Online prescription services: what if you disagree?

Technology undoubtedly has a lot of benefits and the use of online healthcare services can be very beneficial for patients. However, a tricky situation can arise if a patient has been taking medication that you do not recommend. 

Communication

Good communication with your patient is essential to resolve this issue. If, following your assessment of the patient and their records, you reach the conclusion that the medication is not safe or appropriate for their use, then this needs to be communicated clearly and sensitively. You will need to explain your reasons why the medication is not appropriate, provide advice on stopping the medication safely and clearly tell the patient that you will not issue any further prescriptions for it. 

If you are able to communicate your reasons effectively the patient should hopefully accept your advice and clinical opinion. However, if the patient questions your decision, you may need to further explain that you can only prescribe drugs if you are satisfied that they serve the patient’s needs, including repeat prescriptions initiated by colleagues. 

GMC guidance

The GMC is clear that you do not have to provide a treatment to a patient that you do not consider to be of overall benefit to them. This is set out by the GMC in its guidance Good practice in prescribing medicines and devices (2013), and you may wish to advise your patient of this. The GMC also advises that patients are given the option to seek a second opinion.¹

It may be a good idea to discuss why the patient would like to continue taking the medication to understand their point of view. You should explain any other treatment options that are available and it may be helpful to offer a follow-up appointment with the patient to discuss these. This will allow the patient time to consider the matter further. 

Complaints procedure

If the patient still remains dissatisfied, you should direct them to your practice’s complaints procedure. Ensure that you carefully document your discussions with the patient in their medical records, and keep a note of any steps you take to raise concerns if this is necessary. If a complaint does arise, or you have any concerns, you can seek assistance from our medicolegal team who can provide advice and support.  

Reporting prescription errors

The GMC also says that you must protect patients from harmful risks posed by colleagues’ prescription, administration and other medicines-related errors. Depending on the specific circumstances of this case, for example if it was a serious medication error or you have noticed a pattern of errors, you will need to consider whether there are concerns about patient safety. These should be raised with your Clinical Commissioning Group or NHS England (or for practices in other UK jurisdictions, the appropriate local body). 

The Care Quality Commission (CQC) does inspect online healthcare services when the company is based in England and it is taking action against those that may present significant risk to patients. However, it is possible for patients to use services that cannot currently be inspected by the CQC because they are based outside England, and some websites may be unsafe for patients. The CQC has provided advice for patients on how to choose an online healthcare service.^2,3

If you do have concerns about an online prescribing service there is GMC guidance available, along with local procedures that should be followed.⁴

For more guidance read the MPS factsheet on Safe Prescribing available at https://www.medicalprotection.org/uk/articles/sco-safe-prescribing.

References