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How EMMA Handles Repeat Prescription Requests and the NHS App Pathway

Purpose of Document

Repeat prescriptions are one of the highest volume call types across all NHS GP surgeries. How EMMA handles these calls has changed significantly with the V12 release. Support staff must understand the full Pathways flow, the NHS contract context behind it, the fallback chain, and how to explain this to practices who are unfamiliar with the new behaviour or who are raising complaints about prescription call handling.

NHS Contract Context: Why Repeat Prescriptions Must Be Made in Writing

Before explaining EMMA's behaviour, support staff must understand the NHS context.

From 1 October 2025, the 2025/26 GP contract requires all practices to keep their online consultation tools open throughout core hours (8:00am to 6:30pm, Monday to Friday) for three categories of patient request. One of those categories is medication queries, which includes repeat prescription requests.

NHS guidance is explicit that repeat prescription requests should be made in writing, not verbally over the phone. This is because verbal requests create clinical risk: the patient may mishear or misspeak the medication name, the dosage, or the quantity, and there is no written record to verify the request against.

EMMA's handling of repeat prescriptions is therefore directly aligned with NHS guidance. When a patient calls to request a repeat prescription, EMMA explains that the request must be made in writing and directs the patient to the fastest digital route available.

This is not a limitation of EMMA. It is clinically correct behaviour.

How EMMA Handles Repeat Prescription Calls: The Pathways Flow (V12, May 2026)

As of EMMA V12 (May 2026), repeat prescription calls are handled through the Pathways feature. This is the first pathway handled by Pathways. Test results and appointment cancellations are planned for future Pathways releases.

The full flow works as follows:

Step 1: EMMA recognises the repeat prescription request

When a patient says they are calling about a repeat prescription, EMMA recognises this regardless of how it is phrased. This includes indirect phrasing such as "I need my tablets," "can I get my medication renewed," or "my prescription is due."

Step 2: EMMA explains the written request requirement

EMMA tells the patient that repeat prescription requests must be made in writing in line with NHS guidance, and offers the NHS App as the fastest way to do this.

Step 3: EMMA sends a secure NHS App deep link by SMS

EMMA sends the patient a secure deep link directly to the NHS App by SMS. The patient can tap the link, open the NHS App, and submit their repeat prescription request in a few taps. This supports NHS App adoption uplift across the surgery's patient list.

Step 4: Intelligent fallback if the patient cannot use the NHS App

Not all patients can or will use the NHS App. Pathways handles this through a layered fallback chain:

Situation What EMMA Does
Patient does not have the NHS App installed EMMA provides clear instructions on how to download and access the app on any device
Patient cannot or will not use the NHS App EMMA falls back to SOPHIA, the practice website, or the reception team depending on the surgery's configuration
Patient struggles with the digital route entirely Lifeline catches the call and captures the medication request in writing via SOPHIA. The practice receives a structured outcome.
Patient insists on speaking to reception Transfer to reception as per standard transfer sensitivity rules

Step 5: The practice receives a structured outcome

Whether the patient completes the request via the NHS App, via SOPHIA, or via reception, the practice receives the relevant information through their normal workflow. Nothing is lost regardless of which route the patient takes.

Surgery-Specific Prescription Routing Configurations

Not all surgeries use the standard Pathways flow. Some surgeries have custom prescription routing configured based on their specific operational needs. Support staff must check the surgery's configuration before advising on expected behaviour.

Standard Pathways flow (V12, May 2026) Default for all V12 surgeries. NHS App deep link sent by SMS, intelligent fallback to SOPHIA or reception.

Custom prescription signposting (from February 2026) Available on request for surgeries with non-standard repeat prescription processes. EMMA and SOPHIA redirect callers to the surgery's designated repeat prescription service rather than the NHS App. Currently live for Gresleydale Surgery and available for others on request.

Dedicated prescription answer machine routing (Nettleham Medical Practice, March 2026) EMMA recognises repeat prescription calls from Nettleham callers and transfers them directly to a dedicated 24/7 repeat prescription answer machine. Patients can leave requests outside surgery hours. This applies only to Nettleham.

Enhanced prescription recognition with confirmation step (Newgate Surgery, March 2026) EMMA recognises a broader range of medication-related phrases for Newgate callers, including indirect phrasing and common STT mishearings such as "subscription" and "description." When indirect phrasing is detected, EMMA asks a brief confirmation question before proceeding. If the patient explicitly says "prescription," EMMA proceeds immediately without the confirmation step.

Time-window prescription routing EMMA can be configured to only accept prescription calls during specific hours, for example 8am to 3pm. Outside those hours, patients are signposted to the NHS App instead. This is available on request and configured per surgery.

