuring patients are:

• offered the full choice of dispensers or all dispensers within the area offered to the patient which should be a minimum of 5 dispensing contractors
• are fully informed about EPS
• are advised of their right to choose
• are told where choice-related complaints can be made (see the later ‘Nomination complaints’ section).

For IT which enables the patient to consider a choice of pharmacy, it is not acceptable to display a subset of pharmacies.

System suppliers must not develop functionality that would support a healthcare provider to either access that patient’s nomination data from the Patient Demographic Service (PDS) or change that patient’s nomination without the explicit consent of the patient for each occurrence . They must not introduce or utilise any functionality that restricts a patient’s free choice of nomination or in any way challenges their choice.

3rd-party service providers must not encourage behaviours that would place EPS users in breach of appropriate PDS nomination data access rules or EPS nomination-related standards.

The following legislative provisions incorporate nomination and patient choice. NHS England ensures that these are upheld.

National Health Service (General Medical Services Contracts) Regulations
National Health Service (Primary Medical Services)
The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013
Health and Care Act

NHS PDS holds the patient nomination and, in accordance with the Data Protection Act, access to the nomination-related data held within PDS must only be where a legal basis exists. For dispensers, that would be because a patient has presented and wishes to change their nomination, requires a consultation or where dispensing activity is required. There would be no legal basis to access PDS nomination data outside of this, and a previous nomination is no guarantee of future intent.

These are based on the legislation and are endorsed by professional bodies.

1. Patients must choose their own nomination

Consent must be obtained for nomination

In obtaining consent for the professional services they provide, health care professionals ensure that patients are provided with sufficient and timely information. EPS is no different. Any websites, apps or technologies that set out nomination change must similarly ensure the patient is fully informed.

Checking consent and reconfirming information is an ongoing process rather than a single act. Health care professionals must seek a patient's consent on each occasion that is necessary, such as after a change in circumstances, or when issuing a new prescription, not only at the beginning of the process.

Obtaining patient consent for nomination is a local process. It is recommended but not mandated that an electronic or written record of the patient’s consent is kept in case of future queries.

Where there is a change in pharmacy ownership the pharmacy should seek to inform patients in advance of this change wherever possible. Where it is not feasible to notify patients of the change in advance then this should happen as soon as possible after the change, for example face to face when a patient first collects their medication following the change of owner.

In all cases patients must be notified within 6 months of the change taking place. This ensures there is a basis for implying the patient's continued consent to this nomination. Throughout this period the nomination will automatically continue with the new pharmacy. A patient who informs the pharmacy that they no longer wish to have the pharmacy set as their nominated pharmacy, must be given appropriate assistance to remove/change the nomination.

All staff should be able to communicate nomination information to patients

This includes:

• prescribers
• pharmacists
• dispensing doctors
• technicians
• dispensing and counter staff
• delivery drivers
• GP practice receptionists
• dispensing appliance contractor staff

There should be at least 1 person at each site who has detailed knowledge on setting, changing and removing nominations and make sure that staff know who to contact to help resolve issues quickly.

Patients should be fully informed

Patients or patient representatives should be fully informed about what EPS is and how it works prior to a nomination being set. Patients need to fully understand the implications of setting a nomination and be aware that the way they collect/receive their prescriptions may change.

Information should be provided to the patient before setting their nomination on the system. As a minimum, this should include:

• nomination is not mandatory
• the prescription will be sent electronically to the nominated pharmacy, dispensing doctor or DAC
• the patient can choose who they wish to nominate and is not restricted to nominating a dispensing contractor located close to their GP practice
• patients can ask to set, change or remove their nomination at any time, at any EPS site - there is no restriction on the number of times they change or move their nomination
• patients do not need computer access to have a nomination or use EPS
• there is no need to collect a paper prescription from the GP practice as it will be sent electronically
• a patient does not have to set a nomination with a dispenser for their prescription to be dispensed there

2. Patients must not be influenced or persuaded to nominate a specific dispensing contractor and inducements cannot be offered

Patients must be supported to make an informed choice about nomination and choose the dispensary that is most suitable for them. Patients must not be unduly influenced in their decision to nominate or in their choice of nomination.

Dispensing contractors must not offer any gift or reward to encourage a patient to nominate them; this also includes the offering of share dividends of profits or discounts.

