The General Pharmaceutical Council (GPhC) will release a consultation on changes to guidance for online pharmacies 'within the next couple of weeks', chief executive Duncan Rudkin has said.

Proposed changes will emphasise the importance of a 'two-way dialogue between patients and prescriber', which may require further interaction beyond an asynchronous questionnaire, Mr Rudkin suggested.

Stronger guidance requiring prescribers to verify information provided by patients will also be proposed for certain categories of medication, including weight loss drugs.

And the GPhC will be strengthening safeguards around categories of medicines 'which have a particularly higher risk of fatality or serious harm if used in overdose or used inappropriately', Mr Rudkin said.

Speaking to delegates at the Avicenna Heathrow conference on Sunday (8 September), Mr Rudkin said its review of online pharmacy guidance had taken account of both the GPhC's own insights as well as media coverage, including a prominent BBC investigation.

He said the regulator had found that online pharmacies met its standards for premises in 72% of cases, compared to 84% of pharmacies overall.

Cases against online pharmacies often involved high risk medicines being supplied against private prescriptions, in particular where an 'excessive reliance' had been placed on online questionnaires.

And he suggested that where online pharmacies were failing to meet GPhC standards, they were often delivering clinical services 'in a very transactional way', with 'poor risk management and governance', and where 'professional perspective has been squeezed out by a commercial imperative'.

'The level of public interest, the level of public appetite for online services, continues to increase, but equally, questions about risk need to be answered,' Mr Rudkin said.

And he suggested that 'significant additional risks' were created when prescribing was based 'exclusively on online forms'.

'We're proposing to strengthen and expand on the guidance for owners and superintendents about what they need to consider when deciding on the right mode of consultation to enable for different sorts of services or different sorts of medicines,' Mr Rudkin said.

'The emphasis that we'll be placing is on the importance of having two-way dialog between patients and prescriber, and if that can't be enabled by an online form, then that form needs to be supplemented in some way or a different mode of consultation needs to be chosen,' he added.

Mr Rudkin said that for weight loss medicines in particular, 'there will need to be additional safeguards put in place to ensure safe prescribing'.

He said that prescribers could be faced with 'a real dilemma' if the patient did not have or would not allow access to a regular GP.

Mr Rudkin said that medicines 'of this kind' should only be prescribed with the GP's knowledge, adding that the new proposed guidance would speak to 'what should be done if that's not possible'.

'The risks of issuing a prescription and then making a supply in those cases are clearly enhanced, and need to be set against... perhaps the risk of not making a supply, which may be less of a worry,' Mr Rudkin said.

Regarding weight loss medication in particular, Mr Rudkin said that supplying GLP1-RAs where a supply shortage notification was in place could also lead to regulatory action.

He also said the new proposed guidance would explore whether patients 'should be able to express a preference in the online process for a particular medicine'.

While 'the current version of the guidance effectively prohibits this until there's been a consultation with a prescriber', Mr Rudkin said that lots of patients had fed back to the regulator that they would find it helpful to be able to express a preference, 'perhaps for a brand or formulation'.

The GPhC has previously told The Pharmacist that it was ‘working to update’ guidance for online prescribers, after the Pharmacists’ Defence Association (PDA) called for the regulator to issue ‘unambiguous guidance’ about what it expects of prescribers using questionnaire-based models.

The PDA had revealed that an expert report commissioned by the GPhC, which is not publicly available, was being used to prosecute ‘significant numbers’ of pharmacist prescribers who use online questionnaires.

And this report conflicted with industry-led Digital Clinical Excellence (DiCE) guidance about how to provide an asynchronous weight management service, the PDA suggested, warning pharmacists not to rely on the DiCE guidance.