Ordering medication using proxy access: Guidance for care homes, GP practices and community pharmacies

GP online services

Since 2005, patients have been able to use online services for booking appointments, ordering repeat prescriptions, and viewing information their GP practice holds about them in their patient record. This has helped to:

  • enhance the quality of care
  • increase choice and convenience for patients

Ordering repeat prescriptions this way is now well established in many GP practices.

What this guide is for

This guide is intended to support best practice for CQC registered care homes and GP practices and pharmacists to work together to allow care home staff to order online repeat medication on behalf of residents. This is called ‘proxy access’ throughout the document.

Each organisation refers to individuals in a different way, for care homes they are referred to as residents and in GP practices and community pharmacies as patients. The language used is focussed to the main audience of each section of information, you can assume that the resident and patient are the same person.

Where GP/GP practice lead is stated throughout the documentation, this may be an individual general practitioner or is more likely to be a member/s of the wider PCN team/s, for example, clinical pharmacists or pharmacy technicians. General medical practices are encouraged to seek support and guidance (where available) from their local Clinical Commissioning Group or Integrated Care System leads.

The GP IT systems which allow proxy access to be set up for care homes are EMIS and TPP, Microtest and Vision Health does not have this function at present.

This guide has been put together by NHSX, following a trial between five care homes and nine GP practices. You can use the guide to set up your own local process and procedures.

Before proxy access for care home staff can be set up, the care home must have a secure email system and preferably the NHSmail system. Further information is available in another guide Data Security Protection Toolkit (DSPT) and NHSmail guidance.

How proxy access works

Proxy access was developed to allow someone other than the patient to access and manage parts of their GP online services account. The proxy is given their own online access account (rather than using the patient’s login details).  It is typically used by the parents of young children and recognised carers of adults.

GP practices can set up proxy access to repeat medications only, meaning that care home staff can’t 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.

Adding a note to the GP practice may be particularly useful when an item is marked on the GP system as needing to be reviewed with the patient. Overdue medication reviews may cause delays when a care home proxy access process is first put in place but becomes less of an issue over time.

Audit trails

An audit trail is kept in the GP system when a proxy accesses a patient’s record. For repeat prescriptions It records:

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

Protecting patient privacy

It is essential that resident/patient privacy is respected and protected. To reduce the risk of a breach of privacy or confidentiality there must it is important that:

  • a data sharing agreement between the care home and the GP practice has been agreed
  • all authorised care home staff are up to date with information governance (IG) training and IG requirements
  • a process is in place to manage any breach of confidentiality or misuse of proxy access.

The Royal College of General Practitioners (RCGP) has developed guidance for GP online services. There is a section on proxy access issues and the safeguards that might be helpful.

Other things you can do with GP online services

As well as ordering medication, GP online services can give access to a resident/patient’s medical record, test results, hospital and other correspondence, and appointment booking/cancelling.

A carer’s access to these other elements can have benefits for patients, such as better communication between different care providers. There are, however, security and confidentiality risks that need to be considered from a patient, GP, and care home point of view before any level of proxy access is set up. These are discussed in the RCGP guidance section on proxy access issues and safeguards.

View the next sections in this guide: