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Online pharmacy closes over 'incompetent' clinical advice

CQC found incidents of patients obtaining prescriptions online with minimal identity checks

One online pharmacy has ceased trading over "incompetent" clinical advice identified by health regulator the Care Quality Commission (CQC), while another has been suspended.

MD Direct, which traded through the website, voluntarily stopped providing services to patients after a CQC inspection in December 2016 identified a number of failings that put patients at risk.

The CQC said “ineffective” staff training had led to "some non-clinical staff with no formal training assessing patients’ needs". 

“The clinician was working outside of her scope of practice and told us they were not competent to carry out the role,” the CQC said.

The inspection revealed that did not have the “experience, capacity and capability” to provide online healthcare.

"For example, we found patients being prescribed large quantities of inhalers, but there was a lack of monitoring or follow up for these patients, whose condition could put them at serious risk of harm."

Another online pharmacy suspended

A BBC Radio 5 Live investigation prompted a CQC inspection into another registered online pharmacy – HR Healthcare Ltd, operating through the website – and its sales of antibiotics.

The CQC said it was “concerned” at some of the prescribing decisions made by staff at, including an incident of one patient being prescribed four seven-day courses of antibiotics to treat a urinary tract infection.

“Prescribing was not in accordance with best clinical practice and national guidance,” the regulator concluded.

"Another patient was prescribed 12 asthma reliever inhalers over a four-month period," it added.

Patients were not always aware if the medicine they were prescribed was unlicensed, and there were “few” procedures in place for monitoring and managing risks to patient and staff safety, the inspection found.

However, the regulator also "observed that members of staff were courteous and very helpful to patients when speaking to them on the telephone". 

The CQC said it would suspend the provider for three months from December 2, 2016, “to protect patients”.

Further inspections

From an internal review of all 43 registered “digital healthcare providers” in the UK, the CQC found incidents of patients being able to obtain prescription-only medicines with "minimal" identity and safety checks.

As a result, it announced a “programme of inspections” which will “prioritise those services it considers as potentially presenting a significant risk to patients”.

General Pharmaceutical Council chief executive Duncan Rudkin said pharmacies linked to the online services being inspected by the CQC will be subject to “further inspections” from the pharmacy regulator "where necessary".

“[We will] assess whether they are meeting our standards and appropriately addressing the issues and risks linked with online prescribing and dispensing,” he added.

“Scant regard” for patients

The Royal Pharmaceutical Society (RPS) said it is “fully supportive” of the “shutting down of online primary care services that offer scant regard for patient care”.

“Although technology – such as the use of Skype or telehealth consultations for diagnosis – can help with access to healthcare in general, there are risks to increasing access to antibiotics specifically,” RPS English pharmacy board chair Sandra Gidley said.

Do you have concerns about online pharmacies?

Anonymous Anonymous, Information Technology

So basically the same way that GPs prescribe... 12 inhalers in 4 months from a GP surgery? No problem! Course after course of antibiotics? Not a concern! Why is it always one rule for us and another for them?!?!?

Valentine Trodd, Community pharmacist

Or every month they prescribe 28 x 7.5mg zopiclone, "when needed - not everyday as addictive"...

Or, I kid you not - "when needed - not everyday as addictive - YOU'RE SUPPOSED TO BE CUTTING DOWN!!!"

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Yet another example of healthcare provision and the internet not mixing. Most of it is sheer laziness of the modern generation who can't be bothered to get off their fat backsides and go somewhere where they can speak to a properly trained individual, be that GP or pharmacist, who can give them accurate advice on their condition. How often are we presented with patients where most of the symptoms are ones you need to actually see? It would be impossible to accurately diagnose, say an allergic reaction by a purely verbal conversation. People who go to online GPs and pharmacies get what they deserve.

ben stokes, Student

haha....i use to locum for a big multinational in th early 2000s where you were told to sell an OTC product even though the patient didnt require that why you want ppl to visit a pharmacy...infact i have seen many owners who sell products which clearly dont work for the sake of a few quid...and you have an issue with  online pharmacies 


move with the times or you will go bust....!!!! the times where owners could just sit back and let ppl walk in is over.....

competition improves the service....


Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

 Incidentally, I'm not an owner but I am given full professional autonomy by my employer which also involves NOT selling something to someone who doesn't need it. This is not an issue with an internet pharmacy where there is no pharmacist input at all - people can have what they want even if it does bugger all. Internet pharmacy is ENTIRELY profit driven or else it has no reason for existence.

Valentine Trodd, Community pharmacist

Does that include MURs? :-D

ben stokes, Student forgot nms LOL

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Both entirely at my discretion - read it and weep!

ben stokes, Student

who cares about the cuts/online pharmacies .....i hve no morgage, i paid cash for my it and weep !!

