Whilst the healthcare agencies criticise the  on-line purveyors of medicines with their pharmacist prescribers to avoid CQC registration. The CQC registered pharmacies which employ European prescribers some of whom lack the controls in place to ensure effective and safe prescribing. There are a lot of very grateful patients who enjoy and praise the on line services. They are often well educated and know what they want and are often time poor and cannot get an appointment with their GP at a time that they can make due to work or family commitments or when they really need one.

How do we educate the public about the dangers of buying medicines on line from a bogus website is the worry of the MHRA and they urge the government to take urgent action to commission public campaigns to protect public health.

But this is a very negative approach and may drive more people to the internet pharmacies and have the opposite effect. Telling a middle aged lady conscious about their wrinkles not to procure Botox from an online pharmacy, as it may be falsified, will not stop her buying the Botox,  she needs the vial for her appointment later in the week.

A more positive approach would be to educate people on how to find a reputable website, what to look for, how to check the registration of the pharmacy and the superintendent pharmacist. How to check if the prescriber is registered. What the storage temperature is for their medication and how it should be transported. How to evaluate what is in a patient information leaflet written in so small writing most people need a magnifying glass to read the dose and side effects.

I would like to see better visibility on the prescribing and dispensing errors in normal practice versus the internet pharmacies which offer prescribing services. An evaluation of the  patient records in a high street practice, village practice and an internet practice.

The key positives in the internet pharmacies are there is no queue of patients staring at you willing you to terminate your consultation and to serve them, there is time to check details with the patient and the prescriber. The internet pharmacies trade often out of normal core hours, some offer on line consultations and a forum for sharing side effects or to ask questions about medication or symptoms and how to alleviate them.

We cannot stop the on-line revolution , we must embrace it and use different tactics to held minimise the risk to patients health. Education and increased public awareness is the best tool in the box , however it takes time to run an effective campaign. Better collaboration of the regulators, sharing intelligence  and  harmonisation of standards would also help to mitigate risk  to patients.

Quality systems need to be written to a good standard and should include qualification of suppliers of medicines and other services such as transportation.  I have never seen a pharmacy check a bonafide of one of their wholesalers unless they have a wholesale dealers authorisation. Internet pharmacies are a half way house between a normal retail pharmacy and  wholesaler thy of medicines. There is no reason why the pharmacy should not work to the highest standards of the regulators for each process and then there should not be huge risks to patients or to the pharmacy contract or reputation.

Why should a cold chain item be delivered in a car or van from a pharmacy with no temperature control, and no transport route risk assessment in place and no passive packaging just a paper chemists bag with a patient address stuck on it to seal the bag keeping .   Whilst a wholesaler who use an over night delivery service similar to the service booked  by an internet pharmacy  will be expected to  have a transport route risk assessment in place , use passive packaging and add data loggers to the shipments to check compliance with the MA requirement to store and transport medicines in compliance with the storage requirements on the packaging. GPhC on the other hand does not expect any pharmacy internet or not to map their fridge they store medicines in or  the delivery route , validate the packaging or provide evidence of compliant deliveries .