Distance selling pharmacies

What change is coming in for the provision of services by Distance Selling Premises (DSP) pharmacies?  

DSPs will no longer be able to deliver in-person Directed Services (Advanced, National Enhanced, and Enhanced Services) onsite (i.e. no longer provide services onsite, face-to-face with the patient).  

Where a service specification allows, DSPs will continue to be able to provide… 

• remote consultations (from the distance selling premises) or  

• off-site provision of a service (face-to-face)(i.e. not on the distance selling premises),  

… will still be possible for DSPs (and for all pharmacies).  

What will this change mean for the provision of services onsite at Distance Selling Premises? 

This change will mean that DSPs may only provide Advanced, National Enhanced and Enhanced Services remotely from their pharmacy premises. They must already only provide Essential services remotely from their pharmacy premises. 

When will this change happen/come into force? 

This change is likely to be in October 2025, after the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (PLPS Regulations) have been amended.  

Why is this change being introduced? 

In simple terms, Distance Selling Premises (DSP) pharmacies will have to do what their name implies, to provide NHS pharmaceutical services remotely (at a distance) and not face-to-face with patients at, or in the vicinity of, the pharmacy premises.  

The intention of the PLPS regulations was for DSPs to be remote providers of pharmaceutical services, and, on this basis, they are allowed to establish or open (subject to application) without reference to local Pharmaceutical Needs Assessments (PNA). The expectation was that DSPs would provide NHS pharmaceutical services nationally. Not that they would deliver clinical services locally or on the High Street.  

Currently, the PLPS Regulations allow DSPs to provide Advanced, National Enhanced and Enhanced Services (Directed Services) to patients present onsite, at the pharmacy premises. However, this was introduced when such services were a small part of the NHS community pharmacy offering. This has since changed and has meant that increasingly, with the provision of such services, DSPs can establish and provide such services locally, undermining the integrity of the market entry controls in the PLPS (which broadly only permit new pharmacies if local patient needs – set out in the local PNA – require one). 

The first formal recognition of this issue – concern with DSPs providing Directed Service onsite, face-to face with patients – was when the Pharmacy First Service was introduced, and DSPs were only allowed to provide Pharmacy First clinical pathways (the new part of the service) remotely. 

How much notice of this change are DSPs being given? 

DSP pharmacy owners are being given 6 months’ notice of this change. 

Will this stop ‘local’ or ‘pseudo’ DSPs? 

No. This change will not stop the establishment of ‘local’ or ‘pseudo’ DSPs (for more information about these, visit the CCA website), but it should stop their provision of Directed Services in a way that undermines the market entry controls in the PLPS Regulations. 

Will DSPs be able to continue to provide the COVID-19 Vaccination Service? 

The COVID-19 Vaccination Service is a National Enhanced Service that may only be provided by NHS pharmacies from designated premises approved by NHS England. The designated premises may be premises other than the pharmacy premises. If the provision of the service is offsite, i.e. not at the DSP pharmacy premises, our understanding is that DSPs will continue to be able to provide the service after the change to the PLPS Regulations in October 2025. 

Will DSPs be able to provide the Flu Vaccination Service? 

The Flu Vaccination Service is an Advanced Service. The service specification states that ‘Vaccinations under this advanced service will usually be carried out on the pharmacy premises, but they can also be undertaken in other suitable locations, such as in the Patient’s home, a long-stay care home, a long-stay residential facility or community venues (e.g. community centres).’  

DSPs will not be able to provide Flu vaccinations at the DSP pharmacy premises.  

The service specification is reviewed annually and will be revised to reflect the changes to DSP provision of Directed Services, which will be introduced in the PLPS Regulations. If DSPs retain the option to provide flu vaccinations offsite, this is likely to be a way that does not undermine market entry controls. This could mean, for example, that off-site provision is only at designated and approved premises.  

Is Community Pharmacy England supportive of remote provision of NHS Pharmaceutical Services? 

Yes. Community Pharmacy England supports the provision of NHS pharmaceutical services remotely, where this can be carried out safely and within the conditions described in the service specification and the Secretary of State’s directions.  

What are the rules around off-site provision of clinical services?

The following table summarises service specification/contractual provisions related to off-site provision of clinical services, i.e. provision away from the pharmacy premises and the provision of remote consultations, where the patient is not present on the pharmacy premises.

