Nomination of patients (EPS)

NHS EPS Patient Nomination Protocols document

NHS England has issued revised Patient Nomination Protocols (v1.09), shared with the CP ITG in advance. The updated guidance clarifies how pharmacy teams, system suppliers and others must manage nominations and use nomination‑related information from the NHS Personal Demographics Service (PDS).

The changes reflect increased scrutiny of nomination practices and emphasise that patient choice must remain central. Patients must be able to select or change their nominated pharmacy freely, without pressure, unintended direction, or the use of technical means that could influence or pre‑empt their choice.

NHS England has confirmed within the document that:

“NHS Patient Demographic Services 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.”

This aligns with the long‑standing CP ITG position agreed previously that:

“Systems must not facilitate automated repeat checking of patients’ NHS Spine nomination settings for bulk contact to patients that have moved their nomination away from the dispenser in question. Use of EPS data has not been approved for this type of data flow.”

To protect patient rights and uphold NHS protocols, systems and pharmacies must not:

• Enable automated checks of a patient’s nomination setting.
• Monitor which pharmacy a patient is nominated to, unless the patient is actively changing their nomination.
• Store or apply any form of “enduring consent” intended to override or pre‑empt a patient’s future choice.

To uphold these requirements, systems and pharmacies must ensure they:

• Do not enable or use automated checks of nomination settings.
• Do not track or monitor patient nominations as part of normal workflow.
• Do not store long‑term consent that would override a patient’s ability to change pharmacies.

NHS England is working with system suppliers to ensure any non‑compliant features are removed and that future functionality aligns with the revised protocols.

These protocols apply not only to NHS bodies and pharmacy owners, but also to technology suppliers, who must ensure their systems do not encourage or allow activity outside the scope of the approved nomination model.

The updated document will be published shortly.

Core Principles Factsheet

NHS protocols outlines four key nomination principles within a one-page factsheet.

The poster

Poster on freedom of choice

Pharmacies must display the NHS poster explaining that patients are free to choose any pharmacy on their wall and within their website and apps include equivalent information.

DSPs should display the notice online or include it with home deliveries.

GPs should also display it or within their website and apps include equivalent information – where this relates to choice of a pharmacy.

NHS England previously wrote to general practices and pharmacies to reinforce this requirement and requested for these to be used going forwards.

Some LPCs and LMCs runjoint campaigns in which the locality is reminded of the need to promote these key messages about the freedom to freely choose a pharmacy.

Use of nomination data

EPS dispensing systems must not use nomination data for automated bulk‑checking or contacting patients who move their nomination.

NHS App feature

The NHS App includes a feature that lets patients view and change their EPS nomination.

Updating nominations in the NHS App helps reduce the time pharmacy teams and GP practices spend setting nominations. It also removes the need for patients to collect paper prescriptions, supporting social distancing.

Distance selling pharmacies (DSPs) require patients to register directly through the DSP’s website or by contacting them, because DSPs must capture more information than the NHS App provides.

When ordering repeat prescriptions, patients can select either a bricks‑and‑mortar (called within NHS App ‘high street pharmacy’) or a DSP (‘online only’). High street pharmacy selection requires a postcode search.

Read more at: NHS App.

One-off nomination

GP EPS systems enable one‑off nomination for scenarios such as:

• emergencies where a pharmacy temporarily closes;
• patients who prefer not to set a permanent nomination; and
• patients on holiday who cannot use their usual pharmacy.

Non-nominated EPS

Non-nominated EPS prescriptions (sometimes called Phase 4 prescriptions) let prescribers issue EPS prescriptions to patients without a set nomination. Nominated patients can also request these for urgent items if their usual pharmacy is closed.

Nomination is most suitable for patients who:

• receive regular medication; and
• usually collect medicines from the same pharmacy.

Patients using repeat prescription collection services or repeat dispensing are ideal groups to discuss EPS nomination with.

Benefits of nominating regular patients
Pharmacies that captured a high number of nominations before GP surgeries went live with EPS Release two saw smoother transitions and faster embedding of new processes.

Split prescriptions
Pharmacy teams should work with GP practices to identify patients whose prescriptions may be split between multiple prescribing systems, as nomination may complicate access for these patients. If the patient still opts for nomination, the prescriber can add a note to highlight any additional paper FP10s.

Overview of safeguards

The EPS nomination model includes important safeguards:

• Patients can still request a paper FP10 at any time.
• Prescribers must not steer patients toward particular pharmacies.
• Pharmacy owners must not offer incentives for nomination.
• NHS England monitors concerns and investigates potential breaches.

