Patient choice and IT

The NHS Constitution gives patients the right to make choices about their care, including which pharmacy they use.

Technology should support patient choice, not restrict it. Where digital systems, apps or processes may limit patient choice, concerns should be raised and reviewed.

The Care Quality Commission (CQC), General Pharmaceutical Council (GPhC), GP practices, pharmacies and technology providers all have a role in supporting patient autonomy and informed decision-making.

Patients have the right to choose which pharmacy provides their NHS services, and that choice should not be influenced unfairly or without their informed agreement.

Community pharmacies may sometimes identify situations where a patient’s choice of pharmacy appears to be restricted. Examples could include an app, website or digital service changing Electronic Prescription Service (EPS) nominations, directing prescriptions, or influencing pharmacy selection without clear patient agreement.

Protecting patient choice is a core NHS responsibility.

This section explains how patients, pharmacy teams and LPCs can raise concerns and what information NHS organisations may need to investigate them.

1. When patients want to make a complaint

Patients have the right to choose which pharmacy they use for NHS prescriptions and services.

Examples of concerns may include:

• Being directed towards a particular pharmacy;
• An app automatically routing prescriptions without clear patient agreement; or
• Any pressure, messaging or process that limits a patient’s ability to choose.

Patients can raise complaints with their local Integrated Care Board (ICB).

Patients can find local NHS contact details through the local NHS team (ICB).

Complaints may be submitted directly or anonymously. Patients may also ask that their GP practice is not informed.

Patients can decide whether to copy other relevant parties into their complaint, such as their chosen pharmacy.

Patient templates (optional)

Patients may use the optional templates below to help explain their experience to their local NHS team.

Choose the template that best matches the situation if you want to provide the patient with the option of using a template feedback form:

• Form – Feedback about a pharmacy and my pharmacy choice
• Form – Feedback about an app, website or technology affecting my pharmacy choice
• Form – Feedback about GP practice information and pharmacy choice

Patients may amend the templates or provide information in their own words.

Practical tips for patient contacting the ICB:

• Patients may wish to view the updated Poster on freedom of choice.
• Patients can scan the QR code, find their local NHS team’s contact details, and email either: a completed template; a photograph of a completed paper form; or their feedback in their own words.

Patients may also seek assistance from a family member, friend or carer if they would like support with the process.

If your local NHS team (ICB) already has its own templates or processes, patients and pharmacy teams may use those instead.

2. How pharmacy teams or LPCs can raise concerns

Pharmacy teams and LPCs can raise concerns directly with their ICB.

To support a timely review, provide clear written information including:

1. Organisations involved

• Include ODS codes where available;
• Identify whether the organisation is a pharmacy, app provider, website provider, IT system supplier or other service provider; and
• Name any relevant organisations involved.

1. Impact of the issue

Explain the impact on:

• Your pharmacy, e.g. diverted prescriptions or changes to EPS nominations;
• Patients, e.g. confusion, complaints or delays; or
• The wider area, e.g. repeated or widespread patterns.

1. Supporting evidence

Useful evidence may include:

• Activity data or statistics;
• EPS-related information;
• Patient feedback;
• Screenshots from apps, websites or services;
• Communications from providers; and
• A timeline of events.

1. Suggested resolution (optional)

If appropriate, explain how the issue might be resolved.

In some cases, pharmacy teams and LPCs may also wish to contact the relevant technology provider directly, as some issues can be addressed without formal escalation.

3. How ICBs and NHS organisations review issues

ICBs may escalate concerns to the national NHS pharmacy team where appropriate.

Where concerns relate to NHS digital services, EPS functionality or technology suppliers, the ICB or NHS pharmacy team may contact:

• Relevant IT system suppliers;
• NHS national digital teams, including EPS and primary care digital teams; or
• Other organisations involved in the service.

These organisations may work together to review and resolve technical issues.

