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Online pharmacies will be required to have a “two-way communication” with patients before prescribing medicines used for weight loss, new draft guidance from the General Pharmaceutical Council (GPhC) has said.
The ‘Draft guidance for registered pharmacies providing pharmacy services at a distance, including on the internet’, published on 18 September 2024, proposes new measures to improve patient safety in response to concerns relating to inappropriate supplies of medicines from online pharmacies.
The draft guidelines update previous guidance for online pharmacies, published in 2022, which set out additional safeguards that should be put in place, particularly when prescribing antibiotics, medicines liable to abuse and medicines that require ongoing monitoring.
These safeguards included using identity verification services and providing information to a patient’s GP.
In the latest draft, the GPhC expanded the list for which additional safeguards should be used, to include: medicines which have a higher risk of fatality; medicines where a physical examination is required; medicines used for weight management; and medicines labelled with a black triangle.
The guidance also added more safeguards for these medicines, including that “the prescriber does not base prescribing decisions just on the information provided in a questionnaire”.
“Instead, they use a system that allows for two-way communication between the prescriber and the person, so that both have the opportunity to ask questions to get the information they need to deliver safe care,” the guidance said.
“Examples include face-to-face, video-chat and end-to-end encrypted online platforms. If this is not possible, the prescriber should consider whether it is safe and appropriate to prescribe in the circumstances and raise concerns if that is appropriate.”
They also include further guidance for prescribers in circumstances where the person requesting a medicine does not have a regular prescriber such as a GP, or if the person has not given consent to the prescriber to share information with the person’s GP.
In these cases, “the prescriber must then decide whether it is safe to prescribe”, the guidance said.
“They should consider whether supplying treatment outweighs the risks, taking into account whether the person would be at risk of death or serious harm if they were also getting medicines from other sources.”
Duncan Rudkin, chief executive of the GPhC, commented: “Through our inspections and investigations, we’ve seen significant risks to patient safety when online questionnaires have inappropriately been the only mode of consultation used, and when the information provided by the patient isn’t verified by the prescriber.
“We are seeking views on some important proposed changes to the guidance, which we think will improve patient safety, and we then plan to publish the updated guidance as soon as possible.”
Claire Anderson, president of the Royal Pharmaceutical Society, said: “Medicines are not ordinary products; if misused, they can cause significant harm. Ensuring online pharmacies adhere to the same high professional standards as traditional pharmacies is crucial.
“Given the recent high profile cases regarding weight loss medication in the media, it’s encouraging that the GPhC is taking action to address this issue.”
In August 2024, a pharmacist trainee wrote in The Pharmaceutical Journal that she had seen unregulated online prescribing of semaglutide lead to clinically inappropriate supplies of the weight loss drug.
In February 2024, The Pharmaceutical Journal reported that the GPhC may consider using mystery shoppers to monitor online pharmacies following publication of an investigation into online pharmacies by the BBC on 5 January 2024.
During investigation, the BBC was able to buy prescription-only medicines from 20 online pharmacies without checks, such as GP approval.
Gordon Hockey, director of legal at Community Pharmacy England, said: “Whether online or in person, we always encourage improved prescribing and dispensing practices to support safe supply of medicines and to improve patient safety.”
The draft guidance is open for consultation until 9 October 2024.
