It was ‘not possible to provide advance notice to pharmacies’ of the multi-factor authentication (MFA) updates that have reportedly ‘caused havoc’ this week, PharmOutcomes provider EMIS has told The Pharmacist.

And Community Pharmacy England (CPE) said it had 'serious concerns' which it had raised with NHS England (NHSE).

This week pharmacy teams have reported being unable to access PharmOutcomes – a system used by pharmacies to manage Pharmacy First referrals – and some have complained that the multi-factor authentication is difficult to set up with little support available.

The outage could also impact patients, as well as the ability of pharmacies to meet their required number of Pharmacy First consultations and of GPs to refer to the service which was launched just weeks ago in England, pharmacists have warned.

Update ‘caused havoc in pharmacy-land’

Pharmacy teams first began noticing issues at 5pm on Tuesday, when ‘all of PharmOutcomes just changed’,  contractor Ashley Cohen told The Pharmacist.

‘[We] needed this MFA to get on – no notice, no warning, no explanation,’ he told The Pharmacist.

‘It caused havoc in pharmacy-land’, he said, adding that in the local pharmacy Whatsapp and Telegram groups he is part of others were also reporting being ‘locked out’.

One X (formerly known as Twitter) user suggested that the issue was particularly affecting pharmacy groups with several sites administrated under one user.


Being unable to access Pharmacy First referrals that might be waiting in the PharmOutcomes system meant ‘missed opportunities’, Mr Cohen said.

And he suggested it might impact on pharmacies being able to reach the minimum numbers of consultations required for monthly payments.

‘It will certainly slow down,’ he said.

Along with other X users, Mr Cohen suggested the outage could also impact patients.

‘And then if you've got a hiatus of two or three days, what's going happen to patients?’ he said.

Meanwhile, Superintendent Pharmacist Derviş Gürol suggested on X that the issue was ‘putting patients at risk’.

‘It was appalling’

Mr Cohen expressed frustration and suggested that pharmacists were repeatedly overlooked, especially with regard to IT systems.

‘It feels the same old problem: we've not got an IT system that’s acceptable for us,’ he said.

‘We're at the bottom of the gene pool, pharmacists. Out of the £645 million [for Pharmacy First and community pharmacy services] a significant number of million was supposed to have been spent on good IT systems.

‘Well, the IT systems weren't even set up and ready for when we launched. And the goalposts have changed after five weeks.’

Pharmacy First in England was supposed to be underpinned by an 'interoperable' IT system that would 'streamline' the referral process.

But in order to make the 31 January launch date, the community pharmacy negotiator 'agreed a minimum viable product' using existing Community Pharmacy Consultation Scheme (CPCS) referral routes, Community Pharmacy England chief executive Janet Morrison recently told a parliamentary inquiry.

And chief pharmaceutical officer for England David Webb revealed last week that the promised updates could still be weeks away.

Dealing with the introduction of MFA this week, Mr Cohen said that he and other contractors had spent ‘hours’ on the phone unable to get through to EMIS customer services, saying that he then had to stay late to finish checking prescriptions.

He suggested that the issue was compounding pressures on community pharmacy and questioned why the updates had been introduced with no prior notice or additional instructions.

‘God knows why these things can't be planned, communicated, given two, three weeks notice for people to get set up before it's turned off,’ Mr Cohen said.

‘I was on a webinar with PharmOutcomes only last Wednesday, an excellent webinar, taking us through [the Pharmacy First system] – nothing in that webinar talking about we're moving towards this [MFA],’ he added.

‘I get it if there was a security breach, but you can't expect 10 and a half thousand contractors and all of their staff, and all their associated locums, to switch over to that immediately with no prior warning, no... roadmap,’ he said, adding that even ‘technical people’ had difficulties setting up the new system.

‘It was appalling,’ he told The Pharmacist.

EMIS: ‘Not possible’ to give advance warning

A spokesperson for EMIS, the company behind PharmOutcomes, told The Pharmacist that while it had been in touch with NHS England about the upgrade, it had not been possible to let pharmacy teams know about the update in advance.

They said: ‘We regularly update our security measures and have recently taken proactive steps to further protect our systems.

‘As we worked towards this upgrade we have remained in close contact with NHS England, however it was not possible to provide advance notice to pharmacies.’

The spokesperson added that EMIS had ‘put additional support in place to assist pharmacies as they adapt to the changes’.

‘As ever, clinical safety and information security remain our top priorities and the focus of our efforts,’ they added.

CPE told The Pharmacist that the 'rapid roll-out of MFA without warning' had 'come at a critical time for pharmacy teams', and followed issues with the Manage Your Service (MYS) portal earlier in the week.

'We have logged our serious concerns with NHSE,' a CPE spokesperson said.

Meanwhile, local pharmaceutical committees (LPCs) shared guidance for contractors on X.

‘Each PharmOutcomes user must have their own login which must be linked to a unique email address’, Community Pharmacy Devon posted, adding that an email documenting how to set this up, along with a troubleshooting guide, had been sent to a shared NHS mail box.

The LPC added that users with shared email addresses could no longer access the system, and that a unique email address was required to set up MFA and access PharmOutcomes.

They also said that MFA was available on a desktop application.