It was only a matter of time. Britain's first internet pharmacy has now opened for business (p843). It is operated by two pharmacists from registered premises in Leeds. The services on offer include the dispensing and delivery of private prescriptions and the sale of medicines. Users with private prescriptions are required to e-mail the name and quantity of the prescribed item or items, and then post the prescription to the pharmacy for dispensing if they are happy with an e-mailed price quote. Users wanting to purchase medicines are required to log on to the pharmacy's website and set out their requirements by filling in an online questionnaire. Once completed, the questionnaire is perused by a pharmacist, who decides whether the sale should be allowed. Deliveries of medicines, including those that have been prescribed, is to be by means of the pharmacy's own network.
The operators of the service do not use the post for delivery because this is ruled out as a general means of supply by the Code of Ethics. Obligation 1.13 of the Code says that a pharmacist must not distribute or encourage the distribution of any medicinal product by mail order or similar third party carrier. Guidance says that the dispatch of medicines by post should only take place if the patient is unable to receive them by any other reasonably practicable means. The proposed revised Code continues these provisions by stating that pharmacists must not supply any medicinal product by mail or third party carrier unless there is no other reasonably practicable means of the patient obtaining the medicine (paragraph 4.1k). Thus, on the face of it, by avoiding the post and the third-party carrier, the new service would seem to be acceptable so far as the Code of Ethics is concerned.
There are, however, other provisions of the Code and of its proposed revision that would seem to be problematical so far as the new service is concerned. They are the ones concerned with contact between pharmacist and patient. Guidance on obligation 1.13 under the existing code makes it clear that supply without face-to-face contact with the patient should be a last resort and states that the patient must have the opportunity to discuss any queries with a pharmacist. The proposed revised Code says that medicines should normally be supplied directly to the patient or his carer in the pharmacy, where there is an opportunity for face-to-face contact. Where that is not possible, standards prescribed in the Code for home delivery should be complied with. Rather than being a method of supply of last resort, the internet pharmacy uses remote supply as a first resort.
However, it would seem to us to be difficult to make out a case against a method of supply that is permitted exceptionally provided that certain safeguards are built in when the method is the one used for the bulk of transactions. By permitting the exception, a general permission is arguably given.
The growth of the internet as a means of communication is expanding at a phenomenal rate. The opportunities for e-commerce are growing with it and this is something the Government wants to encourage. Means of protecting the interests of patients in this new environment are urgently needed. Fortunately, the revision of the Code presents just such an opportunity. Some work has been done by pharmacists' and doctors' representatives in Europe in this area and the Society's Council has given preliminary thought to the matter (PJ, October 16, p631). The developments that we report should add a sense of urgency.