Continued government and regulatory scrutiny of online pharmacies – is further regulation on the horizon to balance patient safety and choice?
Introduction
The rise of online pharmacies has been well documented, not least due to patient safety concerns around the adequacy of safeguards to ensure clinically appropriate prescribing of high-risk medications, as discussed in our earlier article. Following recent government measures to balance ‘digital by default’ and delivery of essential pharmacy services in the community, and a call for evidence on the oversight and regulation of private prescribing, we consider whether increased scrutiny may lead to further measures to balance patient choice and patient safety.
Balancing community and online services
The “Neighbourhood Health Service” envisaged in the NHS 10 Year Health Plan[1] needs pharmacy services in the community, not just online, and must balance patient choice and convenience with public finances and safety risks. On 2 June 2025, the DHSC laid new regulations effecting regulatory changes to the distance selling pharmacy sector in England (operating under NHS contracts) including[2]:
- from 23 June 2025, no new applications for distance selling pharmacies are permitted
- from 1 October 2025, distance selling pharmacies will no longer be permitted to deliver face-to-face services at the distance selling premises (except COVID-19 vaccinations until 31 March 2026)
- where an existing service specification allows, distance selling pharmacies will continue to be permitted to provide remote consultations from the distance selling premises, or off-site delivery of a face-to-face service
The changes were agreed following negotiations between DHSC, NHS England, and Community Pharmacy England, the current number of around 400 distance selling pharmacies with NHS contracts[3] deemed sufficient to meet the needs of patients. The changes seek to level the playing field and distinguish between bricks and mortar and online pharmacies and ensure local patient need is the driver behind distance selling. It is hoped the move could balance distance selling with hybrid models, for example, where prescriptions are initiated online and fulfilled locally and help balance the delivery of essential clinical services both online and in the community.
Private prescribing call for evidence
The online pharmacy sector is split between those operating under NHS distance selling contracts and a private prescription model, typically also offering a doctor consultation, dispensing medications for privately paying customers.
The NHS 10 Year Health Plan[4] aims to provide NHS patients a “doctor in their pocket” by harnessing the “technological revolution in healthcare happening globally” for NHS patients. This model operates in the private sector, albeit on a relatively small scale, in the UK, and is one which the DHSC seeks to better understand through a UK-wide private prescribing call for evidence, launched on 12 August 2025.[5] Evidence is sought on the effectiveness of clinical governance and oversight, and regulation of existing private prescribing mechanisms against which medications can be dispensed in the UK, these are:
- prescriptions (excluding special medical prescriptions, for example, controlled drugs[6]) written by prescribers registered in the European Economic Area and Switzerland
- private prescriptions written by UK prescribers
- medicines accessed through Patient Group Directions (“PGDs”) outside of the NHS
The DHSC hopes to also build the evidence base around themes linked with private prescribing which pose a risk to patient safety, including misuse of medicines, counterfeit medicines and inappropriate advertising, discussed in relation to weight loss medications in our previous article.
Responding to the Prevention of Future Death Report referenced in our earlier article, where a “tick box” online questionnaire was deemed to have contributed to a patient’s death by enabling access to a fatal quantity of prescription medication, without reference to the patient’s medical records, the Minister of State for Health said, “In addition to the duty of the prescriber, patients themselves must be honest when providing information to an online prescriber so that they receive advice and medicines which are appropriate for them and so that risks can be managed. As has been highlighted in this very sad case, prescribers need full information to be able to prescribe safely.”[7] Whether the call for evidence will persuade the government that further regulation is needed to balance patient choice with risk of harm remains to be seen, but seeking views on the oversight of legal routes is a good place to start to ensure the right balance is struck between patient choice and patient safety.
Increased regulatory scrutiny
The government’s actions coincide with widespread reporting of the dangers of obtaining medications online and follow increased regulation of ‘high-risk’ medications supplied online by the General Pharmaceutical Council (“GPhC”) in February 2025.[8] Whilst removing sole reliance on patient questionnaires by prescribers in respect of ‘high-risk’ medications, reference to a patient’s medical records was not mandated.
Following the introduction of the updated guidance, the GPhC’s Chief Pharmacy Officer and Deputy Registrar, Roz Gittins, wrote to registered pharmacists, pharmacy technicians and pharmacy owners on 9 April 2025[9] and 6 August 2025[10] about emerging issues that have led to concerns being raised with the GPhC and contravene the GPhC’s standards. Concerns include:
- pharmacies working with online prescribing services based outside the UK without conducting appropriate risk assessments which resulted in the GPhC taking statutory enforcement action
- checking addresses when supplying medicines at a distance and ensure staff are suitably trained to identify different risks associated with patient addresses
- supplying medicines overseas including medicines being supplied to countries where they are illegal and medicines arriving in a condition where they are not safe to use.
- advertising and promotion of prescription only medicines
Registrants were urged to take any action needed to ensure their practice is compliant with regulatory standards. Additionally, the GPhC has implemented a new inspection methodology which has significantly increased the number of inspections undertaken.[11] The GPhC has published 118 inspection reports following inspections of distance/online selling pharmacies since 1 January 2025, standards were not all met in respect of 44 (37%). Over the same period, 1066 inspections were published following inspections of community-based pharmacies, standards were not all met in respect of 131 (12%).[12]
Looking ahead
The DHSC’s call for evidence closes on 4 November 2025 and responses will be used to inform the government’s ambitious plan for NHS reform and how it can, “continue to ensure that the medicines people need are available conveniently and promptly, while also maintaining the highest standards of safety across the UK.”[13] Government scrutiny on the clinical governance and regulatory oversight of private prescribing in the UK, coupled with changes to NHS distance selling contracts that increase the distinction between remote and in-person services may present opportunities for private providers operating models where prescribing, dispensing and delivery are managed seamlessly and transparently. Effective enforcement of regulatory standards will be key to protect legal routes and ensure that choices available to patients do not risk their safety.
We will be monitoring developments in this area and our team is on hand to assist with your regulatory queries.
[1] Fit for the future: 10 Year Health Plan for England (accessible version) - GOV.UK
[2] We’re all community pharmacy
[3] FINAL Pharmacy Market Review 2024 .pdf
[4] Fit for the future: 10 Year Health Plan for England (accessible version) - GOV.UK
[5] Private (non-NHS) prescribing: call for evidence document - GOV.UK
[6] Prescriptions issued in the EEA and Switzerland: guidance for pharmacists - GOV.UK
[7] 2025-0055-Response-from-DHSC.pdf
[8] Guidance for registered pharmacies providing pharmacy services at a distance, including on the internet
[9] Important information from the GPhC on emerging issues
[10] Important information from the GPhC on emerging issues
[11] GPhC-Council-meeting-public-papers-July2025.pdf
[12] Pharmacy inspection reports | GPhC as at 22 August 2025
[13] Private (non-NHS) prescribing: call for evidence document - GOV.UK
