The Care Quality Commission is calling on people to act with caution when considering buying medicines on the internet.
CQC’s inspections of some companies that provide online primary care have found significant concerns about patient safety.
Although CQC acknowledges that well-run services can offer a convenient and effective form of treatment, inspectors have found services that were too quick to sell medicines without doing enough to check whether they were appropriate, meaning that patients could be at risk of harm.
In a joint statement, four regulatory bodies - CQC, the General Medical Council, the General Pharmaceutical Council, and the Medicines and Healthcare products Regulatory Agency - have reminded providers and healthcare professionals working for these services that they must provide safe and effective care, including following professional guidelines.
The statement says: “Technological advances have brought opportunities to deliver healthcare in new ways, including online primary medical services. Potentially, this innovation allows patients easier access to care and treatment when they need it.
“We share a joint commitment to ensure that the same safeguards are in place for patients whether they attend a physical consultation with their GP or seek medical advice and treatment online.
“We will continue to work closely together to share intelligence where we have concerns and take action where necessary to protect patients. We will ensure providers and clinicians are clear on their responsibilities to protect people who use their services and deliver safe, high quality care.”
CQC has also published information on how it inspects and regulates providers of digital primary care, as well as advice for the public when considering using an online doctor. People are being advised to ensure that the service follows guidance set out by the General Medical Council to protect patients from harm.
Professor Steve Field, Chief Inspector of General Practice at the Care Quality Commission, said: “We know that these websites can present convenient ways for people to access advice, treatment and medication.
“However some services may be putting patients at risk. We are particularly concerned that risks to patients may not always be appropriately assessed or managed when they buy medicines online.
“As with conventional GP surgeries, these online companies and pharmacies are required to provide safe, high-quality and compassionate care and must adhere to exactly the same standards. They must not cut corners.
“We will continue to work closely with the other regulatory bodies to share intelligence where we have concerns and take action where necessary. Providers and clinicians must be clear on their responsibilities to protect people who use their services.”
Today (Friday 3 March) CQC has published reports based on urgent inspections of two providers of digital primary care, MD Direct (which had traded through the website assetchemist.co.uk) and HR Healthcare Ltd (through the website treated.com).
CQC’s inspection of HR Healthcare Ltd was influenced by an investigation by Dr Faye Kirkland for BBC Radio 5 Live Investigates in October 2016, which looked at the online sale of antibiotics from this provider.
Immediately after the inspections, CQC suspended the registration of HR Healthcare Ltd. MD Direct responded to CQC’s concerns by voluntarily cancelling its registration. Both providers have stopped providing services to patients in England (assetchemist.co.uk now uses an alternative online GP provider for its prescription service).
Inspectors found that the two providers demonstrated significant clinical safety and organisational risk to patients, with widespread failings to provide safe care. Among the concerns which were identified:
- No (or minimal) identity checks for patients.
- No way of identifying whether or not patients lacked capacity to consent or understand their prescribed treatment or medical advice, or if there were any safeguarding concerns (and if they were identified, minimal structures in place to handle them).
- No systems or processes to contact the patient’s regular GP, including when medication was prescribed that required monitoring or follow-up
- Prescribing practice that did not take account of the patient’s clinical condition or consider differential diagnoses.
- Inadequate medical history-taking to inform appropriate prescribing.
- No assurances that clinicians had relevant skills or qualifications for the role they were performing.
Following an internal review of all 43 online services that are registered, CQC has brought forward a programme of inspections prioritising those services it considers as potentially presenting a significant risk to patients.
Using one of these websites, patients can ask a doctor to prescribe from a range of medicines; typically people are invited to choose their drug and select their symptoms or diagnosis from a drop down menu before the prescription is reviewed by a clinician and passed to a pharmacy to supply the order.
If the prescription is authorised by a doctor registered with the GMC or a qualified EU doctor, a pharmacist can lawfully supply the medication as specified.
Professor Field said: “The growth in online technology presents a real opportunity to improve people's access to medical advice and treatment. It is important that healthcare services continue to innovate.
“However, in some cases we have found websites which in effect allow people to select their own medication, including medicines restricted as prescription only, with little or limited clinical oversight. Patients can go online, self-diagnose their condition, order their own medicine and obtain a prescription from the online doctor service, with minimal checks on who they say they are and whether the medication is safe or appropriate for them, often within a matter of seconds.
“We know there are often inadequate identity checks, no checks on patient history or suitability, no checks with patients' GPs, and no follow ups or monitoring.
“Following our review of all online services registered with CQC, we will now visit each provider, working closely in partnership with the relevant regulators, and checking that providers are following the appropriate professional guidance. We will take action to cancel or suspend the registration of providers who are putting their patients at risk."
Health Minister, Lord O’Shaughnessy said: "We have empowered the CQC to run a tough and comprehensive inspection regime and commend their work to uncover failings in digital care provision. Online providers can be a convenient option, but patient safety must always be the priority and we urge the public to follow CQC’s advice when buying medicines online."
Charlie Massey, Chief Executive and Registrar of the General Medical Council, said: “We welcome innovations in medical practice that enable good care for patients, and support the use of remote prescribing that follows our clear prescribing guidance used in consultation with a patient in person or online. However, it is clear that not all practitioners are following the guidance, and we are concerned at these reports.
“We will be reviewing the information passed to us to identify any fitness to practise concerns, and any other learning both for the GMC and the profession."
Duncan Rudkin, Chief Executive of the General Pharmaceutical Council, said: "Patients and the public always have the right to expect safe and effective care, whether they are receiving this care face-to-face or online. The regulators involved all have different responsibilities, but by working closely together, we can help make sure that people are receiving safe and effective care at each stage of the process, from when they first visit an online primary care service to when they receive their medicines from a pharmacy.
“Where necessary, we are carrying out further inspections of the pharmacies linked to the online primary care services being inspected by the CQC, to assess whether they are meeting our standards and appropriately addressing the issues and risks linked with online prescribing and dispensing.”
Gerald Heddell, Director of Inspection, Enforcement and Standards at the Medicines and Healthcare products Regulatory Agency, said: “Prescription-only medicines are prescription only for a reason and should only be taken under the supervision of a healthcare professional.
“They should only be prescribed following a full assessment as to their suitability for you. A proper consultation with a medical professional is essential to ensure that an appropriate diagnosis of your condition can be made, your medical history can be reviewed, your recovery can be monitored and any adverse reactions can be dealt with.
“We are working closely with colleagues at the Care Quality Commission and the General Pharmaceutical Council to ensure online sellers act responsibly to protect public health.
“Anyone selling medicines to the public via a website must be registered with MHRA and display the common logo on every page of the website offering medicines for sale.”
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