Ordering of prescriptions

This policy sets out the position of NHS North East and North Cumbria ICB (NENC ICB) regarding third party ordering of prescriptions. It aims to ensure safe, appropriate, and patient-centred processes for repeat prescription requests and additionally reduce waste and promote self-care.

GP practices should only accept repeat medication requests from patients and their carers unless there are exceptional circumstances (see below). GP practices should not accept requests from third party organisations such as pharmacies, (community and distance selling), Dispensing Appliance Contractors (DACS) and specialist nutrition providers.

Where the needs of patients under the Equality Act require a third party to order on a patient’s behalf, this should be fully supported.

In summary, third party ordering:

  • Is not routinely permitted.
  • Allowed only for vulnerable patients identified by the practice (e.g., housebound, no digital access, no family/carer support).
  • Must be agreed in advance with the GP practice and documented in the patients record

Patient orders should be accepted via NHS App, telephone order line, in-person FP10 slip, post, practice website or email.

Care home providers should retain responsibility for ordering medications from GP practice, ideally using the electronic proxy ordering system.

GP practices are encouraged to send all prescriptions via the electronic prescription service (EPS) as this is considered best practice, is secure and trackable.

Practices discontinuing certain ordering methods must assess risks (e.g., digital exclusion) and provide alternative arrangements for vulnerable patients.

Third party organisations must have written authorisation and confirm patient requirements before ordering.

Prescribers are not obliged to issue prescriptions retrospectively after supply.

Proxy access and linked profile

Proxy access was developed to allow a third party (proxy) to access and manage parts of GP online services account and NHS App on behalf of a given named patient. The proxy is provided with their own online access account (rather than using the patient’s login details). This method of prescription ordering is typically used by the parents of young children and recognised carers of adults, typically care home providers. GP practices can set up proxy access limited to repeat medication only, meaning that the proxy cannot view or order anything else in the patient's online record.

If a person in receipt of care does not consent to their carer/ care home to have proxy access to any part of their record, including repeat medication, the carer/ care home must continue to order using the FP10 counterfoil paper-based process.

Currently, a person can use linked profiles in their NHS account, using the NHS App or NHS website, to act on behalf of another person if they meet all the following conditions:

  • They and the person they are acting on behalf of are both registered at the same GP practice.
  • Both their GP surgeries use either TPP (SystmOnline) or EMIS (Patient Access)
  • The GP practice has registered them for proxy access.

Depending on the level of access the GP practice provides, a person with NHS App access can switch profiles to act on behalf of another person and order a repeat prescription.

GP practices can set up proxy access to repeat medications only, meaning that care home staff cannot see anything else in the record. If, however, a resident does not want care home staff to have proxy access to any part of their record, including repeat medication, the care home must continue using a paper-based process.

When staff in the care home are given proxy access by the GP practice, they can:

  • Order repeat prescriptions.
  • Include a note to the GP. An audit trail is kept in the GP system when a proxy accesses a patient’s record.

For repeat prescriptions proxy records:

  • who accessed the record and when?
  • what medication was ordered
  • who authorised or rejected the request and when?