Prescribers must not seek to persuade a patient to nominate a specific dispenser. If a patient asks who to nominate, they should provide the patient with a list of all the dispensers in the area who provide EPS.

3. Prescribers and dispensing contractors will need to confirm, set, change, cancel and reconfirm a patient’s nomination in a timely manner

This principle has 2 distinct aspects relating to timeliness:

1. Setting, changing and removing a patient’s nomination request.
2. Re-confirming a nomination.

This will ensure that when the patient requests their next repeat prescription they can be confident that their prescription will be sent to their nominated dispensing contractor.

Setting, changing and removing

Nominations should only be changed or removed at the patient’s/representative’s request. Details including the person who set/changed/removed the nomination will be recorded via the user’s Smartcard.

Patients can ask for their nomination to be set, changed or removed at any EPS site including any pharmacy, dispensing appliance contractor or at the GP practice that they are registered with. Patents can also change it within the NHS App or apps which have equivalent NHS IT nomination change functionality.

Some sites enter all nominations at the end of each day or during quiet periods such as during lunchtime.

Prescribing and dispensing staff should be aware that nomination changes will affect any prescriptions on the Spine that have not yet been downloaded by a pharmacy; this includes any recently issued prescriptions as well as any future prescriptions.

It is important to inform the patient that the best time to change their nomination is soon after they have collected their last repeat.

If a patient’s nomination is changed part way through an electronic repeat dispensing (eRD) cycle, all prescriptions that have not been downloaded will be transferred to the new nomination.

If a nomination is removed part way through an electronic repeat dispensing cycle the patient will need to go back to their GP to obtain a new prescription.

The EPS clinical prescription tracker can be used by GP practices and pharmacies to check the status and location of any EPS prescription by searching the prescription ID or the patient's NHS number.

If a patient's nomination is changed after a post-dated prescription was issued, the prescription will go to the new pharmacy or dispensary on the day of the post-date. Non-nominated prescriptions are not affected by nomination changes.

Reconfirming nominations

Nominations must be reconfirmed with the patient in a timely way, when there is a pharmacy change of ownership.

This is to stop patient confusion - for example, they may have forgotten they have nominated that pharmacy. Also, patient’s circumstances often change and may have done so prior to the ownership change, such as change of address.

Reconfirming nominations (such as after a change of ownership) can be done in a variety of ways. Contractors should always choose the appropriate method.

4. Prescribers and dispensing contractors must use clear processes for nomination

Clear processes are critical to ensuring fair patient choice of dispenser.

GP practices need to:

• consider displaying a poster (or equivalent information within websites or app spaces) advising the patient that their prescription will be sent to their nominated dispensary unless they specify otherwise.
• ensure that the right prescription goes to the right place (where a patient has more than one nomination, for example, a pharmacy and a DAC nomination) and that they confirm the patient’s chosen nomination when issuing a new prescription where possible
• understand the process for one-off nomination, where that is required, or for producing a paper FP10 prescription for a patient as a 'one off' without removing the nomination

Health care professionals will need to consider how:

• an auditable nomination process is used, such as use of a standard operating procedure
• contractors will demonstrate compliance with these rules if challenged?
• patients and their representatives will sign up
• complaints will be dealt with.

Pharmacy staff will need to consider how they will confirm a patient’s identity when collecting a prescription (as now).

Any complaint about the nomination must be investigated and dealt with appropriately. By following this guidance, complaints about nominations will be minimised.

Some examples of nomination complaints are:

• setting, changing or removing a nomination without a patient’s consent
• pharmacy offering gifts to patients to nominate them
• GPs setting nominations for all patients to one pharmacy without patient consent
• pharmacy nominating all their prescription collection service patients without their consent
• pharmacy not reconfirming nominations
• GP practice refusing to set nominations

If the patient wishes to register a complaint, they should make that complaint to the pharmacy, DAC or GP practice that has caused their complaint directly.

Patients can also complain to the integrated care board (ICB) if their complaint cannot be resolved. Any healthcare provider in the area should be able to provide details of the local ICB if needed.

If a GP practice, pharmacy, or DAC wishes to make a complaint about another contractor, they should discuss with the relevant commissioning team in the ICB the most appropriate method for raising the complaint.

ICBs and the NHS have overall responsibility for monitoring nominations and ensuring that complaints are dealt with in a fair and equitable way.

Find your local integrated care board