4. Sharing information with Community Pharmacy England

LPCs may choose to share summaries or correspondence relating to patient choice concerns with Community Pharmacy England’s digital and technology team.

Although Community Pharmacy England does not regulate technology providers, feedback from the sector helps us identify emerging trends and advocate for improvements to pharmacy IT and digital services.

Where appropriate, we may signpost pharmacy teams to relevant escalation routes or help raise awareness of issues affecting the wider sector.

What this supports

This escalation route supports:

• NHS requirements on patient choice;
• Community Pharmacy IT Group (CP ITG) principles, including digital inclusion, user-centred design and reducing unnecessary workload;
• The NHS ambition to improve access through safe, trusted and inclusive digital services; and
• The long-term vision for interoperable and equitable pharmacy IT.

EPS nomination and systems

Community Pharmacy England and the Community Pharmacy IT Group (CP ITG) support patient choice and the safe, transparent use of the Electronic Prescription Service (EPS).

To protect patient choice and support NHS nomination requirements, EPS systems should not:

• Routinely check, monitor or track a patient’s pharmacy nomination status where there is no appropriate reason to do so; or
• Use or rely on “enduring consent” arrangements that could override a patient’s current nomination decision.

A patient’s nomination should always reflect their current wishes.

These safeguards help ensure that EPS nominations remain patient-led and consistent with NHS policy.

If a system automatically changes or restores a patient’s nomination after the patient has changed it themselves, this would be inconsistent with EPS nomination processes.

Read more on our EPS nomination webpage.

Patient Facing Services (PFS) and assurance

NHS assurance arrangements apply to certain Patient Facing Services (PFS), sometimes referred to as GP online services.

Examples include:

1. Viewing health records;
2. Ordering repeat prescriptions;
3. Booking GP appointments; and
4. Receiving selected communications from GP practices.

Some pharmacy owners provide apps or digital services that include access to PFS functionality.

Where pharmacy owners promote digital tools, these should help patients access NHS services while preserving patient choice and avoiding any undue influence on the selection of a pharmacy.

Changes to the GP Contract for 2026/27 included measures intended to support patient choice and joined-up digital pathways.

These changes included the below:

“We will amend the core practice contract to expand the provisions on nominated dispensers, requiring practices to reconfirm the nominated pharmacy whenever a new prescription (not a repeat prescription) is issued, and to ensure that referrals and triage tools used for community pharmacy clinical services offer patients a full choice of providers. We expect in practice that most practices do this already and this should not add additional burden to appointments.”

The intention is to support patient choice while minimising additional workload for GP practices.

Technology providers, website providers and app developers should ensure that patients receive balanced and accurate information when selecting a pharmacy.

Digital tools should support informed choice, not direct or restrict it.

Patients should always be able to:

• Decide whether to use a digital tool; and
• Choose their preferred pharmacy.

Principles for supporting patient choice within digital tools

1. Patients must be free to choose any pharmacy for dispensing or NHS pharmacy services.
2. Pharmacy nomination or service sign-up processes should be separate from other registration processes and require active patient agreement. Pre-selected options should be avoided.
3. Information that uses NHS branding should not influence, direct or determine a patient’s pharmacy choice.
4. Information that uses NHS branding should align with NHS processes relating to nomination and patient choice.
5. Technology providers should comply with the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 and relevant NHS service requirements.
6. Information provided by GP practices to support pharmacy selection should present a fair and balanced choice of providers.
7. Pharmacies, including those using third-party apps or platforms, should have the informed agreement of the patient before providing services.
8. Pharmacy providers should comply with NHS requirements relating to nominations and prescription inducements, including when using third-party technology.
9. GP practices should not seek to persuade patients to choose a specific pharmacy, including through digital systems.
10. NHS branding should only be used in line with NHS identity requirements.
11. NHS assurance, integration or approval processes should support adherence to these principles.

The NHS Constitution protects patients’ rights to make choices about their care. NHS service requirements also include provisions intended to protect patient choice when pharmacy services are accessed.