If you are considering, where permitted, off-site provision for any of the services or undertaking remote consultations, please first review the information on our service webpage and the service specification.

The following is a guide to the regulations, available at legislation.gov.uk. Regulations 25 and 64 specifically apply to DSPs.

A DSP must not provide Essential services to a person who is present at the pharmacy, or in the vicinity of it. In addition, the pharmacy’s standard operating procedures (SOPs) must provide for the Essential services to be provided safely and effectively without face-to-face contact with any member of staff on the premises. NHS England could ask for sight of the SOPs when considering an application to satisfy itself that the conditions will be met.
A DSP receives a prescription via post and dispenses it the next day, sending it via courier. The pharmacist telephones the patient to counsel the patient on the medicine’s correct use. This arrangement satisfies the conditions as no face-to-face contact has taken place on the pharmacy’s premises.

A DSP returns a prescription to the patient saying that because it orders a Controlled Drug, the pharmacy will not be able to dispense it. In this case, the pharmacy is in breach of the Terms of Service which requires all pharmacies to dispense any drug that is ordered, ‘with reasonable promptness’. NHS England could issue a breach notice, could order a withholding of remuneration, and could in some circumstances remove the pharmacy from the pharmaceutical list.

A DSP may provide Advanced and Enhanced services on the premises, as long as any Essential service which forms part of the Advanced or Enhanced service is not provided to persons present at the premises.
A DSP receives a prescription and dispenses it the next day, sending it via post with a consent form and explanatory leaflet about the New Medicine Service (NMS), inviting the patient to contact the pharmacy. The patient lives locally and so makes arrangements to visit the pharmacy, to complete the NMS. The pharmacy would need to be very careful not to provide or offer to provide any of the Essential services whilst the patient is at the pharmacy. The patient brings some unwanted medicine back to the pharmacy at the same time as attending for the NMS consultation. The pharmacy is therefore in a dilemma, as accepting the waste at the pharmacy would breach the conditions.

The pharmacy’s procedures and SOPs must allow for the uninterrupted provision of Essential services during the opening hours of the pharmacy to anyone in England who requests the service. NHS England could ask for sight of the SOPs, during the application process, to ensure that adequate arrangements have been made to satisfy this condition.
A DSP provides NHS England with an SOP detailing how the pharmacy will receive prescriptions from a drop box in the local GP’s practice, and will have an advice hotline which will operate between 5-6pm during the week. NHS England refuses the application on the grounds that only patients who are local to the GP practice will be able to send prescriptions, and the advice hotline (and so the Dispensing, Signposting and Support for Self Care Essential services) will only operate for a proportion of the pharmacy’s core hours.

Nothing in any written or oral communication such as a practice leaflet or any publicity can suggest, either expressly or impliedly, that services will only be available to persons in particular areas of England, or only particular categories of patients will (or will not) be provided for.
A DSP publishes a leaflet which states ‘Our delivery vans are available within a 25 mile radius. We can arrange for delivery by post outside this area, but cold chain products, such as insulin cannot be sent this way’. The pharmacy is likely to be found in breach of the conditions, as patients with diabetes requiring insulin who live outside the area would be unable to obtain their prescriptions from the pharmacy.

On 20th October 2020, NHS regulations were laid to introduce changes to the Terms of Service for contractors, which included changes to consultation rooms and remote consultations. For distance selling pharmacies, this means:

• they must ensure that there are arrangements in place at the pharmacy which enable staff and patients to communicate confidentially by telephone or another live audio link and a live video link; and
• can choose to install a consultation room at their pharmacy to allow the provision of Enhanced and Advanced services on the premises, but this is not a requirement of the Terms of Service.

Read more about the consultation rooms and remote consultations Terms of Service

On 20th October 2020, NHS regulations were laid to introduce changes to the Terms of Service for contractors, which included from 1st January 2021, all pharmacies had to meet the Healthy Living Pharmacy (HLP) requirements which are detailed in the NHS England regulations guidance.

The majority of the requirements are the same for ‘bricks and mortar’ pharmacies and DSPs; however, there are a few different requirements and suggested evidence that should be collated. For example, DSPs must have a website for patients and the public accessing their services to use, which must have an interactive page that is clearly promoted when they first access the website. This page must provide access to a reasonable range of up-to-date materials that promote healthy lifestyles, by addressing a reasonable range of health issues. Further information can be found in the NHS England regulations guidance.

