Ordinarily, 85-year-old Inaaya* would receive her medication in a dosette box, sorted by her local pharmacy, ready for her to take at the right dose, at the right time. One day, however, a different delivery driver dropped off her medicines and, rather than being carefully arranged into her regular doses, two months’ worth of blister packs were left on Inaaya’s doorstep, still in their boxes.
Inaaya went to her regular pharmacy — Medinet Pharmacy in Manchester — looking for help and to find out what happened. The pharmacy staff were just as confused; as one of their vulnerable patients, they had been expecting to fulfil Inaaya’s next repeat prescription, but it never came through.
“We’re waiting for this prescription to drop down [from the spine], and this patient then comes to with us with a bag full of medication, confused as anything, doesn’t speak the language, so I had to get a local interpreter to find out what was going on,” explains Sadaf Khan, pharmacy technician at Medinet Pharmacy.
It became clear that Inaaya’s electronic prescription service (EPS) nomination had been changed, without her awareness or consent, and another pharmacy had dispensed her medication, Khan says.
The issue has been getting worse over time and is affecting patient safety as well as pharmacy and GP workload, she adds.
“Today we’ve had four patients that have gone to different pharmacies that I’m going to have to now chase up,” she says. “On a daily basis it can be five, sometimes six patients, and then sometimes it can be the same ones again and again.”
Khan says she spends “at least a good five hours” per week fixing the issues caused by nomination switches.
Why are nominations changing?
Since March 2026, The Pharmaceutical Journal has heard reports of EPS nomination switching for a variety of reasons — some of which may be accidental, but others that may be driven by a financial motive.
David Porter, pharmacy contractor at Harrison Healthcare in Ellesmere Port, Cheshire, says he noticed nominations “plummeting” as a variety of factors changed locally, including a pharmacy moving into a local GP surgery premises and a previously closed pharmacy re-opening under new ownership (see Box 1 and 2).
“For the first between four and eight weeks it could have been 50 patients every single week, and it was causing us absolute chaos, trying to chase up the prescriptions and find out where they were, and get them back,” Porter says.
Porter suggests some of his patients’ nominations had been changed when they went to collect an acute prescription from a different pharmacy to their usual one or had been changed back to pharmacies which they had previously nominated but then moved elsewhere.
In some cases described to The Pharmaceutical Journal, nominations appear to have been changed for patients who have had no previous contact with the new pharmacy at all.
Box 1: Can new owners re-nominate former patients?
‘EPS nomination: standards that must be followed’, published and updated regularly by NHS England, state: “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 six 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.”
The standards add that new owners must reconfirm a patient’s nomination “in a timely way” when a pharmacy changes 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.”
Box 2: Can a GP send a patient to a particular pharmacy?
Speaking to The Pharmaceutical Journal, one pharmacist explains: “Another pharmacy in the area relocated into the doctor’s surgery, and ever since then our nominations are plummeting.”
NHS England standards are clear: “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 the electronic prescription service.”
The standards add that patients “must not be influenced or persuaded to nominate a specific dispensing contractor”, including through using incentives such as discounts.
Financial drive
Nomination changes are unlikely to be made accidentally by a pharmacy, the General Pharmaceutical Council (GPhC) has previously said.
Instead, the regulator suggests that pharmacy employees are changing nominations “potentially to increase patient numbers and revenue”.
Porter agrees: “You can see every week if you’ve got plus or minus nominations, so their bosses will see if they’re gaining or losing patients, and if they’re gaining patients, I’m sure their bosses are happy.”
With financial pressures on pharmacies worsening by the day, Porter says this is placing even greater scrutiny on EPS nominations from all players.
“I think the pharmacies are much, much keener to try and do more items, but there’s financial pressures that are put on us, and if you’re not busy, you’re going to close,” says Porter.
Community pharmacies are operating in an extremely challenging financial environment, but this can never justify practices that undermine patient choice or trust
Malcolm Harrison, chief executive of the Company Chemists’ Association
“Community pharmacies are operating in an extremely challenging financial environment, but this can never justify practices that undermine patient choice or trust,” says Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA).
“Most pharmacies act professionally and always place patient choice ahead of their own business considerations.
“However, reports of behaviours that appear to bypass consent are concerning,” he adds, urging commissioners and regulators “to investigate any incidents where providers cannot clearly demonstrate that consent has been obtained”.
The GPhC says has been monitoring the issue of inappropriate EPS nominations for some time. In October 2024, it said it had received “a number of concerns about changes to EPS nominations without patient consent”.
At the time, the GPhC said: “When we receive a concern about the EPS nomination process, we consider several factors before deciding whether to refer the concern to a fitness-to-practise investigation, or to the NHS to investigate.”
The regulator added that ignoring the principle of patient consent may be treated as misconduct for the purposes of fitness to practise.
Auto-nomination
While “discussing this issue with NHS England”, Community Pharmacy England (CPE) said in February 2026 that concerns had escalated over the past year that “certain IT functionality available to some pharmacy owners appears to facilitate automatic patient re-nomination (without patient consent)”.
