Online Prescribing
Online prescribing is the exclusive ability of prescribing healthcare professionals to be able to write prescriptions. In the UK, online prescribing can be performed individually if the prescriber holds sufficient insurance and is registered with their regulatory body. As per the Medicines Act, the following professionals registered with their specific regulator can prescriber:
- Doctors registered with the GMC
- Dentists registered with the GDC
- Nurses registered with the NMC
- Midwives registered with the NMC
- Pharmacists registered with the GPhC
- Physiotherapist registered with the HCPC
- Podiatrist registered with the HCPC
- Paramedic registered with the HCPC
- Optometrists registered with the HCPC
- Therapeutic radiographer registered with the HCPC
The above healthcare professional must then work within a registered online clinic. This can either be a GPhC or CQC regulated clinic as below.
Online prescribing is the process in which a prescribing healthcare professional uses a digital mechanism to enable them to prescribe to a patient online. There are various mechanisms by which this can occur, these include:
- Algorithmic prescribing - this is when a patient answers a series of online yes/no questions, these are then submitted to the online prescriber for review. If the questions meet the prescribers requirements, a prescription is electronically created and submitted to a pharmacy for dispensing.
- Video prescribing - this is when a consult is performed using a video consult system. As consultations are typically confidential in nature, often a bespoke, in house video consult system is used. The prescriber, in this case, tends not to charge for the creation of a prescription but for the use of their time, these rates vary considerably and are similar if not more than average locum rates.
- Algorithmic prescribing plus video consult - this entails a combination of both of the techniques listed above. By using an algorithm which pre-screens patients and then feeds this data to a clinician, the time-saving benefits of algorithmic and the accuracy of video can be harnessed.
- Over the phone prescribing - this is an older form of telemedicine which utilises a standard phone line to offer direct communication with the patient. This method is often seen as outdated as there is no data input from the user; it is difficult to record medical histories accurately.
Before you consider setting up an online prescribing service, there are a few attributes you will need to consider:
Who will you be prescribing for?
Before starting any new service, to avoid medico-legal issues and to meet regulatory requirements it is first best to perform a new service risk assessment. Whatever risks are foreseen, it is always a good idea to initially restrict prescribing to the UK as sending medicines abroad can have issues; this can be done by IP restriction. Once the service is more established, you will find there are other countries which are friendly to telemedicine, including France, Germany and Ireland. However, accessing these require tweaking algorithmic questionnaires and amending protocols to fit the relevant jurisdictions.
What will you be prescribing?
Will you have an open formulary or will you restrict what you prescribe? Since, November 2019, due to the Deborah Michelle Headspeath case, which resulted in numerous online pharmacies being shut down the GPhC, CQC and MHRA (the regulators) put out joint guidance addressing unrestricted sales of certain medicines. The guidance recommended that certain medicines should not be repeated online and that Z drugs, sedatives or opiates should not be sold. From our experience, when starting an online prescribing service out it is best to restrict prescribing to a limited number of medicines via algorithmic prescribing mechanisms and then potentially upscale later on to an open formulary via a video teleconsult mechanism. We have created our own online prescribing formulary to mitigate client risks.
When will you be prescribing?
Unlike bricks and mortar pharmacies, online pharmacies are open 24/7. What will happen if a consult is performed on your website at 3 am in the morning? Do you have a prescriber on call to determine as to whether a prescription should be authorised? This could be restricted through automatic gatekeeping; however, from a commercial sense, this may result in lower patient satisfaction.
How are you checking a patients identity?
The GPhC and CQC expect all online pharmacies to have systems in place to carry out appropriate identity checks.
How are you making sure it is safe?
The regulators expect that your online prescribing system is safe and fit for purpose. To this end, the GPhC not only expect a new set of Standard Operating Procedures for how you manage the operation but systems in place which can monitor patient satisfaction, allow them to complain and contact you where necessary.
How does the flow of prescribing work?
The regulators refer to best practice published by the MHRA (MHRA’s Blue Guide) and expect pharmacy owners to make sure that their website and the websites of companies they work with are arranged so that a person cannot choose a POM and its quantity before there has been appropriate consultation with a prescriber.
How can we help?
HubNet.io contains a fully integrated online prescribing software (including an online independent prescribing course) which you can use with our prescriber or use your own. Whether you are a prescribing nurse, pharmacist or doctor, we can give you the tools to aid you to practice online. We have two off the shelf portals and a further custom option.
- VoyagerHealth.co.uk - is our amalgamated prescriber website which connects patients with prescribers. If you are a prescriber, you can register your organisation on this website and create your own listing.
- Embeddable online prescribing - this is our website specific prescribing module which can be embedded into your own website, for example, have a look at some of our partners:
- Custom online prescribing modules - we offer a wide range of solutions for healthcare practitioners wanting to practice telemedicine using a variety of ways to communicate to patients.
1. Voyager Health
This is our centralised portal for all clinics on our HubNet.io network, you can list your clinic with us free of charge, and we will send you the resulting private prescriptions found by patients using our geolocator. We use our strength in numbers to bring you online traffic from across the UK.
The second type of portal we provide is our embeddable portal.
2. Embeddable Online Prescribing System
This system has the same list of treatments that can be found on Voyager Health; however, it can be embedded into any website such as http://douglaspharmacy.com/online-doctor. We can either use our online prescriber, or you can provide your own. We are transparent in all of our transactions; we provide you with analytics that shows you how many patients visit your site and then use the prescribing system.
Are you looking to create your own online prescribing system?
If you need expert guidance, contact us or register an account free of charge by going to hubnet.io/register.
Hubnet is an online pharmacy information system. We intend to provide healthcare professionals with an online ecosystem to allow for better communication between each other and their patients. Protected by law, the data you enter into this site remains your intellectual property and cannot be used by us. Our goal is to enable you to do more, if you like it you can subscribe for more!