Online chemists should see patients’ records to prescribe medicine safely, but the burden is falling on GPs. There must be another way, says the HSSIB.  

A rise in the use of private online pharmacies is causing extra work for already overstretched GPs. 

Doctors have spoken of being overwhelmed with additional administrative tasks, reviews and checks as pharmacies seek information about patients, a report by the Health Services Safety Investigations (HSSIB) found. 

The use of non-NHS, online pharmacies has grown rapidly, but there is no formal system for the chemists to ask for medical history or information to be shared between the two, creating risks for patients and inadvertently more work for doctors.  

In some cases, pharmacies are asking for screenshots or video footage of medical records in the NHS App in order to verify patient information, the report states. 

Other times, GPs are being asked to confirm medical histories, share clinical information and manually update NHS records after medicines have been prescribed privately. GPs also report having to check whether requests for information were legitimate before responding and, in some cases, removing confidential information before records could be shared.

Investigators heard that some doctors become overwhelmed by the volume of requests, particularly as demand for weight-loss drugs soars. While the work falls outside of their NHS responsibilities, it still has to be completed, diverting time away from caring for patients. 

Incomplete information

The watchdog is urging the government to find a way for NHS patient information to be shared with such pharmacies, and implement a framework for chemists to then update the NHS records themselves, rather than asking GPs to. 

“Online pharmacies can offer convenience for patients and, as such, are increasing in popularity, so it’s important they are held to the same high standards of safety and quality as community and practice-based pharmacies,” said Victoria Tzortziou Brown, president of the Royal College of GPs.

“Part of this will involve pharmacists working for online pharmacies having access to the information necessary to support safe prescribing,” she added. 

Matt Mansbridge, senior safety investigator at HSSIB, says the ad-hoc way things are currently working means independent prescribers are often working with “incomplete information”, which creates a risk that patients could be prescribed medicines that are not right for them. 

The report points to two instances where people have died, including a patient who overdosed on a prescription medication obtained online. The chemist had no access to the patient’s GP records, which included a history of mental health illness and previous overdoses. Evidence during the inquest suggested that had the records been available, the prescription would not have been issued. 

In the second example, a patient who overdosed was prescribed medication by both the NHS and a private pharmacy, with no lines of communication between the two. 

Kathie Cashell, chief executive of the General Pharmaceutical Council, says one of the issues is that there is no “end-to-end” oversight of independent prescribers, with gaps in regulation. 

Online pharmacies must be registered with the council, which then issues guidance and carries out inspections. Inspections can also be carried out by the Care Quality Commission (CQC).  

However, online services that are not pharmacies but use pharmacists or pharmacy technicians to prescribe medications are unregulated, not falling under the council or CQC’s remit. 

“This is a gap we have highlighted previously and have made suggestions for how it could be resolved through legislative changes,” Cashell said. 

She added that the council welcomes the watchdog’s recommendations and will “consider carefully” what further action can be taken.