Spotlight: The battle for EPS nominations — transcription

[Music]  

Carolyn Wickware: Picture this. An 85-year-old woman in Manchester, we’re calling her Inaaya — though that’s not her real name — is expecting her usual dosette box of medicines, sorted and ready to take from a pharmacy she’s used for years.  

[Doorbell rings]

Instead, a delivery driver she’s never met leaves two months’ worth of loose blister packs on her doorstep. She doesn’t speak English. She has no idea what’s happened or why.  

Her regular pharmacy team didn’t understand it either. Until, that is, they realised her prescription had simply stopped coming to them and started going to another pharmacy without her knowledge and without her consent.  

That’s the opening scene of our recent investigation into electronic prescription service, or EPS, nomination switching. As it turns out, Inaaya’s experience is far from a one-off.  

Welcome back to The PJ Pod, brought to you by The Pharmaceutical Journal, the Royal College of Pharmacy’s official journal.

This is a spotlight episode, where I sit down with one of our journalists to go behind a story for the details on what they found and how they found it.  

I’m Carolyn Wickware, executive editor at The Pharmaceutical Journal, and today I’m joined by our investigations editor, Joanna Robertson, whose feature, ‘Electronic prescription service: the battle for nominations’, is live on The PJ website now. Welcome, Joanna.  

Joanna Robertson: Hi, Carolyn. Thanks for having me on the pod today.  

Carolyn: Let’s start with the basics. For anyone who isn’t familiar with EPS, what is an EPS nomination and what do we mean when we say it’s been switched or even stolen?  

Joanna: Yeah. So, EPS is the system that connects patients with their nominated pharmacy. So that’s the pharmacy that they’ve asked for their prescriptions to be sent to. So once the GP has issued the prescription, the pharmacy receives it, they’ll process it, source the medication and then either deliver it to the patient or have it ready for collection.  

In England, pretty much all NHS prescriptions issued by a GP go through this system. But in other UK nations, there’s still a mixture of paper prescriptions and electronic systems in play.  

So, a patient can change their nomination at any time. So, you might do this if you’re on holiday somewhere else in the UK when your prescription’s issued, or maybe if you sometimes live elsewhere for work or university. The key thing is that it’s the patient who decides where their prescription goes. NHS England is really clear about this. Nobody else is allowed to change it unless the patient requests it, and no pharmacy or GP should direct a patient’s prescriptions to a particular pharmacy without them saying so.

This connection between a patient and their nominated pharmacy is often so much more than just an admin plugin. There’s often a relationship there. Pharmacies look out for their more vulnerable patients. They help them get their medication in the most accessible way. They make sure that they understand how to take it. They might advise patients on any side effects or any issues that they might have. So, you’ve got that real two-way relationship between the pharmacy and the patient.  

Carolyn: So how did this land on your desk? What first made you think that there was a story here?  

Joanna: Well, the issue of prescription nominations has always been really important to pharmacies, both because of that relationship I’ve described and because the margin that pharmacies make on medicine supply is part of their income. So, there’s always been concerns about things like GPs directing patients to one pharmacy over another. But what’s new this time is the suggestion that EPS nominations are being changed from the back end, so by someone within the system and without patient consent. So since about March this year, I’ve heard reports from various pharmacy contacts describing a similar pattern. Contractors said they were seeing patient nominations being changed — often in bulk — but they had no idea why. And patients were reporting distress and disruption because of it.  

Carolyn: Since March, right. That’s quite a long time.  

Joanna: Yeah. Well, it actually seems like it’s been going on for even longer than that. So, when I started looking into the issue more, I found that the GPhC, so that’s the General Pharmaceutical Council, the pharmacy regulator, had flagged concerns publicly back in October 2024. But when I spoke to one pharmacy IT supplier, I heard that the issue had been ramping up in the last year. I’ve also heard pharmacists in the last few months raise the issue completely unprompted at conferences, so in question times, for example.  

Carolyn: So, October 2024, that’s a long time for patients and pharmacists to be struggling through this. Talk us through how you found Inaaya’s case.  

