There could be professional risks in moving to an unfamiliar workplace setting, such as online pharmacy, if the appropriate systems and processes are not already in place, suggests one pharmacist. They tell their story anonymously here. 

Are you a pharmacist looking to branch out of your current sector or have recently gained an independent prescribing qualification that has opened up the door to new career opportunities?
You may be thinking that online pharmacy could be the next career move for you. If this is the case, then please read on. My exciting new role didn’t turn out as I expected, and my experience might just save you from taking a wrong step in your career.

Technology in healthcare is moving at such a fast pace, including the growth of the online pharmacy sector. More patients, particularly during the pandemic, have been choosing convenient online options for medicines delivery, moving away from established, well-managed and well-governed services from their local brick and mortar pharmacy. In my view, the rapid growth of online pharmacy may be amplifying risks to public safety.

As a pharmacy professional, I took an established clinical framework in previous roles for granted. I assumed the pillars of clinical governance would be implemented in all private and NHS organisations. However, this was not the case. I found to my detriment that the online pharmacy I moved to work for as a pharmacist didn’t have all the necessary procedures in place to adequately safeguard me in my pharmacy practice.

I am now facing a Fitness to Practice investigation as a result.

If you are thinking of working for an online pharmacy, I’d say think carefully? Make sure the organisation you join has the appropriate systems and processes in place.

My lessons learned

As a pharmacist prescriber working at an online pharmacy, I unintentionally failed to adhere to necessary pharmacy professional standards. I say unintentionally because of course I choose a career as a pharmacist to deliver care to patients. But although I didn’t cause harm, without realising it, I could have.

In that role, I was prescribing high risk medicines to patients using an inappropriate consultation model; an oversimplified questionnaire, completed remotely with no face-to-face interaction and no access to the patients’ medical records.

I had not considered prescribing or referring patients for alternative non-pharmacological therapies, which is key in patients presenting with problems such as insomnia.

Patients were able to pre-select their medication, due to the lack of understanding I had for the IT system, patients would answer the questionnaires based on the medication they wished to obtain. I failed to accurately recognise the scope of the service I was associated with, and continued to prescribe, and not speak up, when I knew something wasn’t right.

I am no longer in that job but have reflected on my experiences and would recommend a series of steps for anyone else making a similar move which I would like to share. Is the pharmacy a suitable employer and operating safely and effectively?

1. Research the organisation and the online pharmacy sector
Consider the requirements of the regulator for online pharmacy businesses.
Find the section on the GPhC website where inspection reports for pharmacy premises are published. This will give you transparency into whether the organisation you are considering is adhering to the Standards for registered pharmacies guidance.

2. Revisit your professional responsibilities as a pharmacist
We should be familiar with the GPhC’s Standards for pharmacy professionals guidance. This guidance is in place to ensure we are able to improve healthcare outcomes for our patients and have a positive contribution to their health.

Both these sets of guidance go hand in hand. If the organisation does not abide by the standards for registered pharmacies, then we as a pharmacy professionals must exercise our professional standard, and vice versa. The purpose of these standards is to mitigate risk. The standards are readily transferrable across pharmacy sectors and should be adhered to at all times as a bare minimum.

3. Understand the systems in place
Do you understand how to use the computer system at your new employer? And is the technology being used sophisticated enough to deliver safe and effective care?

If the answer is that you don’t know, then you should not be providing your professional services via this platform until you are fully confident that it is safe.

A good indicator of safety would be that the system is being regularly audited for quality and safety, and that safety incidents are being reported, well documented and followed up with an action plan.
When the core pillars of clinical governance are in place, there is assurance that risks are being identified and patient safety is prioritised above all.

Do you understand the patient journey? Ensure you see the journey from start to finish and identify any gaps that you feel could potentially compromise patient safety.

4. Be mindful of the organisation’s culture
Is there strong leadership that provides opportunities for learning and development?
An open and honest culture should be promoted that focuses on improving patient safety through reflection and, if necessary, revised processes.

The correct culture should emphasise holistic, patient centred care.

Commercial targets and financial incentives should not be compromising patient safety and care - this is a red flag.

5. Continuously reassess your competence
Always ask yourself whether or not you feel confident in the care you are providing in your new role; identify gaps in your knowledge and reflect when things go well and when they don’t go so well.
Be proactive in your learning; and be mindful that when you make a declaration of competence you are confirming you possess the knowledge and skills to deliver a specific service.

Remember at all times in your practice, that if you are not confident in providing a service this could cause potential risk to patients, and lead to a loss of confidence in the profession.

6. Be confident in using your voice
Have the confidence to speak up when something doesn’t seem right.
Be aware of internal, local and national procedures for whistleblowing. Be prepared to escalate to a regulatory body if you feel your concerns are not being addressed.

Remember that by doing so you could be preventing patient harm.

Patient centred care should be at the core of everything you do, and it is your duty to speak up to highlight deficient practices.

What happens if you unintentionally fail to abide by the pharmacy professional standards and do not make them central to everything you do? Well, you could find yourself in the same situation as me.

I am now facing a Fitness to Practice investigation, which could lead to me losing my GPhC registration. The GPhC is here to regulate and ensure that pharmacy professionals deliver safe and effective care. When in doubt, do ask. Speak to your indemnity providers and speak to the GPhC if needed - they are here to help.

The author is a pharmacist prescriber now working in general practice and has chosen to remain anonymous

The essentials of clinical governances

• Ensuring patient care is evidence based and well researched
• Process of audit - monitoring all clinical practices and highlighting deficiencies in practice so lessons can be learnt and remedied
• Managing risks - systems are in place to identify, monitor and minimise risks to protect staff and patients.
• Training opportunities for staff to maintain competence, develop skills and keep up to date
• Service user feedback - opportunities to improve service provided
• Information governance - data is secure, up to date and accurate.
• Staffing- appropriately skilled staff, staffing levels and the management of staff.

Read: Good clinical governance in an online pharmacy setting, GPhC. October 2022.