Opinion: This outrageous renomination game has to stop

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By Alexander Humphries

So where are we? Well, a few months back, I became aware that contractors in different parts of the country were starting to see a worrying shift in patient prescription nominations. In some areas, new contractors who had bought distressed pharmacies from other operators started to renominate patients back to them en masse, sometimes without even consulting them — obviously a complete no-no.

Naturally, established contractors in these areas were incredibly worried about this precedent. Sometimes they contacted the pharmacy initiating the change of nomination – and sometimes they received unhelpful or unprofessional responses. 

I really do feel for those pharmacies that have helped patients who were left without a pharmacy when their usual one closed on a temporary basis. They have often been through hell, with no extra staff to deal with thousands of additional prescriptions. These pharmacies have done an amazing job under difficult circumstances.

But just because a pharmacy reopens doesn’t mean that the new operator has the right to renominate all their previous patients, thus penalising those pharmacies who helped out in their time of need. I have now been told by two different people that employees of a newly enlarged pharmacy chain have been told that they have six months to re-establish profitable trading and to renominate all previous patients. 

If this is true, it is outrageous. The only person who should – and is allowed to – initiate a change of nomination is the patient. If pharmacy teams are being asked to do this, they should act as whistleblowers to report what is against our NHS terms of service, GPhC standards, and information governance laws and processes. 

Technology arms race

There has been particular concern recently about the technological arms race to capture and retain nominations. One PMR supplier supposedly announced a feature that would automatically renominate patients back to the original pharmacy if the nomination was changed. This led to anger in some parts of the sector. 

Interestingly, if a patient is nominated to a particular multiple and they subsequently change their nomination, they will receive a message within minutes to ask if they really meant to do that. 

So is allowing smaller groups to use this new technology anything different? Well, no –  not really. But if the powers-that-be are going to outlaw this sort of venture, they also need to tackle the big boys who are implementing their own versions. 

Automatically changing a patient’s nomination is never likely to be compatible with the rules, but one of the more interesting areas is whether systems should be allowed to check where a patient is nominated to. This is essentially what automated text systems are doing when they notify a patient that their nomination has changed. If large companies can do this, shouldn’t everyone? 

For a number of different reasons, it is actually helpful to be able to see which patients have changed nominations. Firstly, quality control. If patients are not happy, I’d much rather they told us, but they don’t – so the first thing you know is that they’ve changed their nomination. If I don’t know they’ve changed it, I can’t begin to put right what might have gone wrong in the first place. 

Secondly, it helps to know where patients might be going. Is there an advertising campaign in a certain area, or are competitors targeting a particular type of business such as care homes or MDS? (They are welcome to both if they want!)

Poisonous

Where this gets really ugly, it quickly becomes poisonous, with pharmacies on opposite sides of the street duelling it out to get a nomination here or a nomination there. Patients can feel like piggy in the middle when prescriptions have been sent to somewhere they weren’t expecting and we all start to look a bit ridiculous. 

For the last few years we’ve had a seller’s market where pharmacies have introduced new fees and charges to help cover the shortfall in NHS funding. But if suddenly everyone is fighting over FP10s again, then this becomes a buyer’s market – and things can start to unravel pretty fast. 

If pharmacies think they are under pressure now and believe that targeting nominations in a big way is a good idea, then they will need to be careful what they wish for – especially when they have to throw everything in for free to secure a patient and lose a fortune in the process. And if you’re waiting for the NHS to intervene in this steaming mess, then you will be waiting a long time. Simply – it has to stop.

  
Have you been adversely affected by renominations? Tell us what impact this has had pm@1530.com