Joanna: Yeah, so I’d heard about the issue from pharmacy suppliers and contractors, but I really wanted to understand what the impact was on patients. I found Inaaya’s case through a lot of connections. So, I spoke to an IT supplier who put me in touch with some of their customers — so, pharmacy contractors — who’d reported the issue, and one of them put me in touch with Medinet Pharmacy. So, it was really a case of someone who knows someone who knows someone who’s been talking about this issue. In a lot of cases, pharmacy contractors within a local area are speaking to each other about the issues, whether it’s to try and resolve individual concerns for a patient or to keep track of instances of this happening so that a more formal complaint can be made.  

Carolyn: That’s really impressive work you’ve done there.  

Joanna: Yeah. I mean, it’s really just a case of someone telling me about someone else. I ended up speaking to Sadaf Khan, who was a pharmacy technician at Medinet Pharmacy, and she just shared a few stories of patients, which really brought home the impact that these EPS switches had on them. We’ve anonymised some of those into the character of Inaaya in this story. Speaking to Sadaf also gave an insight into how pharmacy teams experience this issue. So often the first they hear about it is when a patient shows up at their pharmacy confused, and, since the nomination has been changed, it’s difficult to know how to help them. Sadaf said she can spend at least a good five hours a week trying to sort these cases. She said sometimes she sees four to six affected patients a day, and sometimes the same ones repeatedly.  

Carolyn: That’s a huge amount of time that they’re spending on this issue.  

Joanna: Yeah.  

Carolyn: One of the more unsettling sections of the piece, I thought: “Is the idea that some of these switches aren’t one-off mistakes, but something that pharmacies are automating. Can you walk us through how that’s happening?”  

Joanna: I first heard about this as a bit of a suspicion that people had. As I said, there’s often conversations going on locally to try and resolve the issues. Sadaf told me about a local practice manager at the GP surgery who she was trying to nominate a patient back to their preferred pharmacy as they’d requested, and then she’d actually just sat there and watched it on the screen be switched back again and again over the course of a day.  

Carolyn: Wow. 

Joanna: Mm. Another contractor reported something similar. They’d also switched the patient back at their request, and then minutes later, it had been switched back to this other pharmacy. So, both of them said watching it happen in real time set alarm bells ringing that some sort of automated system might be at play.  

Carolyn: Really sounds like a creepy experience for them.  

Joanna: Yeah, absolutely, with absolutely no control over what was happening and where this nomination was going.  

Carolyn: Mm-hmm.  

Joanna: So, I dug into a bit more, and it does seem like it’s more than just suspicion and speculation. An official statement from Community Pharmacy England in February spoke about “certain IT functionality allowing automatic re-nomination without patient consent” and even said: “Some pharmacy teams may be used to system features that checked for nomination changes or restored previous nominations.” It then went on to say: “NHS England has confirmed that these features should no longer operate, and suppliers are expected to disable them.”  

Carolyn: Well, I guess it’s good that they’re taking some action or taking some stance on it.  

Joanna: Yeah. So, NHS England have also written to IT system suppliers to request the removal of any functionality that does not comply with its patient nomination standards, which really emphasise the centrality of patient choice.  

Carolyn: And in your story, you wrote that the GPhC has suggested this isn’t accidental at all, that there’s a financial driver behind it. What did people tell you?  

Joanna: Yeah. So, of course, accidental nomination changes or mistakes, they do happen.  

Carolyn: Yeah.  

Joanna: And the NHS standards do acknowledge that. But I think what we’re talking about here is something quite different. It’s the scale of the nominations, and it’s that automatic re-switching. So yeah, as I said, as early as October 2024, the GPhC said: “We’ve received concerns which suggest that pharmacy employees are changing the nominated pharmacy without patient consent.” And then this is interesting, “potentially to increase patient numbers and revenue”.  

Carolyn: Wow, that doesn’t seem very ethical.  

Joanna: I mean, it’s not. I guess you can understand potentially where the drive for wanting more patient numbers comes from. So, the number of nominations a pharmacy has, it does impact their income, and we know that pharmacies are really squeezed financially at the moment as well. From the IT supplier side as well, so the people that are actually creating these systems, I spoke to one chief executive of a supplier, Cegedim, and she told me that there’s the issue potentially of a “race to the bottom”. So, if one IT system or pharmacy starts doing this, then those that aren’t doing it are at a bit of a business disadvantage, because they’re losing out on that income because they’re sticking to the rules.  

