Pharmacy organisations have warned that proposals from the General Pharmaceutical Council (GPhC) to ensure the public obtains medicines and other pharmacy services safely online do not go far enough.
In response to a discussion paper published by the GPhC on 26 June 2018, pharmacy bodies, including the National Pharmacy Association (NPA), the Company Chemists’ Association (CCA) and the Royal Pharmaceutical Society (RPS), called for additional online safeguards and clarity on several of the proposals, including distinction between online pharmacies and online prescribing services.
In the discussion paper, which ran for consultation until 21 August 2018, the GPhC proposed that certain categories of medicines may not be suitable to be prescribed and supplied online unless further action was taken to make sure that they were clinically appropriate for the patient, such as contacting the patient’s GP.
The NPA agreed that opiates and sedatives, antimicrobials and products for chronic conditions should be singled out, but said that more categories should be added. For example, the NPA said it believes that medicines that require an element of “counselling”, such as erectile dysfunction treatment and the morning after pill, should be included in the list.
“Medicines can harm as well as heal, and they are not ordinary items of commerce. Both the NPA and GPhC recognise this,” said Helga Mangion, policy manager at the NPA.
“The proposed safeguarding measures do not extend far enough into those categories of drugs where a meaningful interaction with a health care professional is vital.”
The RPS suggested that performance-enhancing medicines and slimming pills should be included due to the increase in the supply of these drugs.
In its proposals, the GPhC also asked whether it was appropriate for pharmacy websites to allow patients to choose a prescription-only medicine (POM), and its quantity, before having a consultation with a prescriber.
The NPA said patients should be prevented from selecting a POM before a consultation with a prescriber.
“In the absence of face-to-face support, processes must be in place to ensure the most appropriate advice and recommendation is given and sometimes recorded too,” said Mangion.
The RPS agreed and said that patients should not be able to purchase POMs without some decision support, whether that is a patient group direction-based or a real-time remote prescriber consultation, with or without decision support algorithms.
It said that websites should also not take a “product-led” approach and enable patients to order large or inappropriate quantities of POMs without having an appropriate consultation to gather all the necessary safety information, including verifying the patient’s identity. It also said that relevant information should be shared with the patient’s regular GP and that repeat prescriptions should have a trigger to ensure any changes were noticed and acted upon.
Online consultation should meet the same standards as a face-to-face consultation, it emphasised.
The CCA highlighted specific concerns with the GPhC proposals around pharmacy responsibility for identity checking, and said that it believed expectations that identity is verified, to ensure medicines are appropriate for a patient, should sit with the prescriber, not the pharmacy.
The CCA added that, overall, the paper did not clearly distinguish between online pharmacy and online prescribing services.
“These services are not always integrated, yet the terms are used almost interchangeably in the document,” said the CCA in its response.
The RPS said that the proposals should apply to both providers of online pharmacy and online prescribing services.
The GPhC plans to publish a report in due course to summarise all of the responses to the discussion paper.