Patient choice and IT

The NHS Constitution guarantees patients’ continued entitlement to fair choice.

If new technologies limit this freedom, healthcare providers and patients must take action to ensure that patient choice remains unrestricted. Additionally, the Care Quality Commission (CQC) and the General Pharmaceutical Council (GPhC) require GP practices and pharmacies to uphold patient choice and autonomy. They must also adopt tools that facilitate and support this principle.

Patients have the right to choose any pharmacy for their services, and their choice should not be unduly influenced.

Escalating concerns over technology and patient choice to NHS England

The Competition and Markets Authority (CMA) outlines anti-competitive practices on its website.

NHS England serves as the sector regulator for health services in England. Details about the complaints process are available on the NHS England complaints webpage.

Patients who believe their choice has been restricted using that process also follow the complaints process outlined in NHS England’s Freedom of Choice poster (PDF).

About the process for making a complaint:

• Complaints can be submitted anonymously or directly, and patients can request that their GP practice not be informed.
• They may also include other parties in their complaint, such as their pharmacy, system providers, NHS England, or Community Pharmacy England.
• NHS England and ICBs may also review anonymous complaints submitted in line with whistleblowing procedures.
• The complaints process also sets out how healthcare staff can raise concerns about issues related to patient choice. NHS England has delegated responsibility for managing patient complaints to Integrated Care Boards (ICBs).

Escalating concerns over technology and patient choice for IT solution providers

Patients, healthcare professionals, or others should contact system providers if their technology unintentionally limits patient choice, including fair access to pharmacies, or if they notice technologies used by others are unduly restricting free patient choice. Patient choice must be protected, regardless of the systems used by healthcare providers and patients.

NHS England assurance of IT tools which have completed PFS integration

Key points about patient choice and Patient Facing Services (PFS) (also known as “GP online services”) include the following:

• NHS England assures certain PFS functionalities, such as tools with these PFS features:
  1. Access to Electronic Health Records.
  2. Ordering repeat prescriptions.
  3. Booking GP appointments.
  4. Specific GP-practice communications to patients.

Some pharmacy owners provide apps, tools, or platforms that enable PFS for their patients. Pharmacy owners should explore ways to help patients leverage PFS, such as promoting the NHS App or equivalent tools that allow access to PFS without unduly influencing pharmacy choice.

See EPS nomination.

IT providers, website providers, and app developers offering tools that assist patients in selecting a pharmacy must provide balanced information to ensure patients can make fair and informed choices.

Patients should always retain the ability to decide whether to use an app and their preferred pharmacy.

Principles of patient choice of pharmacy within technical tools

The list:

1. Patients must be free to select a pharmacy of their choice to dispense their prescription or provide other clinical pharmacy services.

2. Patient sign-up for the nomination process or service must be separate and unbundled from any other sign-up procedures. It should also require proactive agreement (not a pre-ticked box).

3. Patient information using the NHS logo must not, directly or indirectly, direct a patient’s choice of pharmacy (take a patient’s choice of pharmacy) for dispensing or other pharmacy services.

4. Patient information using the NHS logo should follow the NHS England processes for nomination and freedom of patient choice.

5. Patient information must comply with the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 regarding nominations and the relevant NHS England service specifications.

6. Patient information provided by General Practitioners to assist with the choice of pharmacy must include a suitable and relevant  fair list o.

7. Pharmacies (including those using third-party apps) must have the informed consent or agreement of a patient to dispense the patient’s prescription and the provision of pharmacy services.

8. Pharmacies must comply with the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, specifically, the regulations on the nomination of prescriptions and prescription inducements (including when using third-party apps).

9. General practitioners must not attempt to persuade a patient to choose a specific pharmacy (as specified in the GP contract), including when using third-party apps.

10. The NHS logo should be used only in accordance with NHS identity guidelines, e.g., by service providers, and not by third parties.

11. The criteria for NHS-approved technologies, or any similar NHS approval procedure (NHS IM1 integration, NHS GP IT Futures, etc), and continued assured status, should be given/continued only if there is adherence to the above criteria (1-10).

The NHS Constitution guarantees patients’ continued entitlement to fair choice. Service specifications also outline service-specific arrangements to protect patients’ choices of a pharmacy.