Carolyn: And there are rules, aren’t there?  

Joanna: Yeah. So, the NHS and GPhC guidelines on this are really strict. And most pharmacists I know have a huge amount of integrity, that’s really important to the profession, and they’ll always put patient safety and patient experience ahead of financial reward. As an example of that, I spoke to Malcolm Harrison, chief executive of the Company Chemist Association, for this investigation, and he said: “Yeah, community pharmacies are operating in an extremely challenging financial environment, but this can never justify practices that undermine patient choice or trust.”  

Carolyn: Okay, right. So, it’s not everyone who’s participating in this.  

Joanna: No, absolutely not.  

Carolyn: So, at this point in your investigation, you’re certain there’s an issue. Pharmacists, companies, organisations on all sides have confirmed. But what I really want to dig into is the data, because to me, that’s where you took the story to the next level. Tell us a bit about the Freedom of Information requests you sent to ICBs [integrated care boards].

Joanna: Yeah. Well, before I go onto that, I’ll tell you what I thought would be an easy way to shine a light on this.

Carolyn: Yeah, please do.  

Joanna: So, the EPS data is all there, it’s collected, it’s published weekly by NHS England. So, I thought: “Well, this will be pretty simple to visualise, and we’ll be able to identify pharmacies that are losing huge numbers of patient nominations and others that are gaining them, and the story will pretty much tell itself from the data that is publicly available.” 

Carolyn: Yeah, and you spent quite a bit of time on that data.  

Joanna: Yeah, to no avail, really. These NHS England figures, they show a snapshot at the end of the week, how many nominations each pharmacy has. But as I’ve already described, and as people told me, these switches are happening in a much tighter timeframe than that. So, within that week, nominations could be changing one day, pharmacies trying to fix it as soon as they notice it, but then sometimes the nominations are being switched back automatically within minutes. None of that back and forth is going to show up within a snapshot report that only captures the final numbers at the end of the week.  

Carolyn: Right. So that data wasn’t very helpful. What did you do next?  

Joanna: Yeah. So then I thought: “Well, where is this going to show up, all this kind of tinkering behind the scenes?” I decided to start looking into complaints about the issue.  

Carolyn: That was a very insightful pivot, I thought.  

Joanna: Thanks. Yeah, well, complaints, numbers of complaints, that’s something that we can get solid data on. NHS England standards say ICBs are responsible for monitoring nominations and handling complaints. So, I thought: “Okay, people have got to be complaining to their ICBs about this issue, so complaint numbers received by ICBs should reflect the scale of the problem.”  

Carolyn: Right. Makes sense.  

Joanna: Yeah. But that’s not publicly available in the same way that the EPS data is. So, what I had to do to get hold of that was send Freedom of Information requests to every ICB in England. And they’ve all changed recently, so I had to do a bit of digging to find out who was the best contact details for all of them. But I asked each of them how many formal complaints they’d received about inappropriate EPS nomination switching in the last year — so I looked at the date range between June 2025 and June 2026.  

Carolyn: And how did that go?  

Joanna: Yeah, pretty well. Not every ICB responded, but most did. Not all of them could share the exact number, but overall, there were at least 150 complaints about this issue to ICBs across England.  

Carolyn: Complaints from who?  

Joanna: Well, not every ICB noted the source of the complaints, but some of them said that they’d come from patients. One of them noted that it’d come from a GPhC inspection, and also some of them noted information about what had happened to the complaints. Some of them had been resolved — at least one was still unresolved a year on from when it was made.  

Carolyn: Wow.  

Joanna: Yeah. Another really interesting thing is that there does seem to be some regional variation in these complaints. So, obviously, we’re tracking it by ICB, so we can get a general sense of where these complaints are being made and potentially give an indication of where the issue is most widespread. So, most of the ICBs reported between 0 and 5 complaints about EPS nominations within the last year. One reported 10, so I thought: “Okay, that’s quite a bit more.” Another one reported 14. And then I got a response from Greater Manchester ICB. So that’s actually the area where Inaaya and Mendinet Pharmacy and some of the pharmacies I spoke to for my original investigation are based, and they said they received 92 complaints about the issue in the last year. 

