BBC News: investigation into safety checks online pharmacies carry out when selling prescription-only medicines

General Pharmaceutical Council Chief Executive, Duncan Rudkin, said:

"The BBC’s undercover investigation raises very serious concerns. We have asked the BBC to provide further information so we can urgently look into these concerns and take action to protect patients and the public.

“We were very sorry to hear of the death of Katie Corrigan and wish to pass on our sincere condolences to Ms Corrigan’s family. 

“Although the Regulation 28 report and recommendations following Ms Corrigan’s death were not directly addressed to the General Pharmaceutical Council, we have reviewed these to identify any action that we can take as the independent regulator for pharmacy in Great Britain. 

“Increasingly people are choosing to access healthcare services online. There can be significant benefits for patients using online services to get medicines and treatment but there are also significant risks that need to be managed to protect patient safety.

“As the regulator for pharmacists, pharmacy technicians and pharmacies in Great Britain, we are committed to making sure people receive safe and effective pharmacy care and have trust in pharmacy. We do this by setting standards for pharmacy professionals and registered pharmacies, and providing guidance to support the people and pharmacies we register to meet those standards. 

“Our guidance for registered pharmacies providing services at a distance, including on the internet states clearly that selling and supplying medicines at a distance brings different risks which need to be appropriately managed to protect patient safety. Medicines are not ordinary items of commerce and must not be treated as such.

“We expect pharmacy owners to carry out a risk assessment to identify which medicines are appropriate for supplying at a distance; identify requests for medicines that are inappropriate, too
large or too frequent; and make sure that their staff are able to check the identity of patients and the safety and appropriateness of medicine supply for every patient.

“We have made it clear that some categories of medicines are not suitable to be supplied online unless further safeguards have been put in place to make sure they are clinically appropriate for patients. This includes medicines liable to misuse and/or when ongoing monitoring is important, such as opioids and sedatives. 

“We have identified cases where some online pharmacies have supplied these high-risk medicines to patients without appropriate steps being taken by the pharmacy owner, prescriber, responsible pharmacist, or other members of the team to check that the medicine being prescribed and dispensed was clinically appropriate for the patient.  

“In response, we have taken enforcement and regulatory action where appropriate against the owners of these registered pharmacies, as well as individual pharmacy professionals involved in both the prescribing and supply of medicines where their conduct may have fallen short of professional standards. 

“In particular, we are taking enforcement action where we see high-risk medicines being supplied where the prescriber is relying primarily on an online questionnaire completed by the patient to inform their decision to prescribe, and without other appropriate steps being taken to check that the medicine being prescribed and dispensed is clinically appropriate for the patient.

“Our guidance is designed to be outcomes focused so that pharmacy professionals must use their professional judgement to provide person-centred care that is safe and effective, including via innovative models that meet patients’ changing expectations. 

“We continue to keep our guidance under review as models of delivering pharmacy services develop to meet changing patient and public expectations.

“People accessing medicines online can also take actions to protect themselves, including by checking if an online health service and the health professionals that work there are registered with UK regulators. And it’s vital that people answer questions honestly about their health and medical history, to help make sure they receive safe and effective care and medicines that meet UK standards. Working with other UK health organisations, we have published a guide to help people keep safe when they go online. 

Background

Standards for pharmacy professionals

The Standards for pharmacy professionals apply to all pharmacists and pharmacy technicians in Great Britain.

The standards for pharmacy professionals describe how safe and effective care is delivered. They are a statement of what people expect from pharmacy professionals, and also reflect what pharmacy professionals have told us they expect of themselves and their colleagues.

Standards for registered pharmacies 

The standards for registered pharmacies set out the requirements for the provision of pharmacy services at or from a registered pharmacy.

Our standards for registered pharmacies are designed to create and maintain the right environment for the safe and effective practice of pharmacy and to improve the quality and safety of services provided to patients and the public.

Guidance on providing pharmacy services at a distance

Our guidance on providing pharmacy services at a distance explains what pharmacy owners should consider before deciding whether any parts of their pharmacy service can be provided safely and effectively at a distance (including on the internet). We have also published an FAQ on meeting online pharmacies guidance.

Guidance for accessing medicines and treatment online

We are committed to making sure people are protected when seeking medicines or pharmacy services online. In conjunction with other healthcare organisations, we launched a guide to buying medicines safely online to help people make sure that medicines or treatment they get online are safe and right for them.

Enforcement action since April 2019

  • 680 inspections of online pharmacies since April 2019. Only 72% met all standards compared to the overall historic benchmark of 84% 
  • Enforcement action has been taken against 54 distinct online pharmacies to address patient safety risks; this includes 57 conditions notices and 12 improvement notices. Typically, enforcement action has been taken against online pharmacies supplying higher risk medicines for private prescriptions based on questionnaire type consultations with little or no evidence of involvement of the patient’s usual GP. We have also focused on the use of overseas prescribers outside UK regulatory oversight. 
  • Since 2019 there have been 1985 concerns related to online pharmacies raised to Fitness to Practise 
  • There are currently 263 open online Fitness to Practise cases which represents over 18% of our open caseload. 
  • There are 10 registrants who are now subject to an interim order who were working in 5 different online pharmacies where concerns have been raised.