EPS nomination is supposed to be one of the simplest parts of the NHS digital experience. You choose a pharmacy, your GP sends prescriptions there and nothing moves unless you decide to change it.
EPS is the NHS Electronic Prescription Service. It is the system that sends your prescription from your GP to the pharmacy you nominate.
Nomination is the digital record of that choice. Once it is set, your prescriptions are meant to go to the same place every time until you ask for it to be changed.
That is the principle EPS was built on.
When prescriptions move without you
In reality, some patients are discovering that their prescriptions have been moved without them knowing.
They choose a new pharmacy, ask the GP to send prescriptions there and assume that is the end of it. Then they turn up to collect their medicine and find it has been sent somewhere else. Often it has gone back to a pharmacy they used in the past.
For carers, this can be even more stressful. They do everything correctly, only to find the prescription has landed in the wrong place and the person they are supporting is left waiting.
Behind these experiences is a technical change in how some systems handle nomination.
What bulk and auto nomination are
Some patient medication record (PMR) systems now include features known as bulk nomination or auto nomination. These tools scan for patients who have moved their prescriptions elsewhere and quietly switch them back.
In some cases, this happens in a single bulk action. In others, it is done on a repeating cycle.
Patients are not asked. They are not told. They believe they have chosen a new pharmacy. The system reverses that decision in the background.
In a growing number of cases, automated tools or bots are used to move patients back at scale. This is not a one-off correction. It is an ongoing process of pulling people back without their knowledge.
Bulk and auto nomination turn a clear, patient-led decision into something software can override.
Real-world consequences
When nomination shifts in the background, the entire supply process becomes unstable.
Prescriptions land in unexpected places. Items need to be returned. GP practices receive calls from patients who think their records are wrong. Pharmacy teams spend time investigating what happened rather than looking after people.
A simple scenario shows how easily this can hurt trust.
Someone decides to stop using an online provider and moves their prescription to a local community pharmacy. They collect a few prescriptions locally and think everything is sorted. Then, without warning, a bot reverses that decision. The next prescription goes back online. The patient arrives at their local pharmacy to find nothing there and no obvious explanation.
For something as central as medicine supply, this is not a minor issue. It undermines confidence in a system people rely on every month.
The scale of the risk
More than 100 million prescriptions move through EPS every month.
When you apply bulk or automated switching to activity at that scale, even a small percentage of changes can create real disruption. If more systems adopt these tools, prescriptions could begin to bounce back and forward between pharmacies as different providers compete to hold on to patients.
That does not just affect individual journeys. It risks putting unnecessary strain on the NHS Spine, the national infrastructure that carries these prescriptions, and on the wider NHS systems that sit around it.
Almost 3,000 people have already signed the petition calling for this practice to be stopped, which shows this is not a theoretical or isolated problem.
A quiet and unfair race
Bulk nomination also creates an unfair environment inside pharmacy.
Pharmacies that refuse to use these tools risk losing patients. Pharmacies that embrace them can gain business by pulling people back, even when those patients have deliberately moved elsewhere.
This is not competition based on service quality, patient experience or clinical standards. It is competition based on who is prepared to use software to interfere with nomination behaviour most aggressively.
Many pharmacists reasonably assume that if bulk nomination is built into their PMR system, it must be acceptable. That makes the lack of clear policy even more serious.
The result is a quiet race to the bottom that patients never agreed to join.
Why the NHS cannot simply switch it off
NHS EPS teams understand the risks of bulk nomination and have issued guidelines to suppliers for many years. However, there is currently no specific law or policy that clearly prevents PMR systems from offering bulk switching features.
Without that clarity, the NHS cannot enforce a firm boundary. Regulators can investigate individual pharmacies after complaints, but they cannot remove the underlying functionality from the software that enables it.
In practice, that means:
Ethical pharmacies lose ground.
Patients lose clarity and control.
GP practices and pharmacy teams absorb the confusion and extra work.
Everyone inside the sector recognises this is a problem. It does not need to be normalised.
What needs to change
The principle is simple.
Nomination must remain a patient-controlled choice.
Bulk changes should only happen in clear, limited situations such as NHS-managed transitions when a pharmacy changes owner or ODS code.
Software should not move patients quietly in the background. Patients should not have to constantly re-affirm a decision or learn how to disable a setting just to stop bots reversing their wishes.
EPS is one of the NHS’s greatest digital successes. Protecting it means protecting the clarity and trust it was built on.
How you can help
This is already affecting real patients, real carers and real pharmacy teams.
The petition calls for clear rules that prevent bulk nomination and protect patient choice. Reaching 10,000 signatures will trigger an official government response.
If you believe your prescription should stay where you choose, and only move when you decide, you can add your name here: 👉 bit.ly/4pF76Jb
Your support helps reinforce what many in the sector already know. Nomination should remain a patient decision, not something software quietly rewrites in the background.
TITAN
Share with your community!
