Written by Technical Team | Last updated 30.09.2025 | 12 minute read
The NHS Electronic Prescription Service (EPS) routes a prescription to a dispenser by marrying two pieces of information: the prescription itself and the patient’s current nomination. That nomination is not stored in the GP system or in the community pharmacy’s PMR as the “source of truth”; it lives on the NHS Spine within the Personal Demographics Service (PDS), alongside the patient’s NHS number and core demographic details. When a prescriber signs and transmits an EPS prescription, the Spine checks the patient’s PDS record. If a nomination exists, the message is delivered to that dispenser’s mailbox. If there is no nomination, the prescription is held in the Spine and can be retrieved by any community pharmacy using the patient’s token (or via Phase 4 workflows where barcoded tokens or demographic search are used).
This separation of concerns is deliberate. EPS is the delivery rail; PDS is the addressing system. Keeping nomination on PDS means the patient’s choice follows them irrespective of which GP practice they’re registered with, what prescribing system is used, or which pharmacy last dispensed for them. It also means that if a patient changes nomination at a pharmacy counter, via a pharmacy app, in the NHS App, or through the GP practice team, the updated choice is immediately visible across the nation. To work reliably, every system in the chain—prescribing, dispensing, and patient-facing apps—needs to read from, and write to, PDS correctly and predictably.
Nomination is best thought of as a routing preference with three properties. First, it is patient-controlled and can be changed at any time. Second, it is not a lock-in: prescriptions can still be collected elsewhere using non-nominated (Phase 4) flows when appropriate. Third, nomination can be granular: a patient may nominate a community pharmacy for general medicines and a dispensing appliance contractor for appliances, ensuring the right provider receives the right category of items. Getting these rules right in your software and frontline processes is essential to honour patient choice and avoid mis-routing.
Because EPS operates across thousands of organisations and multiple software vendors, misalignment can creep in. A pharmacy PMR might show a “preferred pharmacy” locally even when the PDS nomination has been changed elsewhere; a GP system could cache a PDS snapshot longer than intended; an app might capture consent but defer the Spine write because a mobile signal dropped. Good integration treats PDS as the single source of truth, uses read-after-write verification, and reconciles any local view against that canonical record.
There is also an important identity dimension. PDS is keyed by the NHS number, but name, date of birth and address are used for traces and matching. Minor differences in demographic fields (for example, a missing hyphen in a double-barrelled surname) can produce match uncertainty for new patients. High-quality matching logic, clear error handling, and unambiguous user messages reduce the risk of creating duplicate person records or inadvertently updating the nomination on the wrong PDS entry. In practice, this means investing in robust patient search, trace, and verify flows before you touch nomination at all.
A robust implementation starts by mapping your nomination journeys—counter-based, telephone, web, and app—and then specifying how each journey reads from PDS, captures consent, writes the change, and confirms success. The technical integration is only half the puzzle; the other half is the choreography that keeps all parties in step. If your pharmacy app updates the nomination, the PMR needs to know immediately so staff don’t give conflicting information at the counter. If a GP receptionist changes a nomination on behalf of a patient, the GP system should broadcast that fact to the PMR and the patient app, or at least ensure they reconcile on next use.
At a message level, treat every nomination update as an end-to-end transaction anchored to the Spine. Client systems should authenticate properly, read the current PDS nomination, present that to the user for clarity (“You’re currently nominated to… Do you want to change?”), record lawful consent, and then write the new nomination value to PDS. After writing, always perform a fresh read to confirm that Spine reflects the change, and display a definitive success message that includes the name and ODS code of the newly nominated dispenser. This read-after-write pattern prevents “ghost” states caused by network interruptions or transient Spine errors.
For enterprise teams, a small amount of architectural plumbing pays dividends. A lightweight “PDS nomination service” sitting inside your estate can wrap the Spine API, centralise authentication, implement retry with idempotency keys, cache short-lived reads, and emit events to downstream systems. Publishing a “NominationChanged” event—with NHS number (or a hashed proxy), old value, new value, timestamp, channel, and actor—gives your PMR, patient app, contact centre tooling and analytics stack a single, privacy-aware signal to react to. Event-driven design reduces the latency between a change on PDS and what staff see at the point of care.
When you define the integration, it helps to make your interfaces explicit and testable:
Finally, design for real-world imperfection. The network will drop. Spine will sometimes be slow. People will press the back button after submitting a form. Avoid double-writes by using idempotency tokens; make all operations safe to retry without changing the outcome. Keep a short-lived cache of PDS reads (for example, 5–10 minutes) to reduce chattiness without serving stale state for long. Where your local system stores a “friendly” view of nomination—perhaps for rapid display on a patient card—clearly mark it as a snapshot and show the last refreshed time so staff understand what they are looking at.
Changing nomination is an expression of choice, so consent and clarity come first. Consent should be explicit, informed, and recorded in a way that stands up to audit. That does not mean drowning the user in legalese. The most effective designs use plain English, explain the consequences (“Your prescriptions will usually be sent to… You can still go elsewhere if you need to”), and reassure the patient that the choice can be changed at any time. For carers, care-home staff and parents, your design must make the difference between changing their own nomination and changing it on someone else’s behalf abundantly clear.
