Online primary care: response from the regulators

26 Sep 2019 03:50 PM

As regulators of healthcare services, medicines and health professionals throughout the UK, we recognise the importance of encouraging innovation, improvement and sustainability in care, while ensuring that it meets fundamental standards of quality and safety.

Online provision of health and care services challenges the existing regulatory landscape by transforming how care is delivered, where and by whom.

We know the majority of medicines are prescribed and dispensed safely and appropriately online. However, in some cases people are able to access medicines that are not appropriate for them, or in quantities that their regular GP or other NHS services would not prescribe for them. The impact on people and their families can be catastrophic.

Over time, we have become concerned that some providers of online primary care are configuring services in ways that take them out of scope of some or all UK regulators. This means they are not legally subject to the same inspections and safety checks.

A UK-wide cross regulatory forum was established in February 2017. As members, we share information and work together to take a coordinated approach, address regulatory gaps, and help improve the quality and safety of services for people in the UK. We continue to develop our understanding of the benefits and risks of primary care services delivered online, and we work with health and care providers to encourage the use of evidence-based best practice. Members of the forum have specific actions and plans to achieve this:

• The professional and system regulators are working together with partner organisations to develop shared principles on remote consultations and prescribing to provide support to regulated healthcare providers and professionals.
• We are also jointly developing information for the public to consider when using online services, to ensure they can access evidence-based, safe and effective care.
• The General Pharmaceutical Council (GPhC) has published updated guidance for pharmacy owners providing pharmacy services at a distance, including on the internet. This includes further safeguards to help make sure that people can only obtain medicines from online pharmacies that are safe and clinically appropriate for them. GPhC inspectors are looking for evidence that the guidance is being followed during pharmacy inspections.
• The General Medical Council (GMC) has guidance for doctors on remote consultations and prescribing, as well as specific advice on good practice in this area. Later this year GMC plans to launch a call for evidence on whether its prescribing guidance needs to be updated in light of the fast pace of change in remote healthcare services.
• The Care Quality Commission (CQC) has inspected all registered online providers in England and published the findings from the first programme of inspections. All registered online providers will now receive a quality rating following inspection. CQC has requested changes to the law to bring online providers into regulation that have so far been out of scope due to their configuration, which means they must be registered with CQC by law.
• The Regulation and Quality Improvement Authority (RQIA) inspects all registered online providers in Northern Ireland. If the online provider is also registered and inspected by another system regulator, RQIA uses the information from the most recent inspection to inform its inspection approach.
• The Medicines and Healthcare products Regulatory Agency (MHRA) has undertaken a sustained public awareness campaign targeting specific audiences about fake medicines. MHRA is working with the Department of Health and Social Care and others to review opioid addiction, including online sales.