Jood Pharmacy (9012990) - Improvement action plan

The pharmacy does not provide assurance it always provides its weight loss service safely. It holds short video consultations with people, but it doesn't verify people's weight and height during these consultations or by other means. And it doesn't track people's weight loss effectively to ensure people's dose and treatment remain appropriate. The pharmacy records people's NHS prescriber details but it doesn't inform them of the supplies it makes to people. This means there may be missed opportunities for clinical intervention.

Verifying weight and height: Video consultations have been extended from 5 to 15 minutes. Default position is to ask patients to stand on digital scales during video consultation in real time until an in-App verification feature is developed within the patient portal and then will ask for In App video to be completed together with ID checks. Additional ways to independently verify information is to use NHS App and GP connect to collaborate height, weight, BMI and other clinical information provided by patient. All decisions documented in HubSpot. When no independent verification possible supplies will be deferred until it can be. Further website and back end changes will support meeting GPhC Standards. As part of the pre-consultation questionnaire stage, patients are required to upload a photograph of themselves stood on digital scales together with a clear photograph of the scale reading before the consultation can proceed. The pharmacist reviews the submitted photographs and records the weight in HubSpot. This requirement applies at both initial consultation and at each monthly review. Regarding patients where the BMI is close to the lower end of the licensed indication criteria, we have introduced an additional step: where the patient's BMI is close to the threshold (e.g. BMI 27–28 for the comorbidity pathway or BMI 30–31 for the standard pathway), the pharmacist must document specific clinical reasoning in HubSpot confirming the BMI calculation and the basis for proceeding. The same approach applies at each ongoing monthly review where weight loss is being assessed, to ensure dose and treatment remain suitable. Tracking weight loss: Each month the patient must enter their current weight as a required field before a further dose can be purchased. The entry is reviewed and clinically approved by the pharmacist before the medicine is dispensed and dispatched, ensuring the dose and treatment remain appropriate and effective. Informing the GP: An email notification is now automatically sent to the patient's GP to inform them of each supply of weight loss medication, supporting opportunities for clinical intervention.

The pharmacy does not have an effective process to identify and act on medicine recalls and safety alerts.

The pharmacy will subscribe to MHRA drug alerts to identify and act on medicines recalls and safety alerts. These alert emails will be checked daily by pharmacy staff, and the pharmacy's medicines recall SOP is followed wherever action is required.

The pharmacy has standard operating procedures, but the team don't always follow them. This includes the procedures for completing audits, holding governance meetings and verifying people's weight during their video consultation. This means the pharmacy cannot be sure all the supplies it makes are appropriate.

Verifying weight during video consultations: The video consultation SOP has been reinforced and the consultation length increased from 5 to 15 minutes. SOPs and risk assessment now document specific points at which co-morbidities, past medical history and concurrent medications must be verified. There is a monitoring form completed at each monthly supply review, confirming any new medicines or conditions. SOP 13 (video consultation) and SOP 15 (weight verification) has been updated including for the use of NHS records for independent verification. There is a clear documented approach for independent verification of weight. Completing audits: As a newly registered pharmacy (registered December 2025), a full cycle of audits had not yet been possible at the date of inspection. Following the first month of operation the pharmacy has commenced its programme of required audits, which are now completed and documented in line with the audit SOP. Holding governance meetings: To be completed by the Superintendent Pharmacist - e.g. first governance meeting held on [date], minutes recorded, and a recurring governance meeting schedule established.

The pharmacy doesn't effectively audit its weight loss service, and it doesn't have a schedule of clinical audits planned. This means it doesn't have the assurance it is working in line with its Patient Group Directions (PGDs) and people receive suitable treatment. The pharmacy has not completed an audit of its cold chain packaging and delivery. And it has received some complaints. So, it cannot be confident people's medicines will be safe to use when they receive them.

Auditing against the PGDs: The pharmacy now consistently checks all of its operations against its Patient Group Directions (PGDs). A programme of clinical audits has commenced following the first month of operation to provide assurance that the service is delivered in line with the PGDs and that patients receive suitable treatment. Cold chain audit: The pharmacy is auditing its cold chain packaging and delivery by measuring the temperature of the package throughout the delivery process, including a package returned to the pharmacy, to evidence the temperature maintained during packing, postage and transit. Packaging has been ordered from a reputable UK packaging supplier, and confirmation has been sought of the packaging used by comparable UK pharmacy providers.