Project overview

Prescribing is the principal therapeutic intervention available to health services. There are a growing number of online models of healthcare, which have the attraction of potentially improving access to, and efficiency of health services, and prescribing forms a key element of many of the services provided. Online healthcare services comprise online doctor websites providing real-time video or questionnaire based medical consultations which may involve issuing of a prescription; and online pharmacies offering a range of services including prescribing, mail-order of medicines, and collection and delivery of medicines prescribed by a regular prescriber such as a GP. This includes private online pharmacy and doctor services as well as those commissioned by or delivered within the NHS.

Little is known about the nature of online prescribing services, including quality assurance, safety, patient experience or how these services fit within the wider NHS landscape. Developing a better understanding of the characteristics, benefits, disadvantages, and challenges of new models of care with respect to prescribing, is essential for ensuring that services are optimally designed to be efficient, safe and of high quality. The Medicines and Prescribing research team are developing a research programme to look at these issues.

To understand the current literature, we undertook a scoping review of the literature using the term “online prescribing”, identifying 5 relevant UK studies. These included two quantitative studies, one qualitative, and two descriptive studies. Studies focused on some specific clinical areas (e.g. analgesics, men’s and women’s health, antibiotics) with one considering the characteristics of online pharmacies. None of the studies measured quality or safety issues.

In addition, we searched the UK Medicines regulator (MHRA) registration database in November 2020 (this was disbanded in January 2021 due to Brexit), and found nearly 1000 approved companies at the time, marketing through over 2000 websites. Most were selling a combination of General Sales List (GSL), Pharmacy (P) or Prescription Only Medicines (POM) products, with a mixture of private and NHS-contracted providers. Some companies provided access to consultation services in order to issue prescriptions (remote person-to-person, survey, or email), whereas others simply provided a dispensing service for prescriptions provided by the NHS or a private provider.

Development of a research programme around online pharmacy and medication services

We would like to undertake some research to better understand the role of online pharmacy services within the wider health service. To do this, we’d like to speak to GPs, pharmacists and other health service professionals to understand their perspectives in terms of the potential benefits and problems with online pharmacy services, and what further information we need to understand the quality and safety of care that they deliver. This will help us to design a research programme that can answer the questions that matter most to clinicians, commissioners and policy makers.

Next steps

We are currently looking to speak with stakeholders who have experience of working with and/or using online pharmacies. We would like to ask people about their experiences of these services so that we can understand what the key questions are that we should be asking as part of the future research programme.