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Remote Prescribing of Botox Banned By the GMC

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This week the General Medical Council (GMC) will issue new rules to its members, UK Doctors, stating that the practice of remotely prescribing preion only botulinum toxin products, such as the brands Botox, Vistabel,Azzalure, Dysport, Xeomin and Bocouture will no longer be permitted and Doctors must see a patient face-to-face before issuing a preion for the drug; (although they may still delegate the administration of it to someone under their supervision, such as a nurse).

This means that the ongoing loop-hole of writing preions for Botox following a telephone call, fax, email or voice over internet connection (i.e., Skype etc.) will from this week mean that a Doctor is practicing outside of the GMC rules and could face disciplinary charges in the form of a fitness to practice hearing.

There are good reasons why these are preion-only medicines and we believe doctors should assess any patient in person before issuing a preion of this kind,” said Niall Dickson, chief executive of the GMC.

The story broke on the BBC London Evening News on 9th July which highlighted an investigation into the practice of remote prescribing services following concerns that were raised to the broadcaster. The BBC sent a researcher undercover to investigate operations by infiltrating training sessions with one of the UK’s largest purchasers of botulinum toxin products, Dr. Mark Harrison, who runs Harley Aesthetics a company which provides training courses and remote preion services for registered nurses up and down the UK.

For £30 per call, nurses subscribed to his services are able to telephone Dr. Harrison on his mobile phone, whereupon he would speak to them and their patient and issue a preion for the cosmetic injectable treatment without ever seeing the patient face-to-face.

Dr. Harrison was secretly filmed by the BBC candidly remarking to a room full of trainees on a variety of practices which leave many within the industry sharply inhaling, such as obtaining Botox via preions made in the names of friends and family so that a stock of the drug could be obtained ready for injecting patients immediately – something which even Nurse Independent Prescribers (who can legally prescribe themselves as well as Doctors) are not able to do (i.e. stock must not be held, the practitioner must wait for the drug to be delivered in the name of the patient and treat on another day).

Dr. Harrison also pointed out that although ‘a little bit naughty’ if nurses were unable to reach him for a remote consultation, perhaps due to poor mobile phone signal, and wanted to treat a patient there and then, they could do so and he’d ring the patient after the treatment to conduct a retrospective consultation!  This puts the nurse in a position whereby they would be injecting a patient with a preion only medicine (POM) without any form of written preion prior to treatment; a serious issue for patient safety.

The practice of remote prescribing has already been condemned by the Nursing and Midwifery Council (NMC) who state that nurses engaging in treating patients with botulinum toxins following a remote consultation will be going against the NMC standards and thus risk their registration (which could be withdrawn following a disciplinary hearing) if they operate via that business model.

Commenting to the BBC, Dr. Harrison said he had performed more than 50,000 remote consultations since 2005, with no adverse affects on patient health. He told them that the use of preions in one person’s name for the treatment of others was “common, almost universal practice throughout the aesthetics industry” and concluded; “I can confirm that I take my professional and moral obligations to both the patients who have treatments and the nurses who use the service extremely seriously.”

Dr. Harrison is by no means alone in providing remote consultation services, this practice is widespread amongst individuals and smaller service providing companies,  also extending to dentists who have prescribing powers. As the Director of the biggest organisation offering remote prescribing services within our industry it must be no surprise to Dr. Harrison that he was targeted by an investigation such as this to highlight the issues and dangers surrounding remote prescribing of botulinum toxin products.” ”>

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