Along with weathering the funding cuts and striving to continuously enhance patient services, community independents are increasingly having to compete with online pharmacies for prescriptions.
However, as a series of recent cases suggest, some of these sites are not up to the standard expected of a bricks-and-mortar pharmacy. The Pharmacist has investigated the impact of illegally operating online pharmacies on the independent, community sector.
A cautionary tale
Following a series of investigations which led to the closure of two online pharmacies last month, the Care Quality Commission (CQC) called on the public to act with caution when considering buying medicines on the internet.
The online pharmacies in question were MD Direct (which had traded through the website assetchemist.co.uk) and HR Healthcare Ltd (through the website treated.com).
‘The decision to suspend our service was already made’
Director of HR Healthcare, Riaz Vali told The Pharmacist: ‘It was clear when the CQC came to inspect us in November that the decision to suspend our service was already made on the first day of the inspection.
‘The CQC have not identified any specific cases where any of our patients have been in any danger due to our service. The few cases that were identified where the CQC felt the patients may be in danger, when we contacted the patients it was clear this was not the case.
‘Currently, we are working very closely with a private CQC specialist consultant and we have made many changes and improvements to our processes and systems that will satisfy the CQC.
‘We are addressing the findings of the CQC and will be ready for another inspection very soon,’ Vali said.
MD Direct did not respond to any requests for comment.
‘Clinical safety risk’
The CQC’s listed their main concerns about the websites as:
- No (or minimal) identity checks for patients.
- No way of identifying whether or not patients lacked capacity to consent or understand their prescribed treatment or medical advice, or if there were any safeguarding concerns (and if they were identified, minimal structures in place to handle them).
- No systems or processes to contact the patient’s regular GP, including when medication was prescribed that required monitoring or follow-up
- Prescribing practice that did not take account of the patient’s clinical condition or consider differential diagnoses.
- Inadequate medical history-taking to inform appropriate prescribing.
- No assurances that clinicians had relevant skills or qualifications for the role they were performing.
Immediately following the inspections, the CQC suspended the registration of HR Healthcare Ltd. MD Direct then voluntarily cancelled its registration. Both providers since halted their services for patients in England (assetchemist.co.uk now uses an alternative online GP provider for its prescription service).
As a response, the CQC brought forward a programme of inspections for the 43 registered online pharmacies, prioritising those services it considers as potentially of risk to patients.
Community pharmacy response
Unsurprisingly, the news is disheartening for the vast majority of the profession who act within the law.
South London contractor, Al Patel, told The Pharmacist that ‘there is a market for online pharmacies’ but when websites do not follow the standards of treatment, they put patients at risk.
These rogue businesses ‘degrade the standard’ of pharmacy, he said. ‘They are trying to profiteer from cheap medicines at the cost of patient safety.’
Watch our interview with Patel here.
Warning to providers
The CQC released a joint statement with the General Pharmaceutical Council (GPhC), the General Medical Council (GMC), and the Medicines and Healthcare products Regulatory Agency (MHRA), warning providers and staff that they must follow professional guidelines to ensure safe and effective care for patients.
The statement said: ‘We will continue to work closely together to share intelligence where we have concerns and take action where necessary to protect patients. We will ensure providers and clinicians are clear on their responsibilities to protect people who use their services and deliver safe, high quality care.’
Duncan Rudkin, GPhC chief executive said: ‘Patients and the public always have the right to expect safe and effective care, whether they are receiving this care face-to-face or online.
‘The regulators involved all have different responsibilities, but by working closely together, we can help make sure that people are receiving safe and effective care at each stage of the process, from when they first visit an online primary care service to when they receive their medicines from a pharmacy.
‘Where necessary, we are carrying out further inspections of the pharmacies linked to the online primary care services being inspected by the CQC, to assess whether they are meeting our standards and appropriately addressing the issues and risks linked with online prescribing and dispensing,’ he said.
Online pharmacies have also come under fire for failing to do their bit in tackling antibiotic resistance.
The General Medical Committee (GMC) launched an inquiry following claims that some online pharmacies have been overprescribing antibiotics.
The GMC said it is looking into ‘serious allegations’ raised by the BBC after a Radio 5 Live investigation into 17 online pharmacies based in the UK claimed a reporter posing as a patient was given three prescriptions for antibiotics in the space of 24 hours.
The GMC has said such over prescribing, ‘risks the health of us all’, as earlier research has warned that growing resistance to antibiotics could kill 10 million people by 2050.
One reporter involved in the investigation claims he was given antibiotics for a dental infection even though he did not show any of the symptoms described in guidelines from the National Institute for Health and Care Excellence (NICE).
Over the following two days, the reporter alleges he was given two other prescriptions for a swollen ear and a urine infection.
Niall Dickson, chief executive of the GMC, said: ‘Online prescribing is part of a rapidly changing environment and it will have a place in future healthcare delivery. But the doctor’s obligations to patients and their safety does not change because the consultation is online.’
Pair given custodial sentence for illegally selling pills online
Unfortunately, patients can also use the Internet to purchase medication from dubious sources, where the sellers may have no pharmacy training whatsoever.
A married couple was sentenced at Liverpool Crown Court on 31 March for illegally selling unlicensed slimming pills online.
The court sentenced James Donegan and Melissa Donegan of Bootle, Merseyside to a 12-month suspended sentence and ordered them to carry out 180 hours of unpaid work.
The pair were connected to 23,000 pills seized Border Force investigators, which were found to contain sibutramine.
Sibutamine was withdrawn in many countries, including the UK in 2010, after it was found that it increased the risk of heart attack and stroke.
The Donegans made in access of £215,000 from their illegal sale of the slimming pills, which had been sent from Hong Kong and declared as ‘vitamins’.
More than 30,000 of the pills, with a value of over £15,700, were then found at the couple’s home by Medicines & Healthcare products Regulatory Agency (MHRA) investigators.
The head of enforcement for the MHRA, Alastair Jeffrey, said: ‘Unlicensed medicines can be dangerous as they may contain impurities, incorrect ingredients, and there is no way of knowing if they are manufactured to acceptable standards of quality and safety.
‘In this case, they contained an ingredient that has been withdrawn due to the risk it posed to health. What was being sold here had the real potential to cause harm.’