Online prescribing companies are prescribing high volumes of antibiotics, inhalers and opioids without talking to patients’ registered GPs, a major report from the CQC has found.
The ‘state of care’ report on online services found that 15 of the 35 providers it has inspected ‘were found not to be providing “safe” care’ – even after re-inspection.
The CQC also criticised online providers for failing to notify the patient’s regular GP when they issued prescriptions.
In one case, it found ‘a provider had not shared over 400 patient contacts with GPs, when they had the consent to do so and should have done’.
The regulator is currently unable to give its ratings of ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’ for online prescribers, and will only be able to do so from April 2019.
However, it inspected 35 providers, and found that 86% were failing to adhere to safety regulations.
This included ‘not collecting patient information or sharing information with a patient’s NHS GP, who should have an accurate and up to date record of their previous and current treatments and health problems’, the report found.
It listed examples of poor prescribing, including one instance where ‘opioid analgesics and other analgesics subject to misuse had been prescribed for up to two years without contacting the patient’s GP and with no access to the patient’s full medical records’ (see box, below).
Professor Steve Field, the chief inspector for primary care at the CQC, said: ‘After inspecting all independent online providers that were registered with CQC, our subsequent inspections have shown that most can and do improve, but some are not taking quality and safety seriously enough, which has resulted in us using enforcement powers. We are working with the sector to encourage this improvement and continue to keep people safe.’
Professor Helen Stokes-Lampard, chair of the RCGP, said: ‘It’s very concerning to see that even now, 43% of online consultation providers have been deemed unsafe in some respect. New services will inevitably experience some teething problems, but when our patients’ health is at risk urgent, swift action must be taken to comprehensively address these before the service is rolled out further.
‘The inappropriate prescribing of antibiotics, for example, poses risks to individual patients but also is of great concern to the wider public – and the failure to collect and share a patient’s data with their NHS GP could certainly have a detrimental effect on their future care.’
Dr Zoe Norris, chair of the GPC sessionals subcommittee, said that while patients don’t always need to be seen face-to-face, ‘it’s very different for a patient’s usual surgery to [prescribe online] with full access to their notes, compared to a remote service’.
Dr Norris added: ‘There are more and more examples of patients being prescribed inappropriate medication, with no or really poor communication coming to the GP. For these online models, informing the patient’s usual GP is optional.’
Examples of poor prescribing
‘In one particular provider that prescribed a high volume of opioid medicines, a clinician told the inspection team that they had never asked for information from a patient’s GP and the provider could not show evidence of any information-sharing at all. A review of patient records found cases where opioid analgesics and other analgesics subject to misuse had been prescribed for up to two years without contacting the patient’s GP and with no access to the patient’s full medical records. Some of these medicines had been unsafely prescribed and included a case where an opioid medicine was prescribed despite the patient confirming that their GP would not prescribe it. Although on reinspection the provider had increased the amount of information it shared, we still had concerns about the prescribing of opioid medicines.
‘In another provider, although it had implemented limits to restrict some prescriptions (opioid medicines and asthma inhalers) that patients could receive before they had to consent to their GP being informed, they were still able to receive medicines without information being shared with the GP. However, on a further inspection, we saw that the provider had taken action so that it was now mandatory to share information with the GP if opioid medicines or inhalers were being prescribed. In addition, the provider also implemented restrictions in the clinical system where an opioid prescription triggered an automatic letter to the patient’s GP where there was consent. If the GP declared that the patient was not actually registered at that practice or that the treatment was inappropriate, the patient’s account was frozen so that further prescriptions could no longer be issued.’
Source: ‘The state of care in online primary health services,’ CQC