What Changed With the April 2026 Fix

Before 30 April 2026, the repeat prescription deflection to the NHS App was not always working reliably. Specific issues included:

  • The correct guidance message was occasionally paraphrased or not delivered
  • In some cases the call flow stalled after the initial acknowledgement, leaving patients without clear next steps
  • Patients were not always told how to download or access the NHS App if they did not have it installed

These were resolved on 30 April 2026. As of that date:

  • Callers consistently hear the correct approved guidance directing them to the NHS App
  • Clear download instructions are provided for patients who do not have the app
  • The flow completes reliably across all surgery types

If a practice reports the repeat prescription flow stalling or providing incorrect guidance, check whether the affected calls predate or postdate 30 April 2026.

Common Causes of Practice Complaints and What to Check

1. The practice says EMMA is not taking prescription requests over the phone

This is correct behaviour. Repeat prescriptions must be made in writing. EMMA explains this and provides the NHS App route or an appropriate fallback. This is not a fault.

What to do:

  • Confirm to the practice that this is intentional and aligned with NHS guidance
  • Explain the Pathways flow and the fallback chain
  • If the practice wants a custom prescription routing option such as a dedicated line or custom signposting, advise that this can be configured on request

2. The practice says patients are not receiving the NHS App SMS link

Check whether this occurred before or after 30 April 2026. If after, this may be a new issue.

What to do:

  • Confirm the affected call dates
  • If after 30 April 2026, escalate to engineering with the surgery ODS code and affected call IDs
  • If before, reassure the practice the fix was applied on 30 April 2026

3. The practice wants all prescription calls to go directly to reception without NHS App signposting

This is configurable on request. Some surgeries prefer to transfer prescription calls directly.

What to do:

  • Confirm the practice's preferred prescription handling process
  • Raise a configuration change request specifying the desired routing: direct transfer to reception, dedicated answer machine, or custom signposting
  • Confirm with the practice once the change is live

4. EMMA is miscategorising prescription calls as something else

If EMMA is not recognising the prescription intent, this may be a speech recognition issue with indirect phrasing.

What to do:

  • Review the call recording to confirm what the patient said
  • Check whether the surgery has enhanced prescription recognition configured (as Newgate does)
  • If the surgery does not have this and recurring misrecognitions are occurring, raise a configuration request for enhanced prescription phrase recognition

Step-by-Step Triage Process

  1. Confirm the surgery's consultation tool and current prescription routing configuration.
  2. Ask the practice to describe the issue. Are patients not receiving the NHS App SMS? Is the flow stalling? Are prescription calls being misrouted?
  3. Check whether affected calls predate or postdate 30 April 2026.
  4. Review the call recording to confirm what the patient said and how EMMA responded.
  5. If the flow is not working as expected after 30 April 2026, escalate to engineering with the surgery ODS code and affected call IDs.
  6. If the practice wants a configuration change, raise the request with the configuration or engineering team.

What to Tell the Practice

Example wording when a practice questions why EMMA is not taking prescriptions verbally:

"EMMA directs patients to submit repeat prescription requests in writing via the NHS App. This is in line with NHS guidance that repeat requests should not be taken verbally over the phone, as written requests reduce the risk of errors with medication names and dosages. EMMA sends the patient a secure link to the NHS App by SMS so they can complete the request quickly without needing to call back. If the patient cannot use the app, EMMA has a fallback process to ensure the request still reaches your team."

Example wording when a practice wants direct transfer instead:

"We can configure EMMA to route repeat prescription calls directly to reception or to a dedicated prescription line if that better suits your surgery's process. Just let us know your preferred setup and we will arrange this."

Common Mistakes

  • Telling a practice that EMMA should be taking prescription requests verbally. It should not. This is correct behaviour aligned with NHS guidance.
  • Not being aware of the 30 April 2026 fix and treating a pre-fix issue as an ongoing fault.
  • Not checking the surgery's prescription routing configuration before advising on expected behaviour. Each surgery may have a different setup.
  • Telling a practice that custom prescription routing is not available. It is available on request.
  • Not explaining the full fallback chain when a practice asks what happens if the patient cannot use the NHS App.

Escalation Guidance

Escalate to engineering if:

  • The NHS App deep link SMS is not being sent after 30 April 2026
  • The prescription flow is stalling after the initial acknowledgement after 30 April 2026
  • EMMA is consistently misrecognising repeat prescription requests after a configuration update has been applied
  • Multiple surgeries are reporting prescription flow issues at the same time

When escalating, always include:

  • Surgery name and ODS code
  • Consultation tool used
  • Prescription routing configuration in place for that surgery
  • Affected call IDs and timestamps
  • Description of what the call recording shows
  • Whether the issue predates or postdates 30 April 2026

Last Reviewed: May 2026 Owner: Support and Customer Success