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Mummy and Daddy financed it did they?

There is obviously something fishy here - how does Ben Stokes, Student manage to pay cash for a property? Which is the lie here?

Sukhy Somal, Pharmacy owner/ Proprietor

It is a shame Michael Mustoe has such a negative opinion of distance selling pharmacies. As an owner of a Distance Selling Pharmacy, I invested significantly to ensure a safe, clinical and highly professional environment and certainly not as a means of making easy money. There is no such thing as "easy money" in pharmacy. I would like to share a customer comment from our patient questionnaires: "I would be lost without you organising my medication for me, thank you for the prompt deliveries." 

Let's all stick together as one voice for Pharmacy and put more of an effort in identifying poor prescribing practices and put our energy into identifying over prescribing and work together in the best interest of patient care.


sanjai sankar, Locum pharmacist

Not sure why you need to "big yourself up" with a quote from one of your patient questionnaires...Lots of Pharmacists and owners can do the same but in the interest of humility they probably choose not too....

ben stokes, Student

hi ...just viewed your website with respect to can do them in your premises as whats not allowed is face to face contact with respect to essensial services...murs are a supplementary servce so u can do them with permission of nhs england

ben stokes, Student

just to clarify my statement:

you cant have  face to face contact with respect to the essential services.....any enhanced service ie murs nms flu jabs can be done face to face with permission of NHS england/ regional team

The dispensing fees are still way too high and need to be cut further..This can be achieved as online pharmacies have lower overheads and dont require as much funding as highstreet chemists. 

High street chemists should treat long term condns  ie asthma, diabetes, heart failure, COPD etc. 

There should also be a 24 hr pharmacy in each city/town ideally situated near A/E to cut the pressure on hospitals. 


Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Strange how pharmacy is always mentioned as a way of reducing the pressure on some other supplier or other. Who reduces the pressure on us??

michael mustoe, Community pharmacist

The raison d'etre for Community Pharmacy is easy, face to face access to a well-trained healthcare professional, no appointment required. And that is why online Pharmacy should NOT exist at all. These 'shed' operations are set up by individuals who just want to make easy money - mainly due to their low cost base. They are definitely NOT patient-oriented. Close them down, please

john barnes, Student

I sense a whiff of jealously on michaels part and agree 100% with ben, move with the times. It seems the article if it is read properly is that these companies had been giving out PRIVATE treatments for long term conditions without proper gp refferal or without protocol/ contact with current patients gp surgeries. So it has nothing to do with distance selling pharmacies that run NHS prescriptions so you shouldn't brass it in the same light, i have checked these websites and they do clearly not run NHS services, obviously if you read the article properly you would have seen this. Furthermore it is not called 'making easy money' good on them for becoming entrepenuers it is something pharmacy needs more of. In fact most of these entrepenuers have most likely worked outside of pharmacy before becoming pharmacist to see a different direction to take pharmacy rather then become a robot and just be chained down by so the called pharmacy 'big companies'.

ben stokes, Student

Move with the times michael......majority of rxs ie 70 % plus are repeats..... and these are mostly delivered to patients homes.....where's the face to face contact there?

more and more ppl are opening online pharmacies..having worked in a few, most are better run than the average high street chemist....

by the way...what happened to the 3000 pharmacies that are supposedly closing due to the cuts?

give online pharmacies the job of dispensing and let high street treat long term conditions ...thats the future...

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Give the cuts time to bite - this is the first month that pharmacies have had reduced payments. The future incidentally is more likely to be no pharmacies at all so if I were you I'd select a different career.

paul lisbon, GP

Firstly, the CQC does not reglulate pharmacies, but they certainly want to. Its also coincidence that the day all this comes out, CQC publish their new guidance on online digital healthcare - good PR move.

More importantly, the head of the CQC who name is plastered on reports and was on the BBC this morning, his own practice has patient safety concerns...




paul lisbon, GP

Firstly, the CQC does not reglulate pharmacies, but they certainly want to. Its also coincidence that the day all this comes out, CQC publish their new guidance on online digital healthcare - good PR move.

More importantly, the head of the CQC who's name is plastered on reports and was on the BBC this morning, his own practice has patient safety concerns...




A Hussain, Senior Management

Prescribing appears to be the major issue here.

Call Me Cycnical, Senior Management

This story is misleading to say the least, CQC do not regulate Pharmacy. They regulate the online doctor element the pharmacy subscribe to Pharma Doctor. Why is there no mention of the prescriber that wrote the dodgy scripts?

Andrew Martin, Primary care pharmacist

The tip of the iceberg?

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