Who Is Exempt from Patient-Led Ordering?

Under Patient-Led Ordering, patients order their own repeat prescriptions rather than the pharmacy doing it for them. But the change was never meant to apply to everyone, and there are recognised circumstances where a pharmacy can continue ordering on a patient’s behalf.

These are the criteria our local Integrated Care Board accepts.

The exemption criteria

• Aged 60 years or over.
• Diagnosed cognitive impairment, dementia or reduced mental capacity.
• Learning disability or significant mental illness affecting medication management.
• Housebound, or receiving home delivery of medicines.
• Significant digital exclusion, including being unable to confidently use the NHS App.
• Limited English proficiency affecting safe ordering.
• Visual impairment or physical disability affecting digital access.
• Receiving end-of-life or palliative care.
• Receiving medicines via a monitored dosage system (MDS or dosette tray), where pharmacy-led ordering is part of the established medicines management pathway.

What each of these actually means

Digital exclusion is the one people most often assume does not apply to them. It does not only mean having no phone. It covers not having reliable internet, not being confident using apps, or finding the sign-up process genuinely impassable. If you have tried the NHS App and could not get through it, that is what this criterion is for.

Housebound covers anyone who cannot readily leave home unaided, and also anyone already on a home delivery service — the ordering and the delivery are treated as part of the same arrangement.

Monitored dosage systems matter because the pharmacy is already managing the timing of your medication cycle to fill the trays. Splitting the ordering away from that creates a real risk of a tray being made up with a missing item.

Limited English proficiency is about safety rather than fluency. The NHS App is English-only, and ordering the wrong item because of a translation difficulty is a genuine clinical risk.

Why pharmacy-led ordering helps where it applies

The exemption criteria are not simply an act of kindness towards people who find apps difficult. Where a patient genuinely cannot manage their own ordering, having the pharmacy do it prevents problems that are expensive and unpleasant for everyone involved.

• Fewer gaps in treatment. When the pharmacy is tracking the cycle, the request goes in at the right point each month. Simply forgetting to order is the most common reason people run out.
• Medication stays aligned. Items ordered together arrive together. Once a repeat list drifts out of sync, someone ends up collecting a different item every fortnight — which is both confusing and far more likely to lead to a missed dose.
• Fewer emergency supplies. Running out means an urgent request to the surgery, an emergency supply, or a trip to an out-of-hours service. All of it is avoidable, and all of it lands on the patient at the worst moment.
• Less to keep track of. For carers, and for anyone managing several long-term conditions at once, one less monthly task is not a small thing.

That is the reasoning behind the criteria. They exist because for these particular patients, the waste PLO is designed to prevent is smaller than the harm caused by a missed prescription.

Being honest matters here

Please only tell us about circumstances that genuinely apply to you. We may need to confirm what you have told us with your GP surgery, and the arrangement has to be one we can stand behind if the ICB asks about it.

There is also a practical reason. Exemptions exist so the people who really cannot manage their own ordering do not fall through the gap. If the list gets diluted, the whole arrangement becomes harder to defend for the patients who most need it.

What happens after you tell us

We check what you have told us against your record. Where it fits, we carry on ordering for you and you will not notice any difference. If we need to confirm something, or if we do not think the criteria are met, we will ring you and explain — we will not simply stop ordering without speaking to you first.

If none of these apply

Then you will need to order your own. Our step-by-step NHS App guide walks through it, and if you would rather have someone show you, come in and we will set it up with you.

Not sure where you stand? Call us on 0121 500 5756 and ask. We would far rather have the conversation than have you run out of medication.