Pressure to prescribe comes in several forms. An online service sets a time limit per consultation. A manager asks why your approval rate is lower than a colleague's. A patient in a consultation room or a chat window insists on a named product and threatens a bad review. Each one asks you to put speed or sales ahead of the assessment. UK regulators say the assessment comes first.
You must not let targets, incentives or patient demand override your professional judgement. GPhC guidance for pharmacist prescribers, updated in April 2025, says incentives and targets must not compromise your judgement, and you must explain your reasons when you decide not to prescribe. GMC and NMC standards place the same duty on doctors, nurses and midwives.
Key facts
- Pharmacist prescribers
- GPhC "In practice: guidance for pharmacist prescribers", updated April 2025
- Online and distance services
- GPhC guidance for pharmacies providing services at a distance, including on the internet, published 4 February 2025
- Questionnaire-only prescribing
- Not allowed for high-risk medicines, including weight management medicines
- Weight-loss medicines online
- The prescriber must independently verify weight, height or BMI. A phone call alone is not enough.
- Doctors
- GMC guidance on prescribing and managing medicines and devices, in effect since 5 April 2021
- Nurses and midwives
- NMC Code, standard 18 on prescribing and standard 21 on gifts and hospitality
Where the pressure comes from
In high-street pharmacy, the pressure often comes from service numbers: a monthly count of consultations or clinical service claims, or a regional league table. In online pharmacy and private prescribing, the pressure sits inside the workflow. A queue of questionnaires waits for sign-off, a dashboard counts approvals per hour, and a rejected order turns into a refund. In private clinics, a patient who has paid for a consultation often expects a prescription at the end of the appointment.
None of this changes your duty. The GPhC standards for registered pharmacies say incentives or targets must not compromise the health, safety or wellbeing of patients and the public. The GPhC's October 2025 guidance on a safe and effective pharmacy team asks owners and leaders to manage targets without compromising the professional judgement of staff.
What the GPhC expects from online and distance prescribing
The GPhC tightened its guidance for pharmacies providing services at a distance in February 2025. The pharmacy owner and the superintendent pharmacist stay responsible for the service even when prescribing is contracted to a third party. The guidance lists medicines unsuitable for a questionnaire model alone. These include weight management medicines, antimicrobials, medicines liable to misuse, medicines which need ongoing monitoring, and medicines under a pregnancy prevention programme.
For these medicines the prescriber must verify the information independently, through two-way communication with the person or access to their clinical records. For weight-loss medicines, the prescriber must verify the person's weight, height or body mass index, and a phone call does not meet the standard. Prescribers should share relevant information with the person's GP when the person consents. Without consent or a regular prescriber, the prescriber makes a risk-based decision and records the reasoning.
The guidance also rules out arrangements which give prescribers incentives to issue prescriptions. If your pay rises with the number of approvals, raise the arrangement with the superintendent pharmacist in writing.
Doctors, nurses and other prescribers
The GMC's guidance on good practice in proposing, prescribing, providing and managing medicines and devices covers remote consultations as well as face-to-face ones. You need enough information about the patient to prescribe safely, and you must be able to hold a dialogue and obtain consent. The GMC's guidance on identifying and managing conflicts of interest, in effect since 30 January 2024, tells you to prioritise patient care when interests compete and to be open about your interests, including target payments.
The NMC Code says nurse and midwife prescribers prescribe only when they have enough knowledge of the person's health and are satisfied the medicine serves the person's health needs (standard 18.1). Standard 21.1 tells you to refuse all but the most trivial gifts, favours or hospitality.
Steps when you are asked to approve or supply
- Pause the decision. Note the information you have and the information still missing.
- Ask the person for the missing information through the service's two-way channel. For weight-loss medicines, ask for a form of verification the GPhC guidance accepts.
- If the information does not support a prescription, decline. Explain your reasons and set out other options, as the GPhC prescriber guidance requires.
- Write down any instruction to approve faster or skip a check, with the date and the name of the person who gave the instruction.
- Raise the pattern with the superintendent pharmacist, clinical lead or responsible officer. If nothing changes, use the whistleblowing policy or contact your regulator.
- Get advice from your defence body or union, such as the PDA for pharmacists or the BMA for doctors, before you resign or sign a new contract.
When the pressure comes from the patient
A patient might arrive with a product name from social media, or ask for a higher dose than the assessment supports. Explain the clinical reason for your decision in plain words and record the conversation. If the patient becomes abusive, follow your workplace safety process and read our guide to patient aggression.
UK law bans the advertising of prescription-only medicines to the public. If you see a patient-facing advert for a named prescription medicine, you can report the advert to the MHRA. If you suspect a patient has had a side effect after a rushed assessment, report the reaction through the MHRA Yellow Card scheme as well as your local incident system.
Before you speak to your manager
Write down the decision you were asked to make, the safeguard the request would skip, and the change you want. Keep patient details inside authorised systems. Our guide to keeping appropriate records of workplace concerns explains what to keep and where.
Support for prescribers under pressure
Pharmacists can contact Pharmacist Support for wellbeing help and the PDA for professional advice. The services below support doctors, nurses and specialist groups.
BMA wellbeing services
Counselling and peer support for doctors and medical students.
The main wellbeing services have their own access rules. Additional member services may require membership.
RCN member support
A starting point for nursing members seeking advice and support.
Membership and service-specific criteria apply. Read the current service information.
Psychiatrists' Support Service
Peer support for psychiatrists facing personal or work-related difficulties.
For psychiatrists. Read the provider's confidentiality policy and professional safety exceptions.
GLADD
A community representing LGBTQ+ doctors, dentists and medical and dental students.
Check membership and event information. The organisation does not provide medical or dental advice.
Common questions
Can my employer make me prescribe to hit a target?
No. GPhC guidance says incentives and targets must not compromise a prescriber's professional judgement, and GMC guidance says patient care comes first when interests compete. You stay accountable to your regulator for every prescription you sign.
Can an online pharmacy prescribe weight-loss injections from a questionnaire?
No. Since February 2025, GPhC guidance says weight management medicines are unsuitable for a questionnaire model alone. The prescriber must independently verify the person's weight, height or BMI.
What should I do if I refuse to prescribe and the patient complains?
Record your clinical reasons and the options you discussed at the time of the decision. A clear record supports you if the complaint reaches your employer or regulator. Our guide to patient complaints covers the personal impact.
Who do I report an unsafe online prescribing service to?
If you work for the service, raise the concern with the superintendent pharmacist or clinical lead first. If nothing changes, or the problem sits at the top, report the service to the GPhC. Online doctor services in England are also regulated by the CQC.