How to Set Up an Online Prescribing Service in the UK: Governance, SOPs and Safe Prescribing
Everyone wants to open an online prescribing service right now — weight loss, ADHD, dermatology, private prescribing through a pharmacy. And the regulators have noticed. The HSSIB — the Health Services Safety Investigations Body — has been looking into online prescribing and found serious issues with how some of these services operate. Here’s the honest version of how you set one up safely: and it comes down to one word almost nobody wants to hear. Governance.
The honest summary
- Governance is where clinics fail: the ADHD Panorama scandal and the weight-loss mis-prescribing stories are governance failures, not knowledge failures.
- Set up an independent governance committee: no shareholders, no directors, no conflicts — a doctor, a pharmacist, an ex-inspector, a lay member, ideally legal input. Around £400 for a meeting every 6–8 weeks is money well spent.
- SOPs must be bespoke, evidence-based and actually followed — not bought in, ticked and shelved.
- Verify, don’t trust: weight-loss services must independently verify weight; get access to medical records (summary care record with consent, contact the GP).
- Questionnaires alone don’t work: pre-screen with them if you like, but a proper consultation and history is what prescribing decisions rest on.
Why is everyone suddenly looking at online prescribing?
Because it keeps going wrong in public. The HSSIB has investigated online prescribing services and found serious problems with the whole model as some operators run it. Before that we had the Panorama investigation into private ADHD clinics — diagnoses handed out after cursory assessments — and now the same pattern is repeating in weight-loss management: inappropriate treatment, medicines prescribed on the strength of whatever the patient typed into a form, no records checked, no follow-up. All sorts is happening out there.
And when you strip each scandal back, it comes down to one simple concept: governance. Not a lack of clever clinicians. Not a lack of demand. A lack of structure around the prescribing. I see a lot of clinics and a lot of pharmacies genuinely struggling with this — and I understand why, because nobody teaches it. So let me set out what I’d put in place, in order.
Start with the right people — and the paperwork to prove it
Before anything else: appropriately trained staff. Whether you’re setting up a weight-loss service, an ADHD clinic, a dermatology service or a private prescribing service inside a pharmacy, the people doing the clinical work must be trained for that work — and you must be able to prove it. That means CVs on file, references taken up, training records kept. Not because a filing cabinet makes anyone safer, but because if you can’t evidence competence, then as far as an inspector or a court is concerned, it doesn’t exist.
If you’re a pharmacist who isn’t yet a prescriber, that’s your first job — and I’ve written separately about how to find a DPP to get you there.
What does a proper governance committee look like?
This is the single biggest thing I wish I’d known when I set up my own pharmacy business: build a governance committee before you build the service. It makes an enormous difference.
The critical word is independent. This committee sits separate from the organisation. No shareholders. No directors. Nobody with any conflict of interest in the business. The moment the people scrutinising your decisions have a financial stake in your decisions, you don’t have governance — you have theatre.
Who goes on it? For an online prescribing service run from a pharmacy, I’d want:
- A doctor — independent, not linked to you.
- Another pharmacist — someone who knows your world but isn’t in your business.
- An ex-inspector — enormously useful; they know exactly what failure looks like.
- A lay member — a member of the public with no link to the profession, who asks the obvious questions professionals stop seeing.
- Legal input — ideally someone with legal expertise, even if not at every meeting.
Then the rule is simple: everything goes through them. New service ideas, protocols, significant changes, incidents. They evaluate, they challenge, they feed back, they make the final call. And honestly — no reasonable committee says no to a well-argued, well-evidenced proposal. What they say no to is the corner you were about to cut.
Pay your committee for their time — an hour’s meeting every 6–8 weeks might cost you around £400. Set that against one regulatory investigation, one suspended service, one harmed patient. It is some of the best money your business will ever spend.
SOPs, audits, insurance: the unglamorous middle
1. SOPs that are yours — and actually followed
A lot of pharmacies and clinics think governance means “I’ve got my standard operating procedures in place.” SOPs are part of it — but here’s the trap we’ve all seen. You buy a set of generic SOPs, everyone signs the sheet, they go on the shelf. Then an inspection comes, the inspector watches what actually happens on the floor, and it bears no resemblance to the folder. Now you’re in trouble — and the SOPs you paid for are the evidence against you.
Your policies and procedures need to be designed for your service: bespoke, evidence-based, reflecting best practice, and describing what your team genuinely does. If the SOP and reality disagree, fix one of them — fast.
2. Regular audits
An SOP is a claim. An audit is the proof. You need regular audits confirming that what you’ve said — the best practice you’ve committed to on paper — is actually happening. This is exactly where your governance committee earns its fee: they set the audit schedule, review the results, and chase the actions.
3. The right insurance
Make sure the insurance and indemnity in place actually match the service you’re running — online prescribing, the specific conditions you treat, the professionals doing it — not a vague description given over the phone when you took the policy out.
What extra rules apply to services like weight loss?
Every service has its own intricacies, and you need to sit down and work through them for your service. Take weight management as the obvious example, because the guidance has tightened:
Verify the weight independently. You can no longer just take the patient’s word for their weight, height and BMI. It makes complete sense — the entire eligibility for treatment hangs on those numbers — so build independent verification into your pathway.
