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The General Pharmaceutical Council (GPhC) has raised concerns over the rising risks related to online pharmacy services. It revealed over 30 per cent of its open Fitness to Practise (FtP) cases were related to online pharmacy, which is disproportionate to the sector of the market that online services occupy. The regulator has advised pharmacists and pharmacy owners providing online services that they should "not work with online providers who try to circumvent the regulatory oversight put in place within the UK to ensure patient safety". In the past five months, the Council has imposed seven interim orders on the registration of pharmacists who have worked for or with online prescribing services - after identifying serious concerns with their practice. It said: "These pharmacists were working as pharmacist independent prescribers for online services or were dispensing medicines prescribed online. Some of these pharmacists were the Responsible Pharmacist (RP) or the Superintendent Pharmacist (SP)."

Online pharmacies have to operate from bricks & mortar premises that are registered with the General Pharmaceutical Council, but recent cases show that, in reality, the practices of online pharmacies are often very different to other pharmacies, and the regulation of online pharmacies is also different - and evolving as issues arise. For a start, the General Pharmaceutical Council (GPhC) is only one of the regulators taking an interest in online pharmacy services. Other regulators include the Medicines and Healthcare products Regulatory Agency (MHRA) which enforces the advertising and promotion of medicines, and the Care Quality Commission (CQC) which regulates prescribing services. The different regulation of online pharmacies is attributable to the higher risk to patients and the public from medicines bought online. These risks often arise from a combination of patients who do not tell the truth in order to obtain medicines and the nature of a transaction in which a pharmacist does not see patients face-to-face. "The GPhC has strong enforcement powers that it uses when it considers its premises standards have not complied with." However, there are also things that go wrong because pharmacists have simply failed to act professionally or take sufficient care, as well as cases where things have gone wrong through misfortune.

A BBC investigation has found 20 UK online pharmacies selling prescription-only medicines without adhering to the regulatory standards, such as checking for GP approval or patient's medical records. The news organisation was able to purchase over 1,600 restricted pills, including anti-anxiety drug, painkiller and sleeping medication, from these regulated online pharmacies easily by providing false information. However, the report didn't mention the names of the drugs as "they can be dangerous when taken without medical guidance." Some pharmacies were also found selling high-risk and potentially addictive medicines, including benzodiazepines and antidepressants, based on online questionnaires and did not require further checks. The General Pharmaceutical Council (GPhC), which regulate online pharmacies in the UK, states that selling and supplying medicines at a distance brings "different risks which need to be appropriately managed to protect patient safety."

In a recent announcement, the British supermarket chain, Asda has launched its first online prescription service becoming the first self-serving shop to offer prescribed medicine supply at the doorsteps through its latest healthcare accessibility venture. The NHS certified online pharmacy service, Asda Online Pharmacy, is set to offer patients a digital platform designed to simplify the prescription process for patients, offering the convenience of online management and home delivery with their partnership with Pharmacy2U. Effective immediately, new patients can register for an account on the platform via pharmacy.asda.com. Once registered, they gain access to a seamless prescription ordering system that facilitates home delivery, along with the ability to monitor the progress of their orders. Prescriptions submitted through Asda Online Pharmacy will undergo rigorous scrutiny by qualified pharmacists before being dispatched directly to patients' doorsteps, all without any additional charges.

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Increased cooperation between countries is needed to ensure better regulation of online pharmacies, said authors of a new report - 'Online pharmacy operations and distribution of medicines', published by the International Pharmaceutical Federation's (FIP) Community Pharmacy Section. The report presents findings of a global survey of pharmacy organisations covering various aspects, such as type of medicines supplied by these pharmacies in different countries, how the authenticity of online pharmacies can be verified, and the usage of e-prescriptions and shared patient health records. Of the 79 countries responding to the survey, 51 per cent acknowledged that no regulation of online pharmacies exists. A quarter of the respondents reported cases of irresponsible self-medication by consumers who had purchased medicines through online pharmacies. A lack of regulation creates "an avenue for illegal pharmacies and may impact the overall quality of medicines and services offered to consumers," authors of the report said. Lars-Åke Söderlund, immediate past president of FIP's Community Pharmacy Section and co-editor of the report, said that the pandemic has increased preference for online services, including in the pharmacy sector.

