Incomplete prescription information putting patients at risk

Patients using online prescription services could be at risk of harm because NHS and private systems are not properly connected, an independent investigation has found.

A new report by the Health Services Safety Investigations Body (HSSIB) warns that vital information about a patient’s health could be missed because NHS services and independent prescribing organisations are often working with 'incomplete information'.

The report said that clinicians working for independent online prescribing organisations often do not have access to a patient's NHS medical records, while NHS healthcare professionals may also be unaware of medicines prescribed privately because these are not routinely recorded in NHS systems.

This lack of information sharing creates a risk that patients could be prescribed medicines that are inappropriate, interact with other treatments or are contraindicated because of their medical history, it added.

Matt Mansbridge, senior safety investigator at HSSIB, said: ‘People are increasingly using independent online services to access medications, but the systems that support safe prescribing have not kept pace with this change.

Related Article: Childhood vaccine changes boost MenB uptake, UKHSA data shows

‘Our investigation found that NHS services and independent prescribing organisations are often working with incomplete information.

‘This creates a risk that patients could be prescribed medicines that are not appropriate or that interact with other treatments.’

HSSIB’s warning comes as the government is developing plans for a single patient record (SPR), through the NHS Modernisation Bill.

The investigations agency said that any future SPR system will need to include information from non-NHS providers if it is to provide a complete picture of a patient's care.

Mr Mansbridge added: ‘The ambition to introduce a single patient record presents a real opportunity to address these issues, but to hold a truly complete record, it must consider how care provided by non-NHS organisations is included.’

HSSIB’s report, published today, said that the expansion of online prescribing has been driven by increasing demand for services such as weight-loss medication and ADHD treatment.

The report notes there were 409 independent online pharmacies available to access in England in 2023/24, while a Healthwatch survey found 18% of people had used an online pharmacy during the first three months of 2024.

In the absence of access to NHS records, some providers rely on patient-reported information or contact GP practices directly to verify medical histories, it said. Others ask patients to provide screenshots or videos from the NHS app, although it has not been designed as a clinical verification tool.

According to the report, this places additional pressure on GP practices, creates delays and increases the risk that incomplete or inaccurate information could be used when prescribing medicines.

Related Article: NHS Scotland to offer semaglutide injections for heart attack and stroke prevention

HSSIB also warns that no independent prescribing organisations currently have 'write access' to NHS records, meaning prescriptions issued privately may never appear in a patient's NHS record.

The report also highlights examples from coroners' prevention of future deaths reports where patients died after obtaining medicines online, with investigations finding that access to NHS records may have altered prescribing decisions.

HSSIB has made three safety recommendations to the Department of Health and Social Care, including:

• Developing a mechanism to allow independent prescribing organisations to access appropriate NHS patient information with consent;
• Exploring options to allow them to update NHS records directly; and
• Creating a framework for sharing safety-critical information about patients known to multiple online prescribing providers.

The General Pharmaceutical Council (GPhC) has voiced its support for HSSIB's recommendations.

Kathie Cashell, the regulator's chief executive, said: 'We agree that more action is needed to ensure the regulatory model keeps pace with the rapid growth and development in this sector.'

She also acknowledged that there is 'a gap in regulation relating to online services in England that are not pharmacies, and which only use pharmacists or pharmacy technicians to prescribe'.

Related Article: Shorter benzodiazepine prescriptions could reduce long-term use

Ms Cashell said: 'We agree with the HSSIB that independent prescribing organisations, including online pharmacies, should have access to appropriate NHS records to improve patient safety.

'We believe that all pharmacies, including online pharmacies, should have read-write access to a person’s records, so all health professionals have the information they need to make safe and informed decisions about a person’s care and treatment.'

The GPhC will 'consider carefully' any further action it can take in response’, Ms Cashell added.