Get access to the medical records. If you’re prescribing, there should be shared care or some arrangement giving you access to the patient’s records. This is one of the recurring failures in online prescribing: no records, no continuity of care, and suddenly nobody treating the patient knows what anybody else is doing. In practice: contact the GP practice, and with the patient’s consent where appropriate, get hold of the summary care record. Independently verify what you’re told rather than prescribing into the dark.
These aren’t bureaucratic extras. They’re the difference between a clinical service and a vending machine with a prescriber’s registration number attached.
Why don’t questionnaires alone work?
Because a questionnaire isn’t an assessment. I’ll say it plainly: stop the questionnaires — or rather, stop pretending they’re the whole job. Using a questionnaire for pre-screening is fine; it’s efficient triage. But then you do an appropriate consultation, you take an appropriate history, you do your assessments — and then you make a prescribing decision. The questionnaire-only model is precisely what the investigations keep criticising, and it’s indefensible the day something goes wrong.
| Area | Questionnaire-only service | Properly governed service |
|---|---|---|
| Assessment | Patient self-completes a form; prescriber skims it. | Form used for pre-screening only; proper consultation and history before any decision. |
| Verification | Weight, height and history taken on the patient’s word. | Key facts independently verified — weight checked, identity confirmed. |
| Medical records | None accessed; GP never contacted. | Shared-care or records access; summary care record with consent; GP informed. |
| SOPs | Bought-in, signed once, shelved. | Bespoke, evidence-based, matching actual practice — and audited. |
| Oversight | The owner marks their own homework. | Independent governance committee with no conflicts reviews everything. |
| When it’s inspected | Folder and reality disagree; enforcement follows. | Audit trail shows what you claim is what you do. |
Keep training, keep building evidence
Setting up safely isn’t a one-off event — it’s a habit. You have to constantly train, constantly stay up to date, and constantly build the evidence that you’re doing so: seminars you’ve attended, reflective work you’ve written up, articles you’ve read, formal training courses you’ve completed. That file is your professional armour. If you want structured CPD to build it with, my courses are at medlrn.co.uk.
Do all of this and you’re on a good ladder. Done properly, a private prescribing service is also one of the strongest income streams a pharmacy can build — but only the “done properly” version survives contact with an inspector.
Putting it together
So here’s the playbook, in order. Trained staff, evidenced with CVs, references and records. An independent governance committee — doctor, pharmacist, ex-inspector, lay member, legal input — that everything goes through, for roughly £400 a meeting. Bespoke, evidence-based SOPs that describe what you actually do. Regular audits to prove it. The right insurance. Service-specific safeguards — independent verification, records access, GP contact. And real consultations, not questionnaires. That’s how you set up an online prescribing service that keeps your patients safe and keeps you out of trouble.
If you’re struggling with any of this — or you’d like someone who’s built these structures to walk you through it — get in touch. Happy to help. And if you want the infrastructure ready-made, Clinickly Co-pilot solves exactly this: your SOPs, policies, procedures and training in one admin panel, plus access to a governance committee — a multidisciplinary team — without having to assemble one yourself.
Frequently asked questions
Can I prescribe based on an online questionnaire alone?
No — and this is where online services keep getting into trouble. A questionnaire is fine as pre-screening, but it cannot be the assessment. Before prescribing you need an appropriate consultation and an appropriate history, and then you make your clinical decision based on that assessment — not on a form the patient filled in unsupervised. Questionnaire-only prescribing is exactly the model that investigations into online prescribing have criticised.
What is an independent governance committee and who should sit on it?
It’s a small group, separate from the organisation, that evaluates your service, challenges your decisions and provides genuine oversight. Crucially, its members must have no conflict of interest — no shareholders, no directors, nobody with a financial stake. A sensible mix is an independent doctor, another pharmacist, an ex-inspector, a lay member of the public, and ideally someone with legal expertise. Everything significant — new services, protocols, incidents — goes through them.
How much does a governance committee cost to run?
Far less than people assume. Pay members for their time — say an hour-long meeting every six to eight weeks — and you might spend around £400 a meeting. Set against the cost of a regulatory investigation, a suspended service or a harmed patient, it is some of the best money an online prescribing business will ever spend.
Do I need access to a patient’s medical records before prescribing online?
For most services, yes — you need shared care or some arrangement that gives you access to the patient’s medical records, because without it there is no continuity of care. In practice that means contacting the GP practice and, with the patient’s consent where appropriate, obtaining the summary care record. Independently verify what the patient tells you; for weight-loss services specifically, guidance now expects the weight itself to be verified independently rather than taken on the patient’s word.
What do I need in place before launching an online prescribing service?
Six things: appropriately trained staff with CVs, references and training records on file; an independent governance committee with no conflicts of interest; bespoke, evidence-based SOPs that reflect what you actually do and are actually followed; regular audits to prove it; the right insurance; and a consultation model that takes a proper history rather than relying on questionnaires. Then keep training — CPD, seminars, reflective work — and keep building your evidence.
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