Key Summary
- GPhC supported the recommendations from HSSIB’s report.
- It highlighted that it is a concern when independent online prescribers don’t have access to patient data.
- The organisation urges the single patient record to be accessible to non-NHS organisations too.
The General Pharmaceutical Council (GPhC) has supported recommendations from the Health Services Safety Investigations Board (HSSIB) to improve the safety of independent online prescribing.
The HSSIB recently published these findings and recommendations following its investigation titled Online prescribing: opportunities to improve patient safety.
A primary concern highlighted is that independent prescribing organisations without an NHS contract do not typically have access to a patient’s NHS medical records, which significantly affects their ability to verify crucial patient information.
To bypass this issue, some independent prescribing organisations have resorted to using photos or videos of a patient’s NHS App to verify medical history.
However, this goes beyond the intended purpose of the NHS App and creates distinct patient safety risks, as the app is not designed to hold a verified, complete clinical picture.
Furthermore, while these organisations have internal systems to identify multiple medication requests from the same patient, address, or payment method, this information is not currently shared outside of each individual provider.
GPhC comment
Commenting on the HSSIB report, Kathie Cashell, Chief Executive of the General Pharmaceutical Council, noted that the report highlights significant changes to prescribing practice in recent years and how these can improve patient access to medicines.
However, she also pointed out the complex regulatory landscape within which independent prescribing organisations sit, with no single body providing end-to-end oversight.
The GPhC agrees that more action is needed to ensure the regulatory model keeps pace with the rapid growth and development in this sector.
She explained that where services are delivered via online pharmacies, they must be registered with the GPhC.
However, Cashell highlighted a gap in regulation relating to online services in England that are not pharmacies and only use pharmacists or pharmacy technicians to provide services, including prescribing.
She concluded by emphasising that collaboration is critical in such a complex landscape.
Current situation
Currently, no independent prescribing organisations have 'write access' to patients’ NHS medical records, meaning they cannot enter information directly into a patient's file.
This creates potential gaps in medical histories, which can negatively impact the identification of complications and potential contraindications - the factors in an individual's condition that make a particular line of treatment unwise.
While NHS GPs are often relied upon to provide clinical information to these independent organisations, they have limited capacity to do so.
The varying approaches to these requests also create uncertainty among GPs regarding whether the queries are legitimate and whether they should respond.
Additionally, a large amount of data is gathered by independent prescribing organisations which could help inform patient care, but there is currently no mechanism to feed this data back into the NHS.
This data often relates to medications more commonly prescribed by independent providers, such as weight-loss treatments, and has wider implications for understanding the ongoing safety of these medicines.
While the Care Quality Commission (CQC) and the GPhC have arrangements to work together regarding organisations registered with both regulators, these joint arrangements could be made much clearer to providers.
Matt Mansbridge, senior safety investigator at HSSIB, commented that people are increasingly using independent online services to access medications, but the systems supporting safe prescribing have not kept pace with this change.
He stated that their investigation found NHS services and independent prescribing organisations are often working with incomplete information, creating a risk that patients could be prescribed medicines that are inappropriate or that interact dangerously with other treatments.
“The ambition to introduce a Single Patient Record presents a real opportunity to address these issues, but to hold a truly complete record, it must consider how care provided by non-NHS organisations is included,” he added.
Industry Response
Major digital healthcare providers have strongly echoed these regulatory calls for deeper data integration with the NHS network.
Phil Day, Superintendent Pharmacist at Pharmacy2U, commented: “As the country’s largest online pharmacy, we support the HSSIB’s recommendations wholeheartedly. Giving regulated online prescribers wider access to appropriate NHS patient data is a must if we are serious about realising the ambition of a modern, digitally-led healthcare system.
“As well as supporting the aims of the 10-year plan, enabling this access has a clear safety benefit, helping to remove the risk of patients being prescribed treatments that could cause drug interactions and contraindications. It’s also important that this data-sharing is a two-way street, recognising the growing use of independent online services for clinical consultations and access to medication, and the value of their evidential data to the NHS.”
Dr Mitra Dutt, Associate Medical Director at LloydsPharmacy Online Doctor, added: “This is a welcome report, and its recommendations reflect calls we have been making for several years. Online healthcare is now a routine part of how millions of people access care, but the information systems supporting it have not always kept pace. As more patients move between NHS and independent services, it is essential that their clinical records follow them safely and appropriately.
“Built on patient consent and proper governance, appropriate access to NHS records would help clinicians make safer prescribing decisions and close gaps between NHS and private care. Another important consideration is read-write access. An online clinician’s notes, including consultation outcomes and recommended follow-ups, should be available to the wider healthcare team where relevant. Keeping this information in siloed systems creates avoidable gaps in care."The Single Patient Record presents an important opportunity to address this properly, but for it to work it needs to reflect the patient journey across both private and NHS providers. Patient safety should not be compromised because someone chooses to access care online.”