An explanation:

• GP Practices must comply with patient choice: Regulations require* that a prescriber must not seek to persuade a patient to nominate a dispensing site recommended by the prescriber. If a patient asks for a recommended pharmacy, the prescriber is to provide a list of all R2 dispensing sites in the area. The information about which pharmacies are EPS-enabled is provided by the NHS website therefore it is essential that pharmacy contact details held there are up-to-date and accurate.
• Pharmacy owners must comply with patient choice: Regulations** prohibit dispensers from providing patients with inducements to encourage nomination of a dispenser.
• ICBs must proactively monitor issues: ICBs have a duty to act on complaints about abuse of the service where the GP or pharmacy Terms of Service may have been breached. The EPS team may, where criteria is fulfilled, provide both summary and detailed reports about nominations to support the ICB investigation of complaints. See Patient Choice and IT.

*The National Health Service (Primary Medical Services) (Miscellaneous Amendments) Regulations 2005

**The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013

Consent templates

• Community Pharmacy England nomination form

Although a written form is not legally required, Community Pharmacy England strongly recommends keeping written consent for audit purposes.

Key messages when obtaining consent

Pharmacy teams must explain:

• EPS removes the need to collect paper prescriptions.

• Patients can choose any pharmacy and can change or remove nomination at any time: including whilst part way through a repeat dispensing cycle. Any remaining repeat prescriptions, which have not been pulled down to the local system, may be accessed by the new nominated dispensing site.
• Patients do not need computer or smartphone access to receive EPS. prescriptions

SOP

The NHS Nomination guidance states that an SOP must be in place for nomination.

Benefits of an SOP

• Ensures information is consistent;
• Provides auditable processes in case of queries or complaints.

Templates
NPA and Numark provide SOP templates.

ICBs may check that an SOP exists but should not approve or decline individual pharmacy SOPs.

Community Pharmacy England’s IT/ODS change checklist explains that ODS code changes may be required when ownership transfers occur on a non‑debts‑and‑liabilities basis.

IT system suppliers must be informed early, so technical changes can be coordinated.

Regardless of ODS changes, new owners must contact patients who previously nominated the pharmacy within the first six months to confirm they still wish to nominate that pharmacy.

More information on maintaining EPS continuity is available via Community Pharmacy England.

Changing a nomination

Nomination settings are stored in the Personal Demographics Service (PDS) on the NHS Spine. Pharmacies and GP surgeries with EPS systems can add, change or remove nominations once they have obtained informed consent.

If two pharmacies update a nomination, the most recent change prevails.

Using the NHS number
A patient’s NHS number is required to set or amend nomination. Most systems display this automatically, but staff may conduct a simple trace when needed.

Staff involved
Any staff member with their own smartcard and correct access rights can update nominations. This does not need to be done by a pharmacist.

Workflow considerations
Nomination updates can be done at any convenient point and do not need to coincide with dispensing.

Use of EPS data
Automated repeat checking of nomination settings is not permitted. However, manual checks can be made for appropriate clinical reasons.

Statistics

Community Pharmacy England and NHS Digital publish weekly nomination data for all pharmacies. This helps pharmacy owners and LPCs identify unusual changes and investigate concerns such as direction of prescriptions.

Useful stats links

• Weekly NHS Digital nomination data
• Example analysis (from past)

Sites that can nominate

After a nominated EPS prescription is generated, it is sent to the EPS and retrieved automatically by the nominated pharmacy’s IT system.

Patients or their carers can set up to three dispensing sites at any Release two‑enabled site:

• a community pharmacy;
• an appliance contractor; and/or
• a dispensing doctor.

Only one site of each type can be nominated. Patients cannot nominate a chain of pharmacies—only individual sites.

Patients may nominate any pharmacy, regardless of location.

Dispensing doctor arrangements
Dispensing doctors may only dispense where regulatory criteria are met. EPS cannot be used to dispense for ineligible patients, and nominations cannot be set to a dispensing doctor via another provider.

Keeping NHS website entries up to date
Accurate NHS website information ensures GP practices can select the correct pharmacy when setting nominations. Pharmacy owners should check details such as trading name and postcode. Update requests for core details must be made to the local NHS England team; other profile edits can be made directly.

‘What If’ case study for pharmacy sites that can be nominated:

Scenario: A patient normally nominates Pharmacy A but requests a one‑off nomination to Pharmacy B.

Changing nomination to Pharmacy B moves all non-downloaded prescriptions from Pharmacy A to Pharmacy B. If the nomination is switched back too early, the intended one‑off item may return to Pharmacy A. Alternative approaches include:

• issuing a paper FP10;
• asking Pharmacy B to change the nomination back to Pharmacy A once dispensing is complete; or
• adding a message in the EPS note to flag the intended temporary change.

Patient choice and nomination FAQs

Q. Does consent have to be obtained to change a patient’s nomination settings?
Yes, it is a professional requirement. The Code of Ethics states that pharmacists must obtain consent for the professional services, treatment or care they provide and the patient information they use. The RPSGB document, ‘Professional Standards and Guidance for the Sale and Supply of Medicines’ contains standards for prescription collection services and the RPSGB document, ‘Professional Standards and Guidance for Patient Consent’ details more general requirements on collecting consent from patients for the provision of services, including guidance on providing sufficient information and presenting this to patients. Failure to adhere to these standards could form the basis of a complaint of professional misconduct.

