Care home, GP practice, ICS operations

Staff who have been approved for proxy access can access the accounts of all residents who have signed a form agreeing to the home ordering their medication online. The care home manager just needs to make sure enough staff are approved for proxy access to allow for holiday and sickness cover. The care home must tell the GP practice when a proxy leaves and when a new person needs to be set up as a proxy.

The process for ordering medication is the same online as in a paper-based system. Just tick the box to request.

The care home must train staff and then approve them as being capable of handling medication.

There are no limits to the number of people who can be set up as proxies by the GP practice.

The NHSmail account issue has been recognised nationally and there is a lot of work going on around supporting the use of the shared NHSmail inboxes in care homes. Individual accounts for named staff are set up to avoid these issues. Every care home staff member has approved as a proxy has access to all residents’ medication records. It is the care home’s responsibility to tell the surgery of any staff leavers or joiners.

No, residents don’t need to be registered for GP online services for proxy access to be given.

The prescriber of the medication has overall responsibility. Part of the process for ordering medication is, however, that all health care professionals are responsible for checking medication before completing the order. This does not change current processes, or policies on managing medication errors.

Yes – this can be done in the message section of the online request.

As with a paper-based system, if an acute prescription is urgent a phone call to the practice may be required. If enabled, you can use the messaging section in the GP system.

Building strong relationships and trust from the outset with key stakeholders is vital. Setting up and managing an agreed process and making it business as usual is key to long-term success.

Every care home staff member has access to all residents. It is the care home’s responsibility to tell the surgery about staff leavers or joiners.

Supporting information:

Setting up talks between GP, care home and pharmacy before moving to online ordering is vital. It’s one of the key conversations to have as part of the project to make this work for all stakeholders to address any issues or changes that are to be made in the workflow.

Here are some comments from the pilots:

Maggie Care Home Deputy Manager, Manor Lodge

No major teething issues.

Care UK instructed us to request medication a week earlier when we went live due to COVID 19. This meant we had to create a lot of custom requests for the first month, as the prescriptions were not due.

The second time we ordered and submitted requests as we were able to just click the box and hardly any custom requests or notes needed so it was much faster.

Tameside and Glossop ICS Medicines Optimisation/Management Teams

Getting agreement between GPs and pharmacists on what would be shared. For example, some GPs wanted to share more than medication ordering information, and some didn’t. We are currently not sharing any other information but this may change and each individual practice may decide what they want to be shown.

Getting best interest forms signed from GPs can take some time, especially now when they have other priorities. The NHSX guidance suggests the care home could sign the best interest form and this would likely speed up the process greatly.

Getting the practice staff to add the new residents to the homes online account. This is mainly because it takes the staff a while to get used to doing it. I have found that as staff have done it more and more it has become part of the registration process for a new resident. It is useful if the care home sends the proxy request forms together with the initial registration form to the practice as part of their admission process.

The guidance available now will eliminate a lot of the initial troubles we had as we were working alone with very little guidance available from EMIS and patient access.

Supporting information:


Care homes will already have staff authorised to order and administer medication. The same staff would be set up for ordering the medication by proxy.