Read more about the HLP Terms of Service

Q. Is a DSP eligible for the Pharmacy Access Scheme?
No. DSPs (e.g. internet pharmacies) are not included in the scheme; this is because the scheme is intended to protect physical access to bricks and mortar pharmacies.

Q. Can a DSP provide an Advanced service?
A DSP may provide an Advanced service such as the Flu Vaccination Service on the pharmacy premises, as long as any Essential service is not provided to persons present at the premises.

For example, if the patient presents an NHS prescription to be dispensed – this is an Essential service. Therefore, the pharmacy is unable to provide this service at the premises.

Q. Can a DSP provide locally commissioned services?
Technically, yes. The Regulations prohibit DSPs from offering to provide Essential services to persons face to face at (which includes in the vicinity of) the pharmacy premises. Therefore, this would not apply to services commissioned locally.

Q. The local authority has decided not to commission my DSP to provide the locally commissioned smoking cessation service. Can I challenge this decision?
The decision of whether to commission or not is one for the local authority. If a pharmacy contractor wished to challenge a decision, then they should be encouraged to seek independent legal advice as procurement law is a complex specialist field outside of the remit of Community Pharmacy England.

Q. Does the European Regulation to inform customers about the existence of an online dispute resolution platform if they have a problem with their online purchase apply to me?
In February 2016, new European Regulations came into effect requiring traders engaged in online sales or services contracts to inform consumers about the existence of the online dispute resolution platform and the possibility of using that platform to resolve disputes.

No. These Regulations do not currently apply to “health care services” which are health services provided by health professionals to patients to assess, maintain or restore their state of health, including the prescription, dispensation and provision of medicinal products and medical devices (see Part (a) of Article 3 of Directive 2011/24/EU).  A “Health professional” includes a pharmacist.

Q. The regulations state that DSPs are to provide Essential services ‘without face to face contact’ between the contractor or their staff and the patient. Can a DSP use a delivery driver to collect prescriptions and deliver medicine to patients?
The prohibition on face-to-face contact has been in place since 2005 and continues under the new regulations. The prohibition on face-to-face contact only covers the provision of Essential NHS pharmaceutical services, at the pharmacy premises. This means that a delivery driver employed by the contractor could (a) collect a prescription from the GP practice; and (b) deliver the dispensed items to the patient at their home.

Q. Can a DSP charge for delivery of prescriptions?
Under the National Health Service 2006 (Part 1 1(3)), all NHS services must be provided free of charge except where a charge has been expressly mandated by legislation. As no legislation has been passed that would allow this, it would be against the Act to request payment for the delivery of a prescription. Bricks and mortar pharmacies are able to charge for delivery as part of a private service (except where the item is a Part IXA specified appliance).

Q. Do I need to display the EU common logo in my DSP?
No. From 1st January 2021, anyone (including traditional “bricks and mortar” pharmacies with an online presence) who sells human medicines online in Great Britain is no longer required to display the EU common logo (also known as the Distance Selling Logo) on every page of their website offering to sell human medicines. For Great Britain the Medicines and Healthcare products Regulatory Agency (MHRA) will be considering an alternative to the use of the Distance Selling Logo in the future. The MHRA is no longer processing new applications for the Distance Selling Logo in Great Britain. The MHRA will continue to disrupt illegitimate online retailers through enforcement activity.

Q. What is the GPhC voluntary internet logo scheme?
The General Pharmaceutical Council (GPhC) operates a voluntary internet pharmacy logo scheme to provide reassurance to patients and the public that they are purchasing medicines online from registered pharmacies who have to meet GPhC standards. If you would like to apply to use the GPhC voluntary internet pharmacy logo, more information is available on the GPhC website .

Community Pharmacy England Briefing 023/15: Providing pharmacy services at a distance (April 2015)
The General Pharmaceutical Council has issued guidance for registered pharmacies providing pharmacy services at a distance. This will apply to most community pharmacies, both distance selling and bricks and mortar, as many now provide collection and delivery of prescriptions as part of their dispensing process. This briefing summarises some of the key aspects of the guidance and how contractors can ensure they are following them.