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Within the last few weeks, at least six pharmacists have been subjected to interim order applications - either suspended or had significant restrictions placed upon their registration pending a full 'Fitness to Practise' hearing into serious allegations being made about their prescribing practices, the Pharmacists' Defence Association (PDA) has found. It said that there has been a "dramatic increase in action being taken by the pharmacy regulator (GPhC) against pharmacist prescribers associated with certain types of online prescribing services". It has warned pharmacist prescribers who work for online pharmacies about the specific risks associated with remote prescribing using a questionnaire-based model, typically with no direct prescriber/patient interaction. Common features that underpin the allegations include the following: Overreliance on a patient questionnaire to inform clinical decision making; No patient/prescriber interaction; Prescribing high risk medicines without adequate safeguards; Inadequate systems and processes leading to inappropriate prescribing; Very high volumes of prescriptions being authorised in short periods of time; and Prescribers/patient relationship established via an unregulated online portal.

Prescribing in pharmacies is an emerging opportunity, and I'm passionate about supporting proper governance arrangements for businesses. But does the governance and administrative burden reduce if your business is not doing the prescribing? Recently, I've come across several independent pharmacy businesses across the UK who have been approached by prescribing clinics to dispense medicines for their patients. While these partnerships can present lucrative opportunities, they also come with significant responsibilities and potential risks. Pharmacy owners and superintendent pharmacists must be fully aware of the guidance set by the General Pharmaceutical Council (GPhC) and ensure that all requisite checks are performed to maintain compliance and safeguard patient safety. The growing trend of prescribing clinic collaborations For one reason or another, private prescribing clinics are sprouting up all over the place, offering specialised services such as weight management, hormone therapy, or dermatological treatments. These are quickly becoming a prominent feature in our healthcare landscape. Many of these clinics lack in-house dispensing capabilities, leading them to seek partnerships with pharmacies to satisfy a growing number of consumers. In the current economic climate, these collaborations can offer a new revenue stream and an expanded patient base. However, with these opportunities come responsibilities that must not be overlooked.

The fusion of the unique in-depth understanding of medicines by pharmacists together with the competence to prescribe offers will improve access to care and increase capacity in the health system, said the Royal Pharmaceutical Society (RPS) Director for England Ravi Sharma to Parliament at the Health and Social Care Select Committee's inquiry on workforce on Monday (May 23). However, he also stated that a new workforce strategy must support and harness the skills of pharmacist independent prescribers in clinical care with investment in training, both for new and existing workforce; access to supervisors; protected learning and development time; and commissioning of services to make best use of independent prescribers across care settings, supported by appropriate prescribing budgets in community pharmacy. "We're about to see new generation of pharmacists independent prescribers that will make a huge difference to the clinical role of pharmacists to support patient care, but this must be underpinned by protected learning time and a more ambitious approach to commissioning new services to use their skills," Ravi said. He spoke to MPs in Parliament at the Health and Social Care Select Committee's inquiry on workforce, highlighting the vital contribution of pharmacy teams during the pandemic and called for action to support the current and future workforce. Some of the key issues highlighted in the parliament included, the risk of burnout and the need to help boost staff retention; staff wellbeing, including a zero tolerance of abuse from the public; the importance of professional development and protected learning time to enhance patient care and support rewarding careers; the potential of new pharmacist independent prescribers and the need for investment in the current workforce and the need for better workforce data and a pharmacy workforce strategy.

The Pharmacist's Defence Association (PDA) has raised concerns over the adoption of Digital Clinical Excellence (DiCE) guidelines for online prescribing of GLP-1 receptor agonists for weight management in adults. This follows a clash with expert recommendations commissioned by the General Pharmaceutical Council (GPhC) as the PDA "believes the final guidance conflicts with the expert opinion underpins the GPhC's prosecution strategy towards pharmacist prescribers under investigation." In a recent statement, the PDA highlighted the discrepancy between DiCE's guidance and the expert report employed by the GPhC to prosecute pharmacist prescribers using a questionnaire-based consultation model. This conflict has prompted the PDA to withhold its endorsement of the DiCE guidance as it differs from an expert report commissioned by the GPhC. The PDA's reservations stem from the inherent risks associated with questionnaire-based prescribing.

The General Pharmaceutical Council (GPhC) has published updated guidance on online pharmacy services in Great Britain, introducing additional safeguards to prevent unsafe supply of high-risk medicines, including weight loss injections. Under the new rules, medicines used for weight-management and medicines requiring physical examination before a prescribing decision is made have been added to the list of high-risk medicines. When prescribing these medicines, prescribers can no longer rely solely on online questionnaires. Instead, they must independently verify patient information, either through timely two-way communication with the person, accessing the person's clinical records, or contacting the person's GP, their regular prescriber, or a third-party provider. These measures aim to prevent individuals from providing false information to obtain medicines that may not be clinically appropriate for them, reducing potential harm. The pharmacy regulator updated its guidance in response to concerns identified relating to unsafe prescribing and supply of medicines online.

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".

"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.

The Medicines and Healthcare products Regulatory Agency (MHRA) has approved a new indication of semaglutide (Wegovy), authorising its use to reduce the risk of serious heart problems and strokes in adults who are obese or overweight. Semaglutide, a GLP-1 receptor agonist, was previously approved for use in the treatment of obesity and weight management, to be used alongside diet, physical activity and behavioural support. The latest approval establishes it as the first weight loss drug to be prescribed to prevent cardiovascular events, such as cardiovascular death, non-fatal heart attack and non-fatal stroke, in people with established cardiovascular disease and a Body Mass Index (BMI) higher or equal to 27 kg/m2. Novo Nordisk, the manufacturer of Wegovy, received this authorisation on 23 July following compelling evidence from a recent post-approval clinical study involving over 17,600 participants. The study demonstrated that Wegovy, administered at a dose of 2.4 mg once weekly via subcutaneous injection for up to five years, significantly lowers the incidence of major adverse cardiovascular events (MACE) by 20 per cent compared to a placebo.

The Department of Health and Social Care (DHSC) has issued an alert to update healthcare professionals on the shortage of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are used to treat type 2 diabetes. It has informed that the supply of the drugs continues to be limited, and is not expected to return to normal until at least the end of 2024. An increase in demand for these products for licensed and off-label indications is cited as the cause of the supply issues. "Rybelsus® (semaglutide) tablets are now available in sufficient quantities to support initiation of GLP1 RA treatment in people with type 2 diabetes (T2DM) in whom new initiation of GLP-1 RA therapy would be clinically appropriate," the DHSC's National Patient Safety Alert reads.