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Online antibiotics: time to level the playing field?

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Last week, news broke of an investigation by BBC Radio 5 live that exposed a number of websites freely prescribing antibiotics to reporters. The backdraft from the investigation has already drawn comment from the GMC (which has launched an investigation into online pharmacies) and the Department of Health. As at the time of writing, I have found no comment from the General Pharmaceutical Council (GPhC), the independent body that regulates pharmacists, pharmacy technicians, and pharmacy premises in Great Britain.

What did the antibiotic investigation uncover?

BBC Radio 5 live looked at 17 UK-based pharmacies selling antibiotics online. First, the good news: the BBC Radio 5 live study found that most of the pharmacies were operating within NICE guidelines. However, it found two specific cases of concern:

  • One pharmacy sold three antibiotics prescriptions to the same 'patient' (BBC reporter) within 24 hours.
  • Another sold a reporter an inappropriate antibiotic at almost five times the price of an NHS prescription.

What is the real argument?

Looking closer at the details of the investigation, what was discovered, and the ensuing conversations, it is clear that the concern isn't with antibiotics being prescribed online, but rather the way that they are being prescribed:

  • In the first case the patient was prescribed drugs for a dental infection. NICE guidelines state that these antibiotics should only be prescribed for patients with a significant facial swelling or condition that shows the immune system has been damaged. The online application (a questionnaire) asked about neither of these symptoms.
  • In the second case, a reporter was prescribed Metronidazole at a cost of £38 (£30 more than an NHS prescription). The patient was male and the questionnaire he had to complete before being prescribed included questions asking if he had symptoms of a vaginal infection.

While over-prescription and inappropriate prescription are the symptoms that have been highlighted by the investigation, the GMC underlines the real issue with this type of prescription selling. In launching its investigation, GMC boss Niall Dickson said, “Our prescribing guidance makes it absolutely clear that doctors may prescribe only when they have adequate knowledge of the patient's health, and are satisfied that the medicines serve the patient's needs.”

The real argument, therefore, is about the way that prescriptions are decided, and perhaps not the fact that they are made online per se. It could also, of course, be something of self-preservation on the GMC's behalf.

Let's look at some background

In August 2015, NICE said that 10 million prescriptions a year in the UK were made inappropriately. It stated at that time that “soft touch” and “hazardous” doctors should be disciplined for prescribing too many antibiotics. GP practices have since made great strides in tightening up controls, strategies, and methods of prescribing.

Simultaneously, the government and NHS have encouraged patients to take more responsibility for their own healthcare and treatment. Both have also encouraged GPs to seek different ways to streamline services. This has included offering digital age consultations – in other words, online.

Level the playing field

The GMC may have launched an investigation, but it is the GPhC that regulates pharmacies. If the GMC has no jurisdiction over pharmacies, why launch an investigation?

Could it be that the GMC wants to ensure that there is a level playing field, and that all patients are afforded the same duty of care and standard of service whatever route of care is chosen?

This study and the arguments and debates that are bound to follow surely highlight the need for greater regulation in the field of patient care. In the digital world, while there may be methods that can reduce wait times and the need to travel increasing distances to appointments and consultations, a blanket online questionnaire is clearly not one of them.

If pharmacies are to be given similar prescribing capabilities as GPs, then they should be regulated and inspected as equals, with the same rules governing prescriptions.

eSupplies Medical is a trading name of Williams Medical Supplies Ltd, a DCC business