Frontline governance is as much about behaviour as it is about policy. Pharmacy teams should avoid “defaulting” patients into nomination without genuine permission. If your business uses assisted digital journeys at the counter, train staff to show the on-screen wording to the patient, confirm understanding, and capture the affirmative action (for example, the patient tapping “Agree” or the staff member selecting “Consent given in person”). For remote channels, reflect the channel in your audit record (web, app, phone). This is especially important if a nomination is later disputed.
To keep teams on the right side of both regulation and public trust, anchor processes around a few pragmatic controls:
The best-run programmes make the patient experience feel seamless across channels. If a patient changes nomination in the NHS App during a GP appointment, it is jarring for them to walk to a pharmacy that still insists nomination points elsewhere. Conversely, when a patient opts out of nomination entirely, the GP team should be confident that the next EPS issue will follow the Phase 4, non-nominated route without staff having to remember a special code. Small touches matter: send a confirmation message that names the new dispenser and their location; provide a quick way to change back; and show helpful prompts such as “Heading away? You can switch nomination temporarily and switch back later.”
Operational reality is where elegant diagrams meet human complexity. One common scenario is the “travelling patient”. They’re nominated to a pharmacy near home, but they’re working away for a fortnight. EPS Phase 4 has reduced the friction: the prescriber can issue a non-nominated prescription that any pharmacy can claim from the Spine using the token. Your role as a dispenser is to help the patient decide between a temporary nomination change—which will route subsequent issues automatically—and a one-off non-nominated item. Good counter scripts set expectations, for example, “Shall we switch your nomination just for this month? We can switch it back later.”
Care-home flows add another layer. A home may have an agreed supply process with a specific pharmacy, but consent still belongs to the resident (or their legal representative). Avoid blanket nomination changes on admission lists. Instead, capture consent individually, and support residents who want to keep their existing nomination. Where your PMR aggregates medication administration records (MARs) and cycle changes, ensure your nomination handling does not accidentally route appliance items to the wrong contractor if the resident has a legitimate split nomination (pharmacy for medicines, appliance contractor for stoma or continence products). Clear on-screen cues about which items are covered by which nomination reduce rework and patient inconvenience.
Digital journeys surface different edge cases. A patient might change nomination in your app at 11:00, then ring the contact centre at 11:02 because they are unsure it “worked”. If your systems have an event-driven spine around PDS writes, the agent should see the new nomination instantly; if not, give agents a one-click “Refresh from Spine” button that performs a live read and updates the view. Another digital edge case is the “ambiguous match” on PDS when a user registers with partial details. Resist the temptation to let users proceed; instead, ask for additional information or direct them to an in-person check. Most complaints about “wrong nomination” stem from mis-identification at the outset.
Occasionally, you will meet the “silent change” problem: the patient swears they never changed nomination, yet PDS shows a recent update by another organisation. A calm, evidence-based process helps. Show the patient your record of how and when the change was made (channel, wording, actor). Offer to restore their preferred nomination immediately and, with permission, contact the other organisation to close the loop and improve practice. Internally, use these incidents as coaching opportunities: were your consent screens confusing? Did a well-meaning colleague click through too quickly? Did a digital flow pre-tick a box that should have been unselected by default?
Don’t overlook prescribing system behaviours. Some GP systems surface nomination prominently and encourage staff to check it during medication reviews or address updates. Others tuck it away, meaning changes are less frequent in that channel. As a pharmacy or integrated provider, be agnostic: your job is to make it easy for the patient wherever they are. If you operate a distance-selling pharmacy, pay attention to friction-free, compliant remote consent and to clear re-assurance that the patient can still get urgent items locally if needed. If you operate a high-street chain, train colleagues to explain options for one-off, non-nominated dispensing when the patient is away from home—without implying that nomination must be changed for every short trip.
Lastly, plan for systems-level contingencies. If the Spine is degraded, community pharmacies may still dispense using the paper or token fallback and upload claims later. Your SOPs should guide colleagues on what to say to patients (“The national system is a bit slow—here’s how we’ll make sure you still receive your medicines today”) and how to reconcile nomination states once services are restored. Your software should queue writes with idempotency, back-off sensibly, and alert the team only when human action is genuinely required.
Turning good intent into everyday reliability takes a structured rollout. Start with a discovery phase that maps your current journeys, identifies where nomination is set today, and clarifies the pain points for patients and staff. Build thin, well-tested slices first: a single, consistent consent wording across channels; a unified PDS access service; a read-after-write confirmation UI; and a real-time event to update dependent systems. Pilot in a handful of locations or with a limited cohort of app users, and measure both the functional outcomes (write success rate, time-to-consistency) and the human outcomes (patient understanding, staff confidence). Use those learnings to iterate before scaling nationally.
Measure what matters, not just what is easy. Nomination volumes tell you activity, but not quality. Add metrics for nomination churn (how often patients switch, and why), mis-routes avoided (items that would have gone to the wrong place without your checks), time to reflect a change across channels, and the number of disputes resolved on first contact. Pay particular attention to inclusion: track how digital-only journeys perform for people who are older, speak English as a second language, or have accessibility needs. Success is a service that quietly does the right thing for everyone, every time, whether they tap a button in an app or talk to a pharmacist they trust.
Is your team looking for help with NHS EPS integration? Click the button below.
Get in touch