Lack of assurance about the safety of remote dispensing services.

Pharmacy type

Internet / Distance Selling

Pharmacy context

This is a pharmacy which offers its services to people through its website. The pharmacy has a prescribing service provided by doctors based in mainland Europe. The website offers prescription medicines for a range of conditions but mainly supplies medicines for the treatment of pain and sleeping tablets. It is a private pharmacy and does not supply NHS prescriptions. People do not visit the pharmacy in person and medication is sent by post, or delivered by a courier.

Relevant standards

• 1.1 - The risks associated with providing pharmacy services are identified and managed
• 1.8 - Children and vulnerable adults are safeguarded
• 4.2 - Pharmacy services are managed and delivered safely and effectively

Why this is poor practice

The pharmacy does not make enough checks to ensure medicines are appropriate for the people they supply. And it supplies some medicines which may not be appropriate for supply via a remote consultation because they require physical examination, blood tests or monitoring.

What the shortcomings are

When patients completed the online questionnaire it was possible for the patient to enter incorrect information, either accidently or deliberately. When a patient answered yes to questions that required a negative response, such as 'are you pregnant or breastfeeding?', or 'are you under the care of a psychiatrist?', a note appeared which stated that the patient should have a face to face consultation with their own GP. But the patient was then able to change the response to the answer. This altering of the answer was not auditable as log in or registration was not required to carry out the consultation. Some of the medicines that were available for selection would not normally be appropriate for supply at a distance due to monitoring requirements, dose adjustments and potential for misuse, and no records were provided by the prescribers to justify their decisions to prescribe. For example, Modafinil which is a stimulant, was advertised for the treatment of Narcolepsy but is often misused. There were questions around having a GP appointment for the condition or whether the patient was treated under a psychiatrist. But, it did not request proof of ID, address or previous prescription. The drug requires regular monitoring of blood pressure and recommendations suggest an electrocardiogram (ECG) before initiation. It also requires dose adjustments in some medical conditions. Some prescriptions for metformin had been dispensed. This medicine is used to treat diabetes and requires monitoring, but can also be misused. The patient’s GP was not contacted in advance to confirm whether monitoring was in place.

What improvements are required

The pharmacy should ensure that pharmacy practices include the safeguards set out in the GPhC's guidance on providing services at a distance.