Mary Agnew

Mary Agnew, our Assistant Director for Standards and Ethics, talks about the challenges that have come with the rise of online prescribing and how doctors can follow our guidance to provide safe care for their patients.

In today’s convenience age, many patients want rapid access to medicines without waiting for a face-to-face consultation. Or they may want to minimise embarrassment when seeking help for particular conditions. All of this can be really positive, giving the patient more control and enabling services to innovate and to respond efficiently.

We have seen some good examples of high quality care being delivered in this way, for example in rural locations where patients may not have easy access to a doctor, or in a situation where a patient may not otherwise have sought medical help.

But we have also heard some alarming examples of extremely poor and unsafe practice, for example prescribing large volumes of opioids on the basis of online questionnaires. This type of practice can put patients at serious risk of harm. Similarly, we are worried by reports of irresponsible online prescribing of antibiotics, which contributes to the challenges of antibiotic resistance.

And there are challenges from the increasing globalisation of healthcare. It’s becoming more common for doctors to prescribe to patients in other countries, via websites or using video-links. Doctors doing so must be careful to follow our prescribing guidance – it still applies to them if a patient lives overseas – and to familiarise themselves with the law in the country where their patient lives.

Prescribing doctors should seek the details of the patient’s registered GP, and consent to update that GP of any changes to medicines. Of course, patient refusal to do this should be considered in deciding whether to prescribe.

Complying with the law in other countries

In the European Economic Area (EEA), the patient must receive a medicine that holds a marketing authorisation in their country, in the form of the medicine licensed in that country, with patient information in the right language.

Anyone selling or supplying medicines to the public via a website to these countries must be registered with MHRA and display the common logo on every page of the website offering medicines for sale.

Plus, anyone selling or supplying medicines to the public via a website to countries outside of the EEA should do thorough due diligence checks to make sure they comply with the provisions and requirements of the country concerned.

Here to help – our guidance

If you prescribe remotely, are you confident you are doing so safely and responsibly? Our prescribing guidance is here to help you.

Here are some key questions to think about:

  • Do you know enough about your patient’s medical history, current medication and current health, including any mental health issues?
  • Are you able to work in partnership with the patient to reach a decision about treatment with their consent?
  • Does your patient need a physical examination or other assessment?
  • Is the type of drug or drugs something it is appropriate and safe to prescribe remotely? And are you prescribing a safe quantity?
  • Are you confident your patient has enough information about their medicines, including possible side effects, when and how to take them, and whether it is safe to drive?
  • Do you have an ongoing doctor-patient relationship with the person you are prescribing for? If not you need to take extra care, including sharing significant information with their GP (with the patient’s consent) to ensure continuity of care and a complete picture of medication.

You can also access our guidance on your mobile devices with our app, My GMP.

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Getting the balance right with our guidance

These areas of practice are evolving rapidly and we try to strike the right balance in our guidance between enabling innovation that responds to patient preferences and ensuring safe care. We constantly review our guidance to make sure it reflects changes to medical practice.

If you have any feedback on our guidance, you can send it to standardsfeedback@gmc-uk.org.

Flagging concerns

If you have concerns about a doctor’s prescribing practice being unsafe, you can raise them with us.