Correspondence from private online pharmacies prescribing GLP-1 agonists

We know correspondence from private online pharmacies prescribing GLP-1 agonists such as Mounjaro (tirzepatide) and Wegovy (semaglutide) is creating challenges for GP practices across the country. Many GPs have asked us how best to deal with this.

Whilst the prescriber is responsible for the prescription, once the practice is made aware of the use of this medication, they do have a responsibility to ensure that it is being used safely. Each case should be considered individually. Check the patient’s medical records to see if the prescription raises any concerns, such as the presence of contraindications or an inaccurate BMI. 

If these steps are missed, patient safety could be at risk, leaving the GP at risk of complaints or claims. For example, if the practice does not act when it is aware of a contra-indication to the prescription. 

Patient care comes first

GMC guidance makes clear that patient care must always be a doctor’s first concern. This includes acting on clinical information received from private prescribers.

Consent for information sharing

Letters from private prescribers often say the patient has agreed to them contacting the GP. This does not mean the patient has agreed for their medical information to be shared.

If the patient has any medical conditions’ which would mean the medication is contraindicated it is important to get the patient’s explicit consent before sharing the information with the prescriber. You can ask the prescriber to provide this or check directly with the patient. Consider if this is best obtained by calling the patient or writing to them, mindful they may not be expecting to be contacted.

In the absence of consent, you should usually only share information if there is a relevant legal requirement (such as a statutory obligation or a court order) unless it is in the public interest to disclose. Where a patient lacks capacity information can be disclosed if it is in the patient’s best interests to do so.  Please see GMC guidance Disclosing patients' personal information: a framework - professional standards.

Managing situations where consent is not provided

Patients with capacity have the right to withhold consent, even if this may put them at risk of serious harm or death. However, they must be fully informed of the implications of such a decision.

If this happens, you should: 

• inform them of the potential risks within the limits of your knowledge and expertise and seek senior or expert support if required.
• offer clinical advice to reduce the risks.
• document the discussion with the patient and advise them that you will tell the private provider that disclosure cannot be made due to the absence of valid consent.
• it is advisable to discuss the matter with a senior colleague and/or seek advice from your medical defence organisation. 

Documentation and recording of medicines

Even if the practice is not prescribing, it is important to add any medicines the patient is taking to their records, including those prescribed privately, ideally, marked as ‘outside prescriptions.’ This approach is also in line with GMC Prescribing Guidance which states that prescribers must ensure they have adequate and accurate information before prescribing.  

If the practice becomes aware a patient is buying weight loss medication online without a prescription, it is also important to make them aware that this can significantly increase the risk of them receiving something which is not genuine or not licensed for use in the UK. 

Whatever steps are taken it is important that they are clearly documented within the patient’s medical records..

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