Prescription nomination: Consent or informed consent?
It’s interesting how some of the same topics keep coming round, recently there has been a growing flurry of complaints about changing of patient EPS nominations.
We have seen first hand on visits that many contractors are obtaining patient consent, ie patients are signing an EPS nomination form* but we are not sure that this is necessarily informed consent.
This is often because a patient has an acute prescription (for example at the weekend or out of hours) or is attending for some other service that they cannot access at their usual pharmacy for whatever reason. It is perfectly reasonable for the “new” pharmacy to ask the patient if they want to change their nomination
However, please bear in mind the language that is used (many patients are not familiar with the term “nomination” they just know where their regular prescriptions go) and be explicit about what the change in nominations means, ie “This means that all your regular prescriptions will come to us, rather than going to Fred Bloggs pharmacy where you have been going before, are you sure you still want to change?”
Ask the patient to repeat this back to you to check they have understood.
If they cannot repeat this back to you, or if there is any other lack of clear understanding then consent is NOT informed and you should not change the patient nomination.
If a patient has recently changed nomination and then returns to their previous pharmacy it is likely that they did not fully understand what they had agreed to- please be gracious if their previous pharmacy asks for the prescription to be returned.
We are sure we don’t need to remind you that claiming for a prescription before it is collected so that it cannot be returned to the spine on patient request is likely fraudulent.
Finally, we are aware that some PMR systems may change nominations automatically when a new PMR is generated. We are aware that this is being looked at nationally, but please check your own system and disable this functionality if installed. We will be speaking to some of the pharmacies with a high number of new nominations to check if they are using automated nomination functionality.
