EPS Nominations & Patient Choice

Terms of Service

The Terms of Service provide that a pharmacy owner must, if requested by a patient, nominate that patient in the NHS Patient Demographics Service (PDS) (paragraph 11 of Schedule 4 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. This is a familiar process for most pharmacies, and patient choice of nominated pharmacy underpins this requirement. In this context, that means, for example:

• Patients must be able to change their nomination without recourse to, or permission from, the currently nominated pharmacy, and
• Pharmacy owners or others must not automatically nominate patients or reverse patient nominations (automatically re-nominate patients), i.e. do so without patient consent.

Community Pharmacy England’s briefing, EPS nomination – core principles, provides additional information on patient nomination. Additionally, Community Pharmacy England has developed guidance for patient choice of pharmacy for clinical NHS pharmaceutical services.

Patient choice of nominated pharmacy is also supported across the NHS, as follows:

• NHS guidance for patients choosing a pharmacy states that ‘when you request a prescription online, you can have your prescription sent electronically to a pharmacy of your choice. This is called choosing a pharmacy (it’s also known as nominating a pharmacy)‘. Patients can also change their nomination within the NHS App.
• The General Pharmaceutical Council (GPhC) guidance on patient consent and the EPS states that deliberately changing a patient’s EPS nomination without their consent could be a serious matter. It can cause unnecessary delays to patients receiving medication, as well as undermining trust in the profession. It may also amount to a misuse of sensitive patient information in breach of data protection legislation … patients must give informed, explicit consent if they want to change their nominated pharmacy.

The purpose and intent of the various rules and guidance is that, as appropriate, patients should be able to nominate a pharmacy, to stay with their nominated pharmacy, or nominate another pharmacy.

Community Pharmacy England is also concerned that certain IT functionality available to some pharmacy owners appears to facilitate automatic patient re-nomination (without patient consent) and is discussing this issue with NHS England.

Community Pharmacy England has also launched a patient-facing website to promote several of the key Advanced services that pharmacy teams provide and to direct patients to pharmacies in England that provide these services. For more information, see Patient-facing website to promote NHS pharmacy clinical services

NHS England has updated its national standards on how pharmacy teams and IT system suppliers process nominations.

This follows renewed scrutiny of nomination practices and reinforces the principle that patients must be able to set or change their nomination freely, without pressure or unwanted intervention.

Nomination standards: Key points

The four overarching standards:

• Patients must choose their own nomination
• Patients must not be persuaded, and inducements cannot be offered
• Prescribers and dispensers will need to confirm, set, change, cancel and reconfirm a patient’s nomination in a timely manner
• Prescribers and dispensers must use clear processes for nomination

Other important key points:

• The nomination standards are clearly marked up as applying to technology providers and website managers where digital tools invite patients to make an EPS nomination-related choice.
• References to NHS App
• Clarification on the use of Patient Demographic Services nomination data (see just below).

NHS England clarifies how NHS nomination data can be used

NHS England clarifies the appropriate use of PDS nomination data within the guidance:

“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.”

NHS England writes to system suppliers

NHS England advised Community Pharmacy England that it has written to system suppliers to confirm this position and to request the removal of any functionality that does not comply.

NHS England’s approach with the updated standard and with the communications to IT suppliers is intended to:

• protect patient choice and privacy
• prevent unintended or inappropriate nomination changes
• ensure consistent behaviour across all pharmacy IT systems
• reduce queries to NHS England, GPhC and ICBs
• support public confidence in EPS and the NHS App, which enables change to nomination

This position also reduces the risk of “patient ping‑pong”, where nominations switch back and forth between pharmacies without the patient’s knowledge. The instruction also applies beyond EPS IT system suppliers to other types of pharmacy IT suppliers.

What does this mean for pharmacy teams?

Pharmacies can continue to set, change or remove a nomination, but only:

• when the patient (or their representative) requests it
• after providing clear information about EPS and nomination
• with an auditable record of who made the change (as captured in Smartcard logs)

Teams must not:

• routinely look up or monitor patient nomination status
• use tools that perform periodic, automated, or bulk PDS checks
• assume a patient wishes to stay with the pharmacy
• change nominations without explicit consent

Operational considerations

Some pharmacy teams may be used to system features that checked for nomination changes or restored previous nominations. NHS England has confirmed that these features should no longer operate, and suppliers are expected to disable them.

This may mean adjusting local processes – especially where teams previously relied on automated alerts to identify patients who had moved their nomination elsewhere.

Accidental nomination changes will still occur from time to time (for example, when a patient uses a different pharmacy during travel). Clear, consistent and ongoing explanations of how nomination works can help reduce confusion.

Our position

Community Pharmacy England supports patient choice and safe, transparent use of the Electronic Prescription Service (EPS).

The updated standards

The updated NHS nomination standards

Further information and guidance:

Patient Choice and IT

Nomination of patients (EPS)

News items:

Respecting Patient Choice for Pharmacy EPS Nominations

Reminder: Respecting EPS nomination principles and patient choice

For more information on this topic please email comms.team@cpe.org.uk