Carolyn: Wow. Why was there so much variation?  

Joanna: Well, that’s consistent with the conversations I’ve been having with pharmacists and contractors on the ground. Some people will say this is a huge issue for them, like Sadaf, who said she’s spending hours every week dealing with it. But some contractors, they’re not seeing this bulk nomination or this automatic renomination.

So, what the data doesn’t tell us is whether these areas like Greater Manchester are saying they’ve had more complaints because the issue is happening more, so people are complaining more, or maybe because there’s a bit more of a coordinated response to the issue, so contractors and patients are being encouraged to make a formal complaint. And so, maybe the issue is just being recorded more.  

Carolyn: Right. Okay. So where does responsibility formally sit here? Are ICBs enforcing the rules? 

Joanna: Yeah. So, NHS England updated their standards relating to EPS nominations in 2026, and in those standards, they say ICBs and NHS England have overall responsibility for monitoring nominations and ensuring complaints are dealt with fairly.  

Carolyn: And are they?  

Joanna: Yeah, the ICB pharmacy lead in Manchester, which is that area that had a huge number of complaints, told me that they take such cases extremely seriously. They’ve got a Pharmaceutical Services Regulations Panel to review the evidence and take action. So, it does sound like they’ve got something in place and they’re aware that it’s an issue. The fact that NHS England has so recently updated those standards as well, in May 2026, that also feels like it’s something on NHS England’s radar as well, and they’ve been quite strong on issuing statements, as has GPhC, to reinforce that patients must choose their own nomination and that changes can’t be made without patient consent.  

GPhC also said that this could be a fitness-to-practice issue if a pharmacist was discovered that they’d been doing this, changing patient nominations without consent.  

Carolyn: So potentially, there are some consequences for pharmacists.  

Joanna: Yeah, well, there’s definitely pathways in place for this to be dealt with. I haven’t heard of a case where this has happened, that’s the thing.

Carolyn: Mm-hmm  

Joanna: So, I guess, maybe these complaints are still working their way through the system, and it will lead to some kind of enforcement action down the line. I guess that remains to be seen, really.

There’s been hints of more action to come in the future as well. In the latest community pharmacy contract, the Department of Health said that it was going to explore possible actions against a small number of pharmacy owners misusing nominations. So, we can stay tuned for that as well and see if there’s anything stronger in terms of regulatory powers that might come in.  

Carolyn: Right. Interesting.  

Joanna: I think for me, the take-home really was the value of making a formal complaint. As I said, we don’t know whether there’s more complaints in some areas than others because it is happening more or because just people are complaining more. But what became really clear to me is that the complaints seem to be the only way that we have of actually understanding the scale of the issue.  

Carolyn: Definitely. 

Joanna: So, if you’re listening, if you’re a pharmacy owner or a pharmacy team member or a patient who this has happened to, it really is worth making that complaint to the ICB or to the GPhC or both, because that seems to be the only way that the scale of the issue can really be monitored.  

Carolyn: And making those complaints, it’s the only way that you can write great stories like this, and it’s clearly one that we’ll want to keep on top of.  

Joanna: Mm, definitely. So, if any patients, pharmacy team members, any listeners have got a story about this that they want to share, I’d love to hear about it. I think we’ll put our email address in the show notes.  

Carolyn: Yeah, we’ll put your contact info in the show notes.  

Joanna: Great.  

Carolyn: We’ll also leave a link to Joanna’s full feature, ‘Electronic prescription service: the battle for nominations’, in the show notes as well, in addition to her follow-up investigation into complaint numbers.  

Joanna: Sounds great. Thanks.  

Carolyn: Joanna, thank you so much for talking us through it. It’s been great having you on the pod.  

Joanna: Thank you for having me. It’s been fun to share what I did.  

Carolyn: And thank you for listening to this spotlight episode of The PJ Pod. Get in touch with us using #PJPod or email editor@pharmaceutical-journal.com if there’s a story you think we should be looking into. That’s it for now. See you next time.  

Joanna: Bye. Thank you.  

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Carolyn: You’ve been listening to The PJ Pod, brought to you by The Pharmaceutical Journal, the Royal College of Pharmacy’s official journal.  

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