Pharmacists who use new online prescribing guidance to prescribe the new wave of semaglutide-based weight loss drugs like Wegovy are at “risk of possible regulatory action”, the Pharmacists’ Defence Association (PDA) warned on Friday (May 3).

The PDA said that an “expert report” commissioned by the General Pharmaceutical Council (GPhC) conflicts with “best practice” guidance recently released by the Digital Clinical Excellence (DiCE) UK Forum.

On May 1, DiCE launched its “industry-led” guidelines for online consultations that use assessment questionnaires, a practice also known as “asynchronous prescribing”.

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At the launch of the guidelines, Boots Online Doctor medical director Dr Christina Hennessey said that it was important for “online prescribers” to have “a unified set of best practice guidelines”, while LloydsPharmacy Online Doctor also said it “supports” them.

Both online providers are members of the DiCE network, which also includes Pharmacy2U, Chemist4U and Asda, as well as other online pharmacies.

But the PDA strongly cautioned its members against asynchronous prescribing using the DiCE guidelines.

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It said that the guidelines "cannot be regarded as ‘best practice’" since they rely on a "questionnaire-based prescribing model" that the regulator has deemed "unsuitable".

“Pharmacists prescribing glucagon-like peptide-1 receptor agonist (GLP1-RA) medication based upon an asynchronous model expose themselves to the risk of possible regulatory action should their practice come to the attention of the GPhC,” it added.

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DiCE told C+D today (May 7) that its guidelines aim to “manage risk” and respond to “public demand”, adding that it is investigating the “experience and expertise” of the GPhC’s expert.

And the GPhC stressed that it does not endorse the new guidelines but is updating its own guidance around online prescribing.

 

“Cannot be in a patient’s best interests”

 

The PDA said that the regulator was relying on its expert report “to prosecute significant numbers of pharmacist prescribers” who have used the asynchronous model to prescribe medicines.

A “clinical expert” commissioned by the GPhC found that using “a questionnaire-based prescribing” model to prescribe weight-loss drugs such as GLP-1RAs “is not and cannot be in a patient’s best interests”, it added.

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Online prescribing without a face-to-face consultation relies on self-reported information, which fails to give a prescriber “a full and complete clinical picture of the patient”, according to the GPhC’s expert.

The expert concluded that they believed that “weight loss medications should not be prescribed from an online questionnaire”.

 

Not “completely foolproof”

 

However, DiCE’s statement on the release of its guidance struck a more optimistic tone, describing online prescribing as “an established 21st-century societal need in healthcare”.

It hailed the coming together of “traditionally competing businesses” to “benefit patient care and safety”.

And it said that the guidelines would be “dynamic working documents” subject to “regular review and updates as required by changes directed by regulations and research”.

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But the PDA noted that DiCE’s own document “admits” that there is “no completely foolproof way to safeguard against wilful misuse” of GLP-1RAs.

The trade union called on the regulator to provide “unambiguous guidance” on the use of online questionnaires to prescribe medicines.

 

DiCE: “Strongly refute” claims

 

A DiCE spokesperson told C+D today that its members “strongly refute that their service is unprofessional or solely commercially driven” but that they are “responding to the established public demand”.

The spokesperson said that the guidelines were developed to “manage risk in a service that is unlikely to be curtailed”.

While the PDA warned that online prescribing leaves GPs ignorant to the “additional medication” that a patient might be taking and places patients at risk of “potential harm”, the DiCE spokesperson said that this was the fault of “the data security systems in the NHS”.

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They added that the forum would be “exploring the experience and expertise” of the GPhC’s expert “in relation to digital care and in particular their training, practice and personal provision of this type of service”.

“As a highly specialised area of healthcare, it would be reasonable to expect that this expert would have extensive experience and expertise in online and asynchronous digital care to be able to furnish an opinion that may question the provision of online weight management in its entirety,” they said.

 

DiCE guidelines not “endorsed” by GPhC

 

Meanwhile, the GPhC’s chief pharmacy officer and deputy registrar Roz Gittins today stressed that DiCE’s guidelines are not endorsed by the regulator “or any professional body”.

Gittins said that the GPhC is updating its guidance on “working in online settings” to provide “more clarity”.

She added that “the only statutory standards” that healthcare professionals should follow are those produced by the UK’s health regulators or from statutory bodies such as the National Institute for Health and Care Excellence (NICE).

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“Ultimately pharmacy professionals need to work in accordance with GPhC standards,” Gittens said.

According to its website, the DiCE network was created by its chair Professor James Kingsland in 2019 “to give a voice to and support the growing community of digital healthcare providers within primary care”.