HSSIB investigation. Online prescribing: opportunities to improve patient safety (25 June 2026)

Summary

Independent online prescribing has expanded rapidly in recent years, driven by increased patient demand for convenience, long NHS waiting times for some services, and a broader shift toward digitally enabled models of care.

This Health Services Safety Investigations Body (HSSIB) investigation focuses on challenges for independent prescribing organisations in accessing clinical information held by the NHS to inform safe prescribing decisions for the patients who use their services. It also explores how gaps in NHS patient information about medication prescribed by independent prescribing organisations creates risks for the delivery of safe care.

For both NHS and independent prescribing organisations, having limited information about a patient’s medical history and the medications they are being prescribed creates a challenge to making safe decisions about ongoing care and treatment.

The investigation also explores the complex regulatory landscape within which independent prescribing organisations sit. In this regulatory framework, regulators may have jurisdiction over different aspects of a single independent prescribing organisations. The investigation explored the challenges this posed and the impact it had on these organisations’ ability to provide safe care.

The findings of this investigation are offered to support the safe delivery of care for patients who use independent prescribing organisations and NHS services.

Content

Findings

• Independent prescribing organisations without an NHS contract do not typically have access to a patient’s NHS medical records. This can affect their ability to verify patient information.
• Some independent prescribing organisations use photos or videos of a patient’s NHS App to verify information about the patient’s medical history. This is beyond the purpose of the NHS App and creates patient safety risks as the app is not designed to hold a verified complete picture.
• Independent prescribing organisations have systems to identify multiple requests for medication from the same patient, address or payment method, but this information is not currently shared outside of their organisation.
• No independent prescribing organisations currently have ‘write access’ to patients’ NHS medical records – that is, the ability to enter information directly into a record. This creates the potential for gaps in medical records which can impact on the identification of potential contraindications (factors in an individual's condition or medical history that make it unwise to pursue a particular line of treatment) and complications.
• NHS GPs are being relied upon to provide clinical information to independent prescribing organisations but have limited capacity to provide this. The different approaches to such information requests also create uncertainty among GPs around whether the requests are legitimate and whether they should respond.
• Lack of access to patients’ NHS medical records is a barrier to independent prescribing organisations providing safe care in line with standards, regulations, and best practice.
• A large amount of data is gathered by independent prescribing organisations which could inform patient care, but there is no way to feed this back into the NHS. This data often relates to medications more commonly prescribed by independent prescribing organisations, such as those for weight loss, and has implications for understanding the safety of these medications.
• The Care Quality Commission and General Pharmaceutical Council have arrangements to work together in relation to organisations registered with both regulators, but these arrangements could be made clearer to providers.

HSSIB makes the following safety recommendations

• HSSIB recommends that the Department of Health and Social Care develops a policy and implements a mechanism to enable appropriate NHS patient information to be shared with independent prescribing organisations. This is to ensure independent prescribing organisations can access verified patient information, with patients’ consent, to inform prescribing decisions.
• HSSIB recommends that the Department of Health and Social Care undertakes a review to explore the options and determine an appropriate mechanism for write access to health records for independent prescribing organisations. This would inform future developments such as the Single Patient Record, improve the currency of patient information held digitally by NHS organisations, and may remove some burden from general practices.
• HSSIB recommends that the Department of Health and Social Care works with relevant organisations, including Digital Clinical Excellence and the Coalition for Responsible Digital Health, to develop a framework to enable the sharing of safety critical information relating to patients known to multiple independent prescribing organisations. This would create a cross-organisational safeguard for patients who may be at risk of harm, and supporting safe prescribing.

HSSIB makes the following safety observations

• Independent prescribing organisations can improve patient safety by ensuring that patient information contained in the NHS App is not used as a sole source of verification when making clinical decisions, as this is outside the purpose of the App and can result in patient safety risks.
• National healthcare organisations and independent prescribing organisations can improve patient safety by working together to design mechanisms for receiving information held by independent prescribing organisations. Such data may help to inform NHS care and provide insights into the safety profile of medications predominantly prescribed in the private sector.