Doctors who prescribe antibiotics online face GMC investigation

BMJ 2016; 355 doi: (Published 06 October 2016) Cite this as: BMJ 2016;355:i5423
  1. Ingrid Torjesen
  1. London

The UK General Medical Council is investigating whether doctors who work for internet pharmacies are prescribing antibiotics appropriately, after a BBC Radio 5 Live investigation found that doctors were not obtaining an adequate history from patients before offering the drugs and were not following prescribing guidelines.

BBC Radio 5 Live’s undercover reporters posed as patients and contacted 17 UK online based pharmacies and were able to obtain antibiotics from some for conditions they clearly did not have or were provided with a drug that was not appropriate for the symptoms they said they had.

One online pharmacy offered a choice of antibiotics to a reporter who asked for treatment for a dental infection when the reporter did not appear to have any of the symptoms to prompt an antibiotic prescription as specified in guidance from the National Institute for Health and Care Excellence (NICE). Over the next two days the same pharmacy issued the same reporter with two more prescriptions for antibiotics, one for a swollen ear and one for a urine infection.

Another online pharmacy issued a reporter with a prescription for metronidazole for £38 (£43; $49). The antibiotic was issued after the male reporter completed a questionnaire that included questions about whether he had symptoms of a vaginal infection. Faye Kirkland, a GP who was involved with the BBC programme, said, “They’re not even the kind of antibiotics that I would even consider giving to a patient because they don’t kill the bugs that typically cause the problem.”

Niall Dickson, chief executive of the GMC, said, “Our prescribing guidance makes it absolutely clear that doctors may prescribe only when they have adequate knowledge of the patient’s health and are satisfied that the medicines serve the patient’s needs. The guidance also makes it clear that they should take account of clinical guidelines published by established organisations with appropriate expertise, such as NICE.”

He added, “Overprescribing of antibiotics risks the health of us all, and it is important that every practising doctor in the UK reflects on current guidance. Although we cannot comment on specific investigations, the BBC has produced serious allegations, and we will be looking into them carefully. Of course, the law requires us to consider each case on its merits, but doctors who pose a risk to patients can, and do, face sanctions for misprescribing.”

Maureen Baker, chair of the Royal College of General Practitioners, said that the college was seriously concerned that patients could obtain prescriptions for antibiotics through online pharmacies against GMC guidance and in some cases against clinical guidelines from NICE.

“This not only flies in the face of our efforts to curb growing resistance to antibiotics but raises serious patient safety concerns,” she said. “Asking patients to fill out a questionnaire online is no substitute for the comprehensive medical notes that will be held by their family doctor. There are also many signs and symptoms that GPs look out for when making a diagnosis that the patient might not think to raise or that might not be reflected in the questionnaire.”

She added, “GPs are working hard to reduce antibiotic prescribing with notable success—we saw a reduction of 2.6 million prescriptions by GPs last year alone—so it’s concerning that patients are increasingly turning to other means to obtain antibiotics, and the ease with which patients can get prescriptions through online pharmacies and online doctors will only serve to hinder our ongoing efforts.”

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