The National Pharmacy Association (NPA), representing independent community pharmacies, has called for tougher regulation of the online sale of weight loss jabs to protect patients amid a prediction of a new year's boom in demand. The association argues that current regulation "leaves the door open for medicines to be supplied without appropriate patient consultation and access to patient records." It has urged the General Pharmaceutical Council (GPhC) to require greater consultation with patients before dispensing weight loss jabs and other high-risk medication online. The association stressed that online sellers should not just rely on information provided in online questionnaires but also gather important historical medical information before a full two-way consultation between prescriber and patient. Draft guidelines on weight loss medication The GPhC proposed changes to their current guidance for online pharmacies to improve patient safety. It launched a consultation on the revised guidance on 17 September, inviting feedback until 9 October 2024 from the public, carers, pharmacists, pharmacy technicians, other healthcare professionals, and pharmacy owners. In its response to proposed guidelines on prescribing weight loss medication, the NPA highlighted critical gaps, stating that proposed safeguards "still leaves the door open for medicines to be prescribed/supplied without appropriate two-way direct patient consultation and access to patient records for a full clinical picture particularly where high-risk medicines are involved, and the risk to patient safety remains".

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The National Health Service said that over 425,000 patients have utilised its new national online service to complete GP registration within its inaugural year. The GP surgery registration service, managed by NHS England, has granted NHS patients efficient and user-friendly access to GP registration since its inception in August 2022. According to the NHS, more than 1,400 GP surgeries, a fifth of the national count, have joined the NHS online registration service as part of a new plan to improve access to primary care. "This aligns with a new strategy to enhance primary care access, with a target of enrolling 2,000 practices in the Register with a GP surgery service by December 2023." Many GP surgeries still use paper forms, requiring patients to visit surgeries to collect paperwork. However, the new online service has been shown to save GP surgery staff up to 15 minutes per registration by helping to reduce paperwork and admin time, the NHS said. The NHS said that this service enables patients to register with a local GP online at any time, eliminating the need for in-person visits and simplifying the process for both patients and GP surgeries.

The Medicines and Healthcare products Regulatory Agency (MHRA) is doubling down on its efforts to combat online pharmacy frauds, emphasising innovation, eradication of legacy systems, and cybersecurity in its updated technology roadmap. The online sale of medicines and medical devices is a "growing phenomenon offering convenience, anonymity, and lower prices " for the public. However the lack of robust cyber monitoring also "poses significant risks", as many online pharmacies are "unregulated, illegal, or fraudulent." According to the MHRA's recent report highlighting the impact of artificial intelligence on the regulation of medical products, the strategic themes of "fundamental to the successful deployment of AI" are essential for protecting consumers from fraudulent medical products.

The General Pharmaceutical Council (GPhC) is inviting feedback on proposed changes to its guidance for online pharmacies, aimed at enhancing patient safety. These changes are designed to tackle concerns associated with receiving medicines from online pharmacies, particularly those that may not be clinically appropriate and could potentially harm patients. GPhC has identified concerns relating to inappropriate supplies of weight loss medications that could pose risk to patients' health. Duncan Rudkin, Chief Executive of the GPhC, underscored the importance of addressing risks in online pharmacy services. "We know that there can be significant benefits for people using online pharmacy services to get medicines and treatment, but there are also additional risks that need to be managed, to make sure medicines and other pharmacy services are provided safely to patients and the public.

"Our main concerns are that the use of what they call an asynchronous supply, where the prescriber neither sees nor talks to the patient at the time they issue the prescription, does lay itself open to perhaps people getting hold of medication that they shouldn't," the Head of Policy, PDA said. The Pharmacists' Defence Association (PDA) engages in a critical conversation on BBC Radio 4's Woman's Hour, shedding light on the online prescribing of weight loss drugs and advocating for safer practices. The PDA's spokesperson, Head of Policy Alima Batchelor, emphasised the importance of adhering to professional guidelines to ensure patient safety and mitigate regulatory concerns. During the feature, the PDA highlighted the complexities and risks associated with online supply chains, stressing the necessity for direct clinical consultations and pharmacist involvement in medication management. ""There are guidelines and advice about verification within the DiCE guidance, but it doesn't go quite far enough for us. We are concerned when patients decline to allow the online prescriber to advise their GP of what they're taking," Batchelor highlighted.

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