UK-regulated and registered doctorfox.co.uk is a web clinic with a difference.
Run by Bristol GP Dr Tony Steele, it provides prescription medicine online. Doctor Fox also offers non-prescription items and treatments that the NHS does not pay for, such as malaria tablets. Parameters and checks are in place to ensure patient safety and confidentiality.
Available too are items rationed by the health service including hair loss treatments and certain medicines prescribed by NHS GPs, such as treatment for hay fever, thrush, chlamydia and contraception.
Dr Steele has 15 years' experience as a GP and was a partner in a Bristol practice before leaving to set up Doctor Fox.
'The clinical rationale for Doctor Fox is that there are lots of things taking up appointments in surgeries that patients would rather not bother the GP for,' he says. 'The surgery time could be better used.'
Doctor Fox also saves patients embarrassment if they want help with conditions such as erectile dysfunction or services like DNA paternity testing, explains Dr Steele.
Precautionary approach
Dr Steele, who also works as a locum GP, takes a precautionary approach to prescribing and rigorously checks for contraindications. He does not prescribe anything for which a face-to-face consultation is required or drugs that could be addictive or misused, such as painkillers. Nor does he treat chronic conditions such as heart disease or diabetes.
'I won't do weight reduction drugs either because I can't monitor them. My experience is that you have to monitor that kind of medication carefully because people over-medicate,' says Dr Steele. Any request that is unsafe or suggests an unusual pattern of medication is rejected.
'What I do is at the minor end of treatment in the sense that most of it is pretty non-toxic and available from the chemist (community pharmacy). I am providing it at a lower cost and in greater quantities.'
The site provides information about medical conditions for patients who can have online consultations, regardless of whether they place an order.
A consultation involves filling out a questionnaire to check for contraindications and suitability of medication. There is also a box for text so that the patient can add details or ask questions, to which Dr Steele will respond with advice. Patients' personal details are protected and communication online is through secure web links.
Medication is usually issued within 24 hours by Doctor Fox's partner, a registered NHS online pharmacy, and sent to the patient by recorded delivery.
One of the biggest challenges for Dr Steele is the poor reputation of drugs supply websites. In an April 2009 news story picked up by the national press, GP reported the results of an exclusive survey, revealing that one in four GPs had treated patients for adverse reactions to medicines bought online.
Dangers
Also in 2009, Pfizer, the Medicines and Healthcare products Regulatory Agency (MHRA), the Royal Pharmaceutical Society of Great Britain, the Patients Association and HEART UK highlighted the dangers in a public awareness campaign.
Dr Steele wants unregulated websites, many based overseas, to be shut down because they damage the reputation of those, such as his, that are legitimate. Doctor Fox is registered and regulated by the Care Quality Commission (CQC) and underwent stringent checks.
It took Dr Steele 18 months and significant financial cost to set up the site. The application fee for CQC registration for an operation like his is £1,305 with an annual registration fee of £1,025. The application process was so complicated that he employed a consultant to help him. This cost a further £3,400.
He estimates total set up costs at £6,000 to £7,000, excluding his time and IT fees. Under an arrangement he has with his IT provider, computer costs were kept down, but without this arrangement, he estimates that Doctor Fox's set-up costs would have reached around £25,000.
Reasonable amount
Patients are charged a reasonable amount. Dr Steele says that the price of hay fever medication is often less than the NHS prescription charge.
For a traveller wanting anti-malaria tablets, the cost varies from £63 for two weeks' worth of Malarone or £6 for chloroquine for the same period. Viagra prices start at £24 for four occasions' use.
The web clinic is aimed at busy people who are used to buying other items online; those who would otherwise be limited to medication they can get from the NHS; and patients embarrassed about seeking help.
Dr Steele explains that it is not his intention to replace the patient's GP. Rather, Doctor Fox offers an alternative means of accessing a limited number of treatments - and this frees up the GP's time for other consultations. 'It complements general practice,' he says.
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