Online prescribing: challenges and opportunities to improve patient safety

Independent online prescribing has expanded rapidly in recent years, driven by increased patient demand for convenience, long NHS waiting times for some services, and a broader shift toward digitally enabled models of care.

This investigation focuses on challenges for independent prescribing organisations in accessing clinical information held by the NHS to inform safe prescribing decisions for the patients who use their services. It also explores how gaps in NHS patient information about medication prescribed by independent prescribing organisations creates risks for the delivery of safe care.

For both NHS and independent prescribing organisations, having limited information about a patient’s medical history and the medications they are being prescribed creates a challenge to making safe decisions about ongoing care and treatment.

The investigation also explores the complex regulatory landscape within which independent prescribing organisations sit. In this regulatory framework, regulators may have jurisdiction over different aspects of a single independent prescribing organisations. The investigation explored the challenges this posed and the impact it had on these organisations’ ability to provide safe care.

The findings of this investigation are offered to support the safe delivery of care for patients who use independent prescribing organisations and NHS services.

• Independent prescribing organisations without an NHS contract do not typically have access to a patient’s NHS medical records. This can affect their ability to verify patient information.
• Some independent prescribing organisations use photos or videos of a patient’s NHS App to verify information about the patient’s medical history. This is beyond the purpose of the NHS App and creates patient safety risks as the app is not designed to hold a verified complete picture.
• Independent prescribing organisations have systems to identify multiple requests for medication from the same patient, address or payment method, but this information is not currently shared outside of their organisation.
• No independent prescribing organisations currently have ‘write access’ to patients’ NHS medical records – that is, the ability to enter information directly into a record. This creates the potential for gaps in medical records which can impact on the identification of potential contraindications (factors in an individual's condition or medical history that make it unwise to pursue a particular line of treatment) and complications.
• NHS GPs are being relied upon to provide clinical information to independent prescribing organisations but have limited capacity to provide this. The different approaches to such information requests also create uncertainty among GPs around whether the requests are legitimate and whether they should respond.
• Lack of access to patients’ NHS medical records is a barrier to independent prescribing organisations providing safe care in line with standards, regulations, and best practice.
• A large amount of data is gathered by independent prescribing organisations which could inform patient care, but there is no way to feed this back into the NHS. This data often relates to medications more commonly prescribed by independent prescribing organisations, such as those for weight loss, and has implications for understanding the safety of these medications.
• The Care Quality Commission and General Pharmaceutical Council have arrangements to work together in relation to organisations registered with both regulators, but these arrangements could be made clearer to providers.