Patient nominations are highly prized. And it’s easy to see why. For every 300 to 500 new patient nominations a pharmacy can reportedly gain anywhere from £10,000 to £15,000 in gross profit. But that only scratches the surface of their full financial return.
Repeat prescriptions mean returning customers making OTC purchases and accessing NHS and private clinical services.
It’s these patient relationships – built often over years and with deep levels of trust – that are helping to keep many pharmacies afloat.
So, imagine the devastation for a pharmacy when hundreds of these hard-earned patient nominations vanish seemingly overnight.
It’s a reality that sadly lots of pharmacies are now facing. EPS nominations stolen on an industrial scale using automated, bulk re-nomination technology.
Desperate measures
The loss of the odd patient nomination isn’t a new challenge for pharmacies. It’s natural for fluctuation. Patients can change their consent about their nomination at any time.
Read more: ICB investigating pharmacy nominations ‘without consent’
But when pharmacies notice large numbers of nominations changing – in many cases repeatedly and over a very short period – alarm bells start to ring that these are likely being made without the patients’ knowledge, let alone consent.
Running a pharmacy has never been more challenging than it is today. Using automated, bulk re-nomination technology is a sign of desperate pharmacies taking increasingly desperate measures to make ends meet. But there’s much more than money at stake.
Serious breach
Patients trust community pharmacy with their health and their data. Moving an EPS nomination without consent is not just a breach of that trust and NHS guidelines – it’s potentially putting patient health at risk and the reputation of community pharmacy under a deeply uncomfortable spotlight.
Read more: Petition launched to stop bulk EPS auto-renominations on NHS
We recently hosted a round table discussion among pharmacy owners and leaders on this very issue and the experiences they shared were sobering.
Vulnerable patients left upset, confused and bearing the brunt of inevitable dispensing delays unconsented nomination switching causes.
And overwhelmingly the feeling among our panel was that it’s just a matter of time before more serious patient harm is caused.
Nomination war
But let’s be clear, this practice couldn’t have grown as prevalent if it wasn’t for the technology providers powering it.
These providers have not only ignored the strict guidelines in place to prevent unconsented nomination moves. They’ve gone a step further - exploiting community pharmacy and enabling their customers to gain new patients unfairly and unsafely.
From the archive: Contractors highlight fears over EPS nominations abuse
They have invested in functionality that puts growing their own, and their customers’ market share first. When they should be focused on powering patient care and continuity of service.
The industry response has often compounded the issue. Technology providers - who previously strictly adhered to guidelines – are now feeling pressured to introduce similar functionality so they can remain competitive.
Replicating functionality that bypasses consent to keep pace with competitors does not make the practice acceptable. It simply accelerates its spread. It normalises behaviour that undermines the very safeguards designed to protect patients and maintain trust in the nomination system.
I passionately feel that health technology providers have a responsibility to operate to the highest standards and ethics.
Read more: ‘No plans’ to allow DSP nomination on NHS App
We’re helping support the delivery of frontline care, guiding pharmacy teams in challenging and high-pressure situations, and that’s a privilege we should not lose sight of.
A call for greater visibility
The rise in nomination theft has also prompted many contractors who are following the rules, and doing the right thing, to ask for guideline changes to level the playing field and better safeguard patients.
Specifically, a change which would see patient information surfaced so they can make contact directly with those who they suspect may have experienced an unconsented nomination switch.
But currently, once a patient’s nomination has been changed, the previously nominated pharmacy should not contact the patient to encourage them to switch back.
Read more: Contractors highlight fears over EPS nominations abuse
The nomination system is designed to protect patient choice, and pharmacies mustn’t use EPS data or system functionality to bulk identify and target patients who have moved their nomination.
Any change around this demands balance. On the one hand pharmacies want to make sure nominations are genuinely consented. But on the other, they must respect the principle that nomination is patient-led and avoid anything that could undermine patient choice or communication boundaries.
For pharmacies and technology providers alike, healthy competition sparks greater levels of innovation. It drives us all to become better.
But enabling or carrying out nomination theft doesn’t fall into the category of healthy competition. It’s exploitative and it comes with a heavy cost to our patients – their health and their trust – and to community pharmacy’s hard-earned reputation.
Tracey Robertson is managing director of Cegedim Rx