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‘Clear message’: GPhC issues warnings for prescribing via online questionnaires

The regulator has hit three pharmacists with warnings after they provided “high-risk” medicine using “unsafe” online patient questionnaires.

Three pharmacists working for online pharmacies have been hit with warnings by the General Pharmaceutical Council’s (GPhC) investigating committee, according to determinations published last month.

On May 20, the committee considered the cases of Harkirit Kaur Mudhar, registration number 2203538, Sarfraz Patel, registration number 2071654, and Rabia Shaikh, registration number 2068839.

The regulator found that all three had breached numerous GPhC standards by improperly prescribing or dispensing prescription-only medication (POMS) or controlled drugs (CDs) using online questionnaires.

Read more: Wegovy online prescription warning - pharmacists threatened by GPhC action

It decided to issue each of them a warning to remain on its register for 12 months, adding that “further regulatory action” would follow future “similar conduct”.

It warned all three that they must ensure any online pharmacy they work at in the future has “robust systems” to protect patients.


“Unregulated” online pharmacy


Independent prescriber Mudhar worked for an online pharmacy between April 4 and August 16 2022 that ceased to be regulated by the GPhC in September 2021, the regulator said.

It found that Mudhar had not exercised “sufficient due diligence” in agreeing to work for an “unregulated” prescribing service.

As an unregulated “online prescribing platform”, it “almost wholly” used online patient questionnaires for prescribing POMs including “high-risk” drugs such as propranolol, weight loss and asthma medications, according to the warning issued to her.

Read more: Patients hospitalised by fake Saxenda and Ozempic pens filled with insulin

Mudhar did not “regularly approach” her patients’ GPs or seek “independent confirmation” about their history or diagnoses, the regulator said.

Patients that were “vulnerable or at risk of medication abuse” were not given “proper consideration” by Mudhar, it added.

Instead, she “continued to approve” prescriptions for patients that had already received “numerous supplies” from other prescribers at the company, it said.

Read more: Online pharmacy chided by MHRA for advertising POM Ozempic for weight loss

The warning acknowledged that Mudhar had shown insight and remorse, adding that she had completed continuing professional development (CPD) “since becoming aware of this concern”.

Nevertheless, it found that Mudhar had breached five of the GPhC’s professional standards, including to always provide “person-centred care” and to use “professional judgement”.

The regulator warned that “unsafe” online prescribing “puts public safety at risk and can undermine confidence in the profession”.


“Few or no safeguards in place”


Meanwhile, Patel was the responsible pharmacist (RP) at an online pharmacy that also dispensed “high-risk” medications including CDs, the regulator said.

According to his warning, Patel dispensed or oversaw the dispensing of these medicines to patients that had filled in an online questionnaire for 46 working days between June 2019 and August 2021.

The regulator said that as RP, Patel was responsible for ensuring prescribing systems were “safe” through “monitoring and review” before the pharmacy dispensed high-risk medications.

Read more: Fake Ozempic jabs injected into UK supply chain, medicines watchdog warns

It added that he should have made certain that dispensing happened in “a safe and effective pharmacy system, under safe and effective processes”.

The regulator found that the online prescribing system “with few or no safeguards in place” that Patel used to dispense medicine put patients at risk, which amounted to a “serious breach” of the GPhC’s professional standards.

Read more: ‘Many online pharmacies unregulated, illegal or fraudulent’, says MHRA

It said that there was “no two-way consultation” between prescriber and patient to verify the information they had provided and in cases where patients may have needed monitoring, it found that there was no “safety netting or follow up”.

It also found that Patel had prescribed to patients that had already secured “multiple prescriptions” from the same online pharmacy, and that the “risk of misuse or abuse” had been given “little or no scrutiny”.


“Unsuitable” patients


The regulator also found that between October 25 2019 and January 18 2020, independent prescriber Shaikh prescribed “high-risk” medication including CDs “on the basis of an online questionnaire” filled out by the patient.

According to the warning, the regulator had “evidence” that Shaikh prescribed the medication to several “unsuitable” patients using the online questionnaire method.

It again found that some of these patients had already received “multiple prescriptions” from the online pharmacy where she was working.

Read more: Opinion: Pharmacies should be online for better patient access

Like in Patel’s case, the GPhC found that Shaikh did not “clarify or verify” the information provided by the patient and made “little to no contact” with their GP or clinical background checks.

And Shaikh did not follow up after prescribing to patients, according to the regulator, which found that she gave “little or no scrutiny” to the potential for misuse of the medication.

Read more: Online pharmacies are the future - right?

The regulator said that its warning sends “a clear message” to pharmacists and the public that patients are put “at risk” when clinicians prescribe using an online questionnaire “with little to no safeguards in place”.

Such prescribing is “a serious breach” of professional standards, it added.


GPhC updating online pharmacy guidance


Also last month, the regulator issued a firm statement in response to the release of “best practice” guidance by the Digital Clinical Excellence (DiCE) UK Forum for online consultations that use assessment questionnaires, a practice also known as “asynchronous prescribing”.

The Pharmacists’ Defence Association (PDA) warned that pharmacists who use the new guidance to prescribe the new wave of semaglutide-based weight loss drugs like Wegovy are at “risk of possible regulatory action”.

It said at the time that an “expert report” commissioned by the GPhC conflicts with the “industry-led” DiCE guidance.

Read more: DSPs and bricks-and-mortar pharmacies are ‘substitutable’, finds CMA

The GPhC warned 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).

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

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