Khan says she suspects something like this is happening in her local area. A patient who had recently moved complained to local GP surgery Wilmslow Road Medical Centre in Manchester, after her nomination was set as a pharmacy that she had not previously interacted with.
At the patient’s request, the practice manager changed the nomination and monitored it as it changed back to the previous pharmacy repeatedly over the course of the day.
It’s to a level where it makes me think… it’s something automated
Bilal Nazir, a pharmacist at Mauldeth Pharmacy, Manchester
“It was literally multiple times it was being taken over, which then made us think, is there some kind of a system that they’ve got in place that triggers when a patient is changed over and it does it automatically?” Khan says.
Bilal Nazir, a pharmacist at nearby Mauldeth Pharmacy, has similar concerns.
“It’s to a level where it makes me think… it’s something automated,” he says.
“I would nominate the patient back to me now after having spoken to the patient, and within two minutes I check, and the nomination is changed again.”
In July 2026, CPE reminded community pharmacy teams about “the importance of aligning with the EPS nomination principles and upholding patient choice at all times”.
It said NHS England had written to system suppliers to request the removal of any functionality that checks for nomination changes or restores previous nominations.
Tracey Robertson, managing director of pharmacy IT system Cegedim Rx, says that over the past year, the company has seen “increasing concern from contractors about unusually large volumes of nominations moving in very short periods of time”.
“Much of this appears to be driven by automated technology capable of processing nomination changes at scale,” she says.
“The vast majority of community pharmacies work incredibly hard to build trusted relationships with their patients. Those relationships should never be undermined by technology that allows nominations to be switched without a patient’s genuine knowledge or consent.
She adds that IT suppliers that have chosen not to implement this technology “are beginning to feel commercial pressure” to do so in order to remain competitive, which “creates a race to the bottom that benefits nobody, least of all patients”.
“Technology suppliers have a responsibility to design systems that protect patients, not exploit loopholes for commercial gain. If a platform enables the large-scale movement of nominations without robust safeguards around patient consent, then that supplier must accept responsibility for the consequences,” she says.
Formal complaints
NHS England standards on EPS nomination — which were updated in May 2026 — are clear: “Patients must choose their own nomination. There must be no changes made to a patient’s nomination unless the patient has requested it.”
The standards also state that integrated care boards (ICBs) and the NHS “have overall responsibility for monitoring nominations and ensuring that complaints are dealt with in a fair and equitable way”.
Alison Scowcroft, assistant director of medicines and pharmacy for NHS Greater Manchester — where Medinet and Mauldeth pharmacies operate — says the ICB “takes complaints regarding patient EPS nominations being changed without explicit patient consent extremely seriously and has a robust process in place to review them”.
“We gather evidence and data, and submit to our pharmaceutical services regulations panel to agree any actions required to address such matters.
“We also work closely with the local pharmaceutical committee — Community Pharmacy Greater Manchester — to provide information and support to community pharmacies who are impacted by these issues.”
But, despite frequent anecdotal reports from pharmacies about the issue, when The Pharmaceutical Journal made freedom of information requests to ICBs across the country for information on formal complaints regarding EPS nomination switching, they reported low numbers.
Responses revealed that there were six EPS nomination complaints made between June 2025 and June 2026 across the seven ICBs within the South West of England region, and none in Kent and Medway ICB.
A spokesperson for NHS Lancashire and South Cumbria ICB said it had received one complaint in the past year that could fit the description of “EPS nomination theft”.
“For any complaints of this nature we would follow advice given by NHS England, who we understand are now looking into this issue nationally,” the spokesperson confirmed.
In Derby and Derbyshire ICB, two complaints relating to EPS nominations were received in the year to June 2026. One, which has now been resolved, related to a GP practice changing the patient’s nominated pharmacy when the regular one was unable to fulfil a prescription.
CPE guidance acknowledges that this can happen accidentally — for instance, a nomination being changed rather than a prescription being sent to a different pharmacy as a one-off, such as when a patient is travelling — but stresses the importance of patient choice in all situations.
The second complaint to Derby and Derbyshire ICB was raised on 10 July 2025 by an assessment officer at the GPhC. The complaint was passed on to the ICB’s regional pharmacy, optometry and dentistry team, but had not yet been resolved.
In the latest community pharmacy contract, the Department of Health and Social Care pledged to explore possible actions that would “help address inappropriate management of electronic prescription service nominations by a small number of pharmacy owners”.
However, until further action is taken, contractors are “fighting for every item” and patients are being impacted, Porter says.
“Yesterday three patients came in [with nomination issues]. One of them has never set foot in one of these other pharmacies. He didn’t have any acute prescriptions. He had nothing and his prescription found itself in another pharmacy.
“And then he stands in front of us with no medication, and we’re trying to phone the pharmacies to get them back,” he tells The Pharmaceutical Journal.
“They’re reluctant to send it back. It’s just a nightmare.”
*Name has been changed
