Pharmacist Suspended for Unsafe Online Prescribing Practices

A pharmacist working as an Independent Prescriber for an online pharmacy, Instant E-Care Ltd, faced multiple allegations regarding unsafe prescribing practices between 2015 and 2019. The case was triggered by concerns raised by the husband of a patient who had obtained multiple opioid prescriptions from various online pharmacies using different names and accounts.

Key Findings:

• The pharmacist prescribed medications outside their area of expertise, including opioids, without sufficient training or competency.
• Over a one-year period, they issued approximately 11,850 prescriptions for opioids—averaging 32 per day.
• Patients were able to pre-select their medication, strength, and quantity with no adequate review.
• Prescriptions were issued without face-to-face or virtual consultations, relying solely on online questionnaires.
• There was no verification of patient identities, GP records were not checked, and there were no safeguarding measures in place.
• The pharmacist failed to identify or prevent medication misuse, particularly with opioid prescriptions.

Specific Patient Cases:

• Patient P: Used multiple names and accounts to obtain dihydrocodeine. The pharmacist failed to verify identity or check medical history.
• Patient Q: Later died from drug-related causes. A coroner’s inquest found that no doctor or pharmacist checked their GP records before dispensing opioids.
• Multiple other patients received unsafe prescriptions, including for chronic pain conditions that were outside the prescriber’s competence.

Committee Decision:

The committee found that the pharmacist’s conduct amounted to serious professional misconduct. They had disregarded professional guidelines, putting patients at significant risk of harm. Their actions undermined public trust in the profession. Despite expressing remorse, the registrant’s failure to adhere to prescribing standards warranted a 12-month suspension to protect the public and maintain confidence in the pharmacy profession.

Learning Points:

1. Patient Safety First: Prescribing must be based on adequate clinical assessment, not patient self-selection.
2. Scope of Practice: Pharmacists should only prescribe within their area of competence.
3. Communication with GPs: Ensuring continuity of care by sharing prescribing information is essential.
4. Safeguarding Measures: Robust identity verification and screening for potential medication misuse should be mandatory.
5. Regulatory Compliance: Pharmacists must follow GPhC guidelines and national prescribing standards to prevent harm.