There is still the potential for 'significant risk' to patient safety in new guidance about online prescribing of weight-loss injections and other high-risk medicines, the Pharmacists' Defence Association (PDA) has said.

In particular, it raised concerns that medication might be prescribed inappropriately where a patient does not give consent for their GP to be contacted or where access to GP records are unavailable.

Meanwhile, the Medical Defence Union (MDU) has advised GPs not to ignore requests for patient information.

And it said that if patients do not give consent for GP records to be shared, GPs may have to contact the patient themselves, and tell the pharmacy 'that they are aware of information that makes the prescription inappropriate, but the patient has not given them consent to share this'.

PDA: Scope for 'significant risk' remains

New guidance from the General Pharmaceutical Council (GPhC) for online prescribing of weight-loss medication has set out that any information provided by a patient must be independently verified, either through 'timely two-way communication', accessing the person’s clinical records, or contacting the person’s GP, their regular prescriber, or a third-party provider.

But the PDA has warned that 'where there might not be access to the NHS GP patient record, or where consent is not given by the patient for their GP to be contacted, there is scope for a medication to be prescribed without those vital checks being made.

'The PDA believes this could still introduce significant risk,' it said in a statement yesterday.

'While there are some changes that are welcome, the GPhC had an opportunity to strengthen guidance to remove any doubt about what is required from providers in this space. Our view is that the new guidance does not satisfactorily address this,' Alima Batchelor, head of policy at the PDA added.

Do GPs have to share patient information with pharmacies supplying weight-loss jabs?

Separately the MDU has advised GPs not to ignore requests for patient information, as doing so could put them at medico-legal risk.

'Regardless of any approach to information sharing, you will likely need to check the patient record,' the MDU said in an advice webpage published on Tuesday (4 February).

'If it becomes clear that the weight-loss drug has been prescribed to someone with a clear contraindication, then it's probably not an option to simply ignore the correspondence.'

It added that GPs had been asking whether it was 'safe to rely on pharmacy's assurance that they have the patient's consent to disclose information'.

If a patient has misrepresented their body mass index (BMI) or medical history to the pharmacy, the MDU advised GPs to 'check with the patient about whether they consent to the information being disclosed'.

And it emphasised that 'the duty to share information for individual care is as important as the duty to protect patient confidentiality,' according to the General Medical Council's guidance on confidentiality.

What if a patient refuses to allow access to their GP record for weight-loss medication?

If a GP is not sure what information the patient has agreed can be shared, or if the patient refuses to allow the GP to share relevant information, the MDU advised GPs to:

  • Contact the patient to make them aware of the request and any concerns the GP has about the medication in relation to their medical history, and make sure the patient consents to what the GP is planning to disclose to the prescriber.
  • If the patient withholds consent, GPs should explain to the pharmacy that they are aware of information that makes the prescription inappropriate, but the patient has not given them consent to share this. The MDU said this 'will then be for the pharmacy to follow this up'.
  • If a pharmacy has only checked recent or summary records, GPs could 'consider explaining that a general review of the patient's notes might not capture every relevant consideration that the prescriber may need to know when making their decision to continue to prescribe'. The prescriber would then need to go through the patient's online records with them so they can satisfy themselves they are prescribing in line with the guidance from their regulator.

The MDU also suggested that GPs might charge for this work, as it does not fall under the GMS contract.

What should a prescriber do if GP records cannot be accessed?

The GPhC confirmed to The Pharmacist that a prescriber would need to get the patient’s consent before they can contact their GP about a prescription, which should remove any concerns about confidentiality.

And it highlighted the new guidance that states: 'If the person does not have a regular prescriber, such as a GP, or if there is no consent to share information, the prescriber should then decide whether it is safe to prescribe. They will need to think about the person’s best interests and carry out an individual risk-based assessment about whether they can prescribe safely.'

And if a decision is made not to prescribe high-risk medication - for instance, if the prescriber cannot get all the information they need - the person should be directed to an appropriate care provider, such as an out-of-hours service, a local walk-in centre, or urgent care, so that they can be appropriately assessed.

Louise Edwards, chief strategy officer at the GPhC, said the regulator welcomed the PDA's contribution to the discussion on safe prescribing online, and would be meeting with the union to talk through the updated guidance.

'We’ve made clear in the guidance that online pharmacies have to identify which method of consultation is best suited to get the information needed to deliver safe and effective care, and two-way communication should always be available,' she said.

'For ‘high-risk’ medicines, the prescriber would have to have timely two-way communication with the person (such as a video call), access the person’s clinical records, or contact the person’s GP.  All relevant information about the prescription then needs to be shared with the GP.

'If the person doesn’t give consent for their GP to be contacted, the prescriber would have to consider whether supplying treatment outweighs the risks and to make a record justifying their decision.'