Remote prescribing requires safeguards

Claire Garcia discusses the GMC’s updated guidance on Good practice in prescribing and managing medicines and devices, which came into effect from Monday 5 April.

Long before the NHS made changes, in response to the Covid-19 pandemic, about how it delivered services to patients, the independent sector was pioneering the widespread use of remote consultations 

How we reported on the new GMC guidance last month (March)

The number of online healthcare providers registered in the UK rose from 14 to 47 between 2013 and 2021. This expansion may have been partly driven by demand from time-poor professionals needing quick access to medical advice, but now many more patients are accessing healthcare online due to Covid and the necessity to control the spread of infection.

So our updated guidance, Good practice in prescribing and managing medicines and devices, is timely and will, I hope, be welcomed by all doctors committed to ensuring a safe experience for their patients. 

Digital revolution

Alongside our own call for evidence on remote consultations and prescribing, which we held in early 2020, we also took heed of the safety concerns, such as those in the Care Quality Commission’s report The state of care in independent sector primary care online services. 

Our call for evidence enabled us to listen to the views, experience, and expertise of more than 70 individuals and organisations. Their input helped us to fully understand how we could ensure our guidance could keep pace with the digital revolution taking place in our healthcare systems.

Since then, patient bodies, including Healthwatch, published The doctor will Zoom you now: getting the most out of the virtual health and care experience, which sheds more light on experiences and learning from the widescale remote provision of healthcare during the pandemic. 

While our prescribing guidance is about much more than remote healthcare, our updated version had to be structured to reflect the new reality that remote consultations are now as routine for many doctors and patients as face-to-face consultations.

Ethical standards

But the one thing that remains crucial, as made clear in our guidance, is that doctors must meet our ethical standards regardless of the setting in which they work. 

If it’s not possible for doctors to meet those expectations via a remote consultation, they should switch to face-to-face or signpost to alternative services.

Many online healthcare providers have a business model which relies on digital patient questionnaires, sometimes designed to convert inquiries into sales. Such questionnaires may have a role in providing a satisfactory patient experience that enables quick and easy access to healthcare.

But, as our updated guidance makes clear, prescribing requires a sufficient understanding of the patient, and there is a risk if these systems do not provide that. 

Questionnaires for patients should be designed to support a two-way dialogue and, by doing so, allow doctors to meet our professional ethical standards.

Keeping patients safe

One of the key findings from our call for evidence was the crucial role that effective information sharing plays in keeping patients safe – regardless of whether health advice is provided online or face to face. This is especially true when prescribing controlled drugs or other medicines liable to misuse, overuse or addiction.

Here, a failure to share information can mean the difference between life and death. Our updated guidance is clear that doctors must not prescribe these types of medicine without access to medical records unless it’s an emergency and no other suitably qualified practitioner is available without unsafe delay. 

The fragmented infrastructure of UK healthcare means that doctors in the independent sector are not always able to easily access NHS medical records. 

That is why it is so important that independent prescribers should, where necessary for patient safety, seek patient consent to verify information with their GP before prescribing and share information afterwards. 

Eventually, I hope information sharing between all health professionals involved in a patient’s care will become easier. 

But the fact is that each individual doctor is accountable for the prescriptions they sign. They also have a personal and professional ethical decision to make if they feel patient safety is compromised. 

Where this is the case, they have a duty to raise concerns. Doing so not only protects patients but also protects the reputation of healthcare businesses and maintains confidence in the profession.

Good practice in prescribing and managing medicines and medical devices

Claire Garcia (right) is policy manager at the GMC