The pharmacy regulator has acknowledged 'serious concerns' raised by a BBC report into online pharmacies and has pledged to investigate the issue further.
An undercover BBC reporter was able to obtain a potentially fatal dose of anti-anxiety medicine, as well as other restricted drugs supplied without checks such as access to medical records or GP approval.
The media investigation, published today, follows ongoing concerns about the safety of prescribing and supplying drugs online, and raises fresh concerns about whether current regulation and enforcement is robust enough.
A coroner’s report published last year warned that the lack of an integrated system in place to show prescribers what has been dispensed by other online pharmacies, as well as no requirement for online pharmacies to share information with the patients’ GP, could allow patients to place multiple orders even when it is potentially harmful to do so.
And quoted in the BBC article, pharmacist Thorrun Govind said that regulatory guidance was 'too vague' about what kind of checks were required, leading to ‘variation’ in online pharmacy practice.
General Pharmaceutical Council Chief Executive (GPhC) Duncan Rudkin said in a statement published today that while there can be ‘significant benefits for patients using online services to get medicines and treatment’, there were also ‘significant risks that need to be managed to protect patient safety’.
GPhC guidance states that pharmacy owners should carry out a risk assessment to identify which medicines are appropriate for supplying at a distance; identify requests for medicines that are inappropriate, too large or too frequent; and make sure that their staff are able to check the identity of patients and the safety and appropriateness of medicine supply for every patient, Mr Rudkin said.
He added that the GPhC had ‘made it clear that some categories of medicines are not suitable to be supplied online unless further safeguards have been put in place to make sure they are clinically appropriate for patients’.
Mr Rudkin also confirmed that the regulator had identified cases where some online pharmacies have supplied these high-risk medicines to patients without appropriate steps being taken, and had taken enforcement and regulatory action in response.
‘In particular, we are taking enforcement action where we see high-risk medicines being supplied where the prescriber is relying primarily on an online questionnaire completed by the patient to inform their decision to prescribe, and without other appropriate steps being taken to check that the medicine being prescribed and dispensed is clinically appropriate for the patient,’ he added.
Regarding the cases raised by the BBC, Mr Rudkin said that the GPhC had asked the broadcaster to provide further information so that it could ‘urgently look into these concerns and take action to protect patients and the public’.
He also said that the regulator would keep reviewing its guidance as pharmacy service models develop.
But the Pharmacists’ Defence Association (PDA) accused the GPhC of being ‘too slow to grasp the risks inherent with this [remote prescribing] model’, adding that the regulator ‘needs to take more robust action in addressing the risks associated with commercial models of clinical care’.
‘The private online pharmacy prescribing model has developed rapidly over the past few years and its commercial success is heavily dependent on achieving high volumes. This has led to some business owners implementing systems and processes which are more suited to a retail transaction, rather than guaranteeing safe clinical care,’ the PDA said.
And it added that such services are ‘provided privately with limited or no access to NHS care records and sit outside NHS governance and quality frameworks’.
The PDA has previously called for GPhC guidance to be extended and warned that patients refusing to allow the prescriber to contact their GP was a ‘red flag’.
And it has today reiterated its own guidance for online prescribers.
Gareth Jones, director of corporate affairs at the National Pharmacy Association (NPA) called for medicines to be 'handled with great care', saying 'medicines are not like ordinary goods for sale online' and calling for 'robust safeguards for online supply of prescription only medicines, which must be rigorously enforced by regulators'.
And he added that 'high-risk and potentially addictive medicines need special care'.
The Royal Pharmaceutical Society (RPS) also highlighted the need not to treat medicines as ‘typical commercial products’.
‘They possess the ability to both effectively treat illnesses and potentially cause harm, so it’s critically important that they are provided to the public safely and effectively,’ the RPS said.
The society expressed concerns about the BBC’s findings. ‘There is no excuse for poor professional practice or inadequate systems of care in the safe supply of medicines,’ it said.
‘Numerous online pharmacies operate within the law and adhere to regulatory standards, providing medicines safely and appropriately,’ the RPS added.
But it said that any registered pharmacy, online or otherwise, that failed to safely supply medicines ‘must improve and face robust and appropriate sanctions from the regulators in this space’.
The RPS called on the GPhC, the Care Quality Commission (CQC) and the Medicines and Healthcare Products Regulatory Agency (MHRA) to work together and share information ‘to help eradicate poor professional practice by online providers and support them to be active in addressing the issues raised by this BBC investigation’.
How can online pharmacy websites have patients' best interests at heart? Read more from pharmacist Thorrun Govind’s own investigation, published by The Pharmacist in March 2023, including practical pointers for understanding patients’ online experience.