Prescription Direction


Background Information

Direction of prescriptions describes the exercise of undue influence by a medical practice over the choice of where a patient takes or sends their prescription to be dispensed. It can also be used to describe situations where pharmacy owners and pharmacists encourage medical practitioners to recommend their pharmacy, by way of offering a gift or reward.

Prescription direction can take many forms:
  • Staff within GP practices seeking to influence and direct patients to specific pharmacies
  • Staff within pharmacies nominating patients to their pharmacy without patient consent

Prescription direction should not take place as it undermines the patient’s decision about where they want their prescriptions to be dispensed. Therefore, if a patient prefers to use a particular pharmacy, the NHS Constitution requires that this preference is respected. Please see below for further guidance on how to deal with and manage potential prescription direction issues.

There have been increasing numbers of Prescription Direction issues being reported to the LPC and also the Greater Manchester Health and Social Care Partnership (GMHSCP).

Please see useful resources below:

  1. A letter to all GP practices and Pharmacies from the GMHSCP
  2. Poster on freedom of choice  (Pharmacy contractors can obtain additional copies of the poster from the PSNC by contacting shantel.christian@psnc.org.uk)

  3. Poster on freedom of choice (high res version)

In order to ensure patients are fully informed of their choice, please display the poster prominently close to where patients receive prescriptions. Distance-selling and internet pharmacies should display this information prominently on their websites and take reasonable steps to bring this notice to the attention of all patients.

A number of these cases are being investigated at this time and the LPC have been working closely with the GMHSCP to address these issues, and they take the matter of prescription direction very seriously.

They will discharge their duty to ensure that patients’ rights under the NHS Constitution and also for data protection are met. This assurance may be by way of taking appropriate contractual action against contractors to protect those rights by the GMHSCP , where evidence of prescription direction or switching patient nominations without consent is found.

There are increasing numbers of cases reported where  patient EPS nominations have been changed either by a pharmacy or GP practice:

  • without the patient’s explicit consent, or
  • where patients have allegedly been influenced to choose one pharmacy over another (either by another pharmacy or a GP practice); or
  • where patients have allegedly been actively discouraged from choosing a particular pharmacy (either by another pharmacy or a GP practice)

It is reported that patient care has been significantly detrimentally affected in some cases, e.g. where delays in obtaining medication have occurred while the nomination issues are identified, investigated and rectified (see useful resources below for a template letter for EPS promotion).

Reporting Prescription Direction Issues

If you suspect that prescription direction is happening in your area, please follow the appropriate procedure outlined below:

1. Explain to patients that doctors and pharmacists across the country have agreed that this is not the right way to behave – patients should always be free to choose their pharmacy, and no-one should seek to undermine that right

2.  Report any GPs or pharmacies behaving in this way by following the in-house procedure

3.  Offer the patient the Your Prescription Your Choice” form, explaining that it contains information about this problem and gives them the opportunity to report what has happened to them

4.  Advise them that the back half of the form can be detached and submitted by the following methods to the appropriate body:

They can submit the form themselves, or ask you to do it for them.

5.  Encourage them to complete the form in the pharmacy, and say that you’ll send their form off for them, along with any other forms that you receive. Further information relating to the NHS complaints procedure can be found here:  https://www.england.nhs.uk/contact-us/complaint/complaining-to-nhse/

Once the patient has returned the form to you, the following steps should be taken:

  1. Send the form to NHS England Complaints Team. We also request that you notify your LPC so they have sight of these issues by emailing enquiries@gmlpc.org.uk
  2. Keep a log of the forms that you have sent off

If you wish to escalate the case further or need advice please contact GMLPC by emailing enquiries@gmlpc.org.uk or phoning the office number on 0161 228 6163.

Other useful resources

BMA, Pharmacy Voice and PSNC statement on prescription direction

Joint BMA and PSNC guidance on prescription direction

Template letter for patients who have stopped visiting a pharmacy – Pharmacies can use this letter to write to the patients that have stopped visiting the pharmacy and ask why they have chosen to do so – the pharmacy can then use any responses to help review the quality and range of services it provides.

Template patient leaflet for EPS promotion – Pharmacies can use this leaflet to promote their pharmacy whilst informing patients of the benefits of EPS and clearing up any potential misunderstandings about the ways that pharmacy services are provided. The text can be modified to reflect local circumstances.

NOTE:

If a patient/customer has already complained directly to a pharmacy about their prescription direction material, and they are not satisfied with the pharmacy’s response to that complaint, they should contact the Parliamentary & Health Service Ombudsman (PHSO). The PHSO makes final decisions on all complaints about NHS services. NHS England cannot investigate complaints that have already been made directly to the pharmacy.

To take a complaint to the Parliamentary & Health Service Ombudsman, visit www.ombudsman.org.uk or call 0345 015 4033.