“All online pharmacies in Great Britain will have to strengthen safeguards” thanks to GPhC guidance updated “in response to concerns identified relating to unsafe prescribing and supply of medicines online”, the regulator today (February 4) revealed.
The new guidance, which sets out how pharmacies can meet the regulator’s legal requirements, comes after its consultation launched in September garnered concerns that proposed changes risked “watering down” online pharmacy rules.
Now, the GPhC has said that it has taken feedback on board to further strengthen the guidance, which “emphasises that for high-risk medicines, [a] prescriber cannot base prescribing decisions on the information provided in an online questionnaire alone”.
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“Instead, the prescriber has to independently verify the information the person provides,” it said.
Information can be verified “either through timely two-way communication with the person, accessing the person’s clinical records, or contacting the person’s GP, their regular prescriber or a third-party provider”, it added.
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But the guidance said that prescribers can choose “not to use two-way communication” if they “make a record, specific to the individual person’s circumstances, justifying their reasons”.
It added that if the online prescriber “cannot independently verify” the information, the patient “should be directed to an appropriate care provider so that they can be appropriately assessed… [including] an out-of-hours service, a local walk-in centre or urgent care”.
Weight loss drug crackdown
Weight loss medicines have also “been added to the list of high-risk medicines requiring extra safeguards before being prescribed”, the GPhC announced.
The new guidance said that “when supplying medicines used for weight management, the prescriber [should] independently [verify] the person’s weight, height and/or body mass index”.
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“Verifying information through a phone call would not be appropriate when supplying medication for weight loss,” it added.
The GPhC told C+D that during its consultation, some providers questioned the regulator’s plans to including weight management medicine in the high-risk category.
But the regulator said that it did not take forward this feedback, as it had seen evidence of the drugs’ risks in Medicines and Healthcare products Regulatory Agency (MHRA) drug safety alerts and C+D reporting of leading doctors’ calls for regulation and patient incidents.
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“We can confirm we have taken enforcement action against at least 12 pharmacies since 2021 in relation to their supply of weight management medicines,” GPhC chief strategy officer Louise Edwards told C+D.
She added that the regulator has also acted against “at least nine other pharmacies for inappropriately supplying medicines online without taking appropriate steps to verify information, and/or relying too much on the information provided via an online questionnaire”.
Who is responsible?
“The guidance is coming into effect immediately,” Edwards told C+D.
“Online pharmacy owners and superintendent pharmacists are expected to review the updated guidance and make any changes needed to their online pharmacy’s operations, processes and digital platforms at the earliest opportunity,” she said.
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“GPhC inspectors will continue to inspect online pharmacies and will be looking for evidence that pharmacies are meeting our standards,” she added.
The GPhC told C+D that the guidance also applies to pharmacists and pharmacy technicians working within online pharmacy teams when they are prescribing or supplying a medicine.
It added that these pharmacy professionals should raise concerns where guidance is not followed.
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Pharmacies and pharmacists are still responsible for ensuring that guidance is being followed, even if the prescriber is a doctor working for a third party, it said.
Where parts of the pharmacy service – “including a prescribing service” – are the responsibility of a third party, agent or contractor, pharmacy professionals should consider “making sure the provider has policies, procedures and safeguards in place”, guidance added.
“Enforcement action”
“Not meeting our standards could result in us taking enforcement action,” the guidance said.
“This could be against the pharmacy, the pharmacy owner, the superintendent pharmacist or all three,” it added.
“We could also investigate the fitness to practise (FtP) of all the pharmacy professionals involved,” it said.
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Commenting on the new guidance, GPhC chief executive Duncan Rudkin said that the regulator has “seen too many cases of medicines being supplied inappropriately online and putting people at risk”.
“We have listened carefully to feedback we had from organisations representing pharmacy and patients, and have further strengthened the guidance,” he added.
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Reacting to the news, National Pharmacy Association (NPA) chair Nick Kaye said that the pharmacy body is “pleased that the GPhC has taken on board concerns expressed by the NPA about a small number of patients who have been able to access higher risk medication…without proper consultation”.
“It is important to note that the vast majority of pharmacies, including online sellers, already adhere to good practice in this area and do all they can to support patients,” he added.
Weight loss worries
In July, a pharmacist independent prescriber (IP) was struck off from the GPhC register after issuing tens of thousands of prescriptions using online questionnaires.
And in May, the regulator hit three pharmacists with warnings after they provided “high-risk” medicine using “unsafe” online patient questionnaires.
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The updated guidance comes after C+D exclusively reported in June that a “young girl” was rushed to A&E after presenting with life threatening symptoms after taking weight loss drug Wegovy that she had obtained through Boots Online Doctor.
That month, now health secretary Wes Streeting revealed plans for “much closer clinical oversight and regulation” around accessing weight loss drugs from online pharmacies, saying he was “terrified that someone is going to die”.
