Independent prescribing organisations should have write access to patients’ health records to improve the safety of online prescribing, a new report published today has recommended.
The Health Services Safety Investigations Body (HSSIB)’s investigation into online prescribing found that patients being prescribed medicines online “may be at risk of harm” because those treating them cannot access a “complete picture of their health information”.
It said some prescribers may be missing “vital information” about patients and there is “no consistent way for independent prescribing organisations to see NHS records or for their prescribing decisions to be recorded within them”.
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This lack of write access to patient records creates “the potential for gaps” that leave prescribers unable to check what other medications a patient is on or understand what complications may arise from prescribing a certain treatment.
Some independent prescribing organisations use “photos or videos of a patient’s NHS App” to verify a patient’s medical history, it added, but this is “beyond the purpose of the NHS App and creates patient safety risks”.
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The body also noted that the safety issues identified in the report had led to “direct patient harm, including deaths”.
It cited one patient who died of an overdose after being prescribed medication by a clinician who could not see the “history of mental health illness and previous overdoses” on the patient’s GP records, and another who overdosed on medication being prescribed to them by both NHS and independent prescribing organisations.
Recommendations
The HSSIB recommended that the Department of Health and Social Care (DH) develops a policy and implements a “mechanism” that allows independent prescribing organisations to access “verified patient information, with patients’ consent, to inform prescribing decisions”.
The DH should also review and “determine an appropriate mechanism for write access” to improve the “currency of patient information held digitally by NHS organisations”, it added.
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The body said this could help “remove some burden” from general practice who are “relied upon” to provide clinical information to these organisations “but have limited capacity to provide this”.
“The different approaches to such information requests also create uncertainty among GPs around whether the requests are legitimate and whether they should respond,” it noted.
Risk
HSSIB senior safety investigator Matt Mansbridge said the body’s investigation “found that NHS services and independent prescribing organisations are often working with incomplete information”.
This “creates a risk that patients could be prescribed medicines that are not appropriate or that interact with other treatments”, he stressed.
He added that the single patient record formally introduced by the government last month is a “real opportunity to address these issues” - but said a “truly complete record” needs to “consider how care provided by non-NHS organisations is included”.
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HSSIB also recommended the DH develops a “framework” that will allow the sharing of “safety critical information” regarding patients who are known to multiple independent prescribing organisations.
Its report found that independent prescribing organisations may be able to identify multiple requests for medication from the same patient, but this is not shared outside of their business.
Such a framework would create “a cross-organisational safeguard for patients who may be at risk of harm”, it said.
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General Pharmaceutical Council (GPhC) chief executive Kathie Cashell said the regulator agrees with the HSSIB that independent prescribing organisations “should have access to appropriate NHS records to improve patient safety”.
“We believe that all pharmacies, including online pharmacies, should have read-write access to a person’s records, so all health professionals have the information they need to make safe and informed decisions about a person’s care and treatment,” she said.
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It comes as the GPhC this week called for “coordinated action” to address the “growing threat of fake online pharmacies and unregulated medicines” this week.
And it follows pharmacist and MP Sadik Al-Hassan proposing to the DH a new NHS-owned patient medication record system that would link up patient data across all of primary and secondary care.
