Online pharmacies ‘putting patients at risk’, watchdog cautions

Online pharmacies are putting patients at risk, a watchdog has warned, after a doubling in their use since the first lockdown.

The General Pharmaceutical Council (GPC) has issued a safety alert, saying more than 30 per cent of disciplinary cases now being considered by regulators relate to prescriptions from websites.

The figures show how the public increasingly turned to pharmacy websites after struggling to access GP appointments in the wake of the first lockdown.

Watchdogs said firms were doling out too many drugs without asking sufficient questions and in dangerously high quantities.

Too often, patients were put in danger by sites which simply asked customers to complete an online questionnaire, without any further interactions, even with high-risk drugs, they said.

Watchdogs found sites prescribing “high volumes” of prescriptions to the same patients over short periods, and high-risk medications being approved without proper monitoring.

Enforcement action

The GPC said it had placed restrictions on a number of online pharmacies already over safety risks, with further action expected pending ongoing investigations.

The regulator said that more than 30 per cent of its current 653 “Fitness to Practice” investigations of pharmacists relate to those working for online pharmacies.

The GPC has written to pharmacy owners saying: “We are writing to make you aware of serious patient safety concerns we are continuing to identify relating to some online pharmacies and online prescribing services.”

Data from the NHS Business Services Authority show how the use of such firms has soared since the pandemic. Last year, 53 million items were issued by online pharmacies, up from 42 million items in 2020 and 29 million items in 2019.

Regulators have registered 635 pharmacies in the UK as providing online services.

The number is dwarfed by the 14,000 physical pharmacies in existence - but watchdogs on Tuesday warned that they were having a “disproportionate” impact on the number of disciplinary cases.

The GPC said it has taken enforcement action against more than 50 online pharmacies since 2019, after identifying patients’ safety risks.

Inspections of 394 online pharmacies between April 2019 and April 2022 found just 71 per cent met its standards, compared with a figure of 85 per cent across the rest of the sector.

Diagnosis via Google

Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said increasing numbers had become accustomed to going online in search of medication, especially if they had struggled to see their GP.

She said: “It has become a habit for a lot of people. If you can’t see your GP people get desperate and start treating themselves, especially if they are in pain. The danger is it becomes diagnosis via Google, and patients end up at risk, with medicines that can do a lot of harm.”

Dr Hannbeck said wider trends, with a higher reliance on online purchasing and home deliveries since the pandemic, had exacerbated the pattern.

She urged those considering buying prescriptions online to seek advice from a local pharmacist, or see their own GP.

The pharmacist said the online sector was rife with poor practice, including the use of counterfeit drugs, and needed far closer scrutiny. And she said high street pharmacies were far better at spotting “alarm bells” such as attempts to abuse heavy painkillers.

Duncan Rudkin, GPC chief executive said: “Online pharmacies and prescribing services can bring real benefits for people, but people can be put at serious risk if they are able to obtain medicines that are not appropriate for them. We are taking robust action to protect patient safety whenever we identify unsafe prescribing or supply of medicines online.

“We would urge people wanting to get medicines online to only use online pharmacies registered with the General Pharmaceutical Council, to ask questions about how the service works, and to answer questions about their health fully and accurately.”

Prescriptions for opioids

In a separate email to pharmacy owners today, the council urged them not to work with online providers who “try to circumvent” UK regulations in place to “ensure patient safety”.

Earlier this year an investigation by the Pharmaceutical Journal found that 22 per cent of online pharmacies which had been inspected had failed at least one standard, compared with less than three per cent of physical pharmacies.

It follows repeated attempts to crack down on pharmacy services working with medics outside of the UK.

Under current regulators, anyone prescribing in the UK must be registered in the home country from where the prescription is issued, while following Britain’s prescribing guidelines.

The analysis in April found that a third of inspection reports for failing online pharmacies had links to prescribing services based outside of the UK - most commonly in Romania, as well as the Czech Republic and Germany.

Some online firms were found to be almost entirely dispensing prescriptions for opioids and similar drugs, without evidence of attempts to ensure safe use.

Doctors based in Romania

In February, the online medic service Pharmacorp Ltd, also known as Medicine Direct, was ordered to pay £13,670 by Tameside Magistrates’ Court after pleading guilty to providing services without being registered with regulators.

Watchdogs found that high-strength co-codamol and drugs for nerve pain were being prescribed to patients by doctors based in Romania, who were registered with the UK’s General Medical Council. The Care Quality Commission said the company’s website had been “misleading” in suggesting that UK-based doctors were being used.

In evidence submitted to the Health and Social Care Select Committee last year, the CQC said that it had “current examples of death and severe harm caused by digital services delivered from outside England”.

“Our view is that as digital services grow in popularity, and breadth, over the coming decade there is a gap in government’s power to intervene where harm is being caused,” the evidence said.

The regulator had previously said online pharmacies were putting patients at risk by doling out drugs after assessments lasting just 17 seconds.

Watchdogs said powerful and addictive drugs, including opiates, were behind handed out without proper checks on patients’ identities or medical history.