Q. Does consent always have to be given by the patient?
No, in some circumstances, consent can be obtained from the patient’s representative on behalf of any:

• child by either parent, or in the absence of both parents, the guardian or other adult who has the care of the child;
• person under 18 years of age who is in the care of an authority to whose care he has been committed under the provisions of the Children Act 1989, by a person duly authorised by that authority or in the care of a voluntary organisation, by that organisation or a person duly authorised by them;
• adult who is incapable of nominating a pharmacy, by a relative or the primary carer of that person;
• person by any duly authorised person.

A pharmacy contractor is not able to provide consent on behalf of a patient nominating his pharmacy.

Q. My pharmacy serves a large care home. Do the patients need to provide their consent to nominating my pharmacy or could this be done by care home staff?
The regulations state that patients or in some cases their carers can set a patient’s nominated dispensing site, therefore the care home staff can on behalf of the patient provide the required consent for the patient’s nomination setting to be changed.

Q. Do I have to change my Standard Operating Procedures?
Pharmacies must have ‘local accountable auditable processes’ for obtaining explicit consent before changing a patient’s nomination settings.

The RPSGB publication ‘Professional Standards and Guidance for Patient Consent’ advises that processes for obtaining consent must be taken into account when developing SOPs and that consideration needs to be given to which members of staff may obtain consent, the information that should be provided in obtaining consent and the way that consent is collected (e.g. written, verbal).

Both the NPA and Numark have developed template Nomination SOPs.

Q. How long should I keep a nomination consent form that has been signed by the patient?
Pharmacies must have ‘local accountable auditable processes’ for obtaining explicit consent from the patient or their representative before changing a patient’s nomination settings. Whilst it is not mandatory for a pharmacy to collect a patient signature to confirm consent, this has been recommended by the Royal Pharmaceutical Society. The collection of a signature will support the pharmacy by providing an audit trail in the event that a complaint is made about the pharmacy’s use of the service.

It is for a contractor to judge how long forms should be kept for, balancing the need for an audit trail against the 5th Data Protection principle of not keeping information longer than necessary. Note, if the patient chooses to change their nomination setting at another pharmacy, the original nominated pharmacy will not be alerted to this. There is scope for PMR systems to generate reports of patients regularly receiving prescriptions at the pharmacy via the nomination functionality which will help identify patients with ‘active’ nominations.

Q. I have an existing repeat prescription collection service. Do I need to obtain consent to change the patient’s nomination settings to nominate this pharmacy as their preferred pharmacy for electronic prescriptions?
Yes. Explicit consent must always be obtained from the patient or their representative before changing a patient’s nomination settings.

Explicit consent can be collected in advance of the pharmacy deploying Release 2. If there is a delay between collecting consent and changing the patient’s preference on the Personal Demographics Service, the pharmacy contractor should ensure there has been no change in the patient’s circumstances, including their choice of nominated dispensing site, since the original consent was obtained.

Q. Can I provide patient’s with loyalty points or a free gift if they choose to nominate this pharmacy?
No, the Terms of Service prohibit pharmacies and appliance contractors from providing patients with inducements to encourage nomination of a pharmacy. A breach of the Terms of Service could result in the Primary Care Trust taking disciplinary action against the pharmacy contractor.

Adding or changing a patient’s nomination

Q. What if a patient changes nomination but their prescriptions had been for another pharmacy?

Where a patient changes their nominated dispensing contractor, all nominated prescriptions that have not yet been retrieved (downloaded or ‘pulled down’) for dispensing from the original nominated dispensing contractor will be transferred across to the new nominated dispensing contractor. Once a nomination has been set, there is no ‘expiry’ date on the system.

Q. Will the pharmacy team be notified of a patient changes their nomination choice from our pharmacy to another?

No. Pharmacies will not be notified when they have been nominated or when the patient changes their nomination setting. However, pharmacies can, with patient consent, query a patient’s list of nominated dispensing sites, for example to aid patients who are trying to obtain their medication at an incorrect location.

Q. What controls are in place, regarding my access of patient information held on the PDS on Spine?

Every time someone accesses information held on the Personal Demographics Service, a record is made about who is accessing that data and how it is being used. This would include when a pharmacy queries a patient’s list of nominated dispensing sites. Privacy officers, in specific circumstances, are automatically alerted when actions have been taken by staff which may constitute a breach of confidentiality.

Q: Can patient patients currently nominate a Distance Selling Pharmacy (DSP) directly in the NHS App?

While the NHS App allows patients to nominate bricks-and-mortar pharmacies instantly, DSPs require a different process because B&Ms and DSPs have differing processes. DSPs have fed back that they need to first collect key information from patients—such as delivery details, contact information, and payment or exemption status—before they can apply a nomination. This makes the process more complex and less suited to a one-click experience within NHS App.