Archived: White Pharmacy Ltd

Updated 12 September 2017

White Pharmacy Ltd is based in an industrial unit in Farnham, Surrey. White Pharmacy Ltd employs information technology (IT), pharmacy, dispensing and office staff at this site. They also have contracted clinicians who work remotely to authorise the prescriptions requested by patients.

The service is accessed through a website www.whitepharmacy.co.uk. Orders can be placed seven days a week and the service is available to patients in the UK and the European Union. Orders are processed onsite by staff working during normal working hours; Monday to Friday 9am to 5pm. Patients are able to register with the website, select a condition they would like treatment for and complete a consultation form which is then reviewed by a clinician and a prescription is issued if appropriate. When certain medicines are ordered for new patients for the first time, such as opioid analgesics and neuropathic pain relief medicines, a pharmacist speaks with the patient to discuss their treatment. The prescription is sent to the affiliated pharmacy before being supplied to the patient. (The affiliated pharmacy is regulated by General Pharmaceutical Council). Patients to the service pay for their medicines when their on-line application has been assessed and approved.

White Pharmacy Ltd was registered with the CQC on 12 June 2015 and they have a registered manager in place. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out our initial inspection on 12 and 16 January 2017. Following this inspection conditions were placed on the provider’s registration requiring changes to be made to how the provider operated. Further inspections were undertaken on 28 March 2017 and 22 May 2017. At those inspections we found further improvements were still required and additional conditions were added following the May 2017 inspection.

This report covers the findings from the 14 July 2017 inspection. This inspection was carried out to review the provider’s compliance with the conditions. During the inspection we found there had not been sufficient improvements to meet the conditions imposed.

During our inspection, we spoke with the registered manager, the acting medical director, and a superintendent pharmacist. We looked at policies, other documentation and patient records.

Our inspection team was led by a CQC Lead Inspector who was accompanied by two GP specialist advisers and a member of the CQC medicine team.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Updated 12 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at White Pharmacy Ltd on 14 July 2017.

We carried out our initial inspection on 12 and 16 January 2017. Following this inspection conditions were placed on the provider’s registration. Further inspections were undertaken on 28 March 2017 and 22 May 2017. At these inspections we found further improvements were still required.

This report covers the findings from the 14 July 2017 focused inspection. This inspection was carried out to review the provider’s compliance with the conditions imposed on their registration following our inspection in May 2017. During the inspection we found further improvements were still required. The reports from our comprehensive inspections in January 2017, March 2017 and May 2017 can be found by selecting the ‘all reports’ link for White Pharmacy Ltd on our website at www.cqc.org.uk.

We found this service did not provide safe and well led services in accordance with the relevant regulations.

Our key findings were:

• We identified continued significant risks to the safety of patients’ health and welfare, which related to insufficient or ineffective systems in place in relation to remote prescribing of medicines having regard to the General Medical Council (GMC) ‘Good practice in prescribing and managing medicines and devices’ guidance.
• We found cases of long term opioid analgesic and neuropathic pain relief prescribing with no access to the patients’ full medical history. We saw individual risks had not been identified in the prescribing of these specific medicines and no contact had been made with the patients’ GP. Furthermore, there was no documented consideration of the risks of long term opioid analgesics use and management plans for individual patients.
• Patients were at risk of harm because effective governance systems and processes were not in place to keep them safe
• The care and treatment records of patients did not always contain sufficient documentation of clinical rationale for decisions to prescribe medicines where consent was not given to contact a registered GP.
• The prescribing policy (implemented on 12 June 2017) did not outline the corporate responsibilities in relation to the issuing of prescriptions, or the governance processes in place to ensure patient safety is assured.

We identified regulations that were not being met. The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way for all patients. Including the safe and effective prescribing of medicines.
• Implement effective governance systems and processes to enable the provider to assess, monitor and improve risks relating to the health, safety and well being of patients and staff.

Summary of any enforcement action

We are now taking further action in relation to this provider and will report on this when it is completed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice