The Pharmacists’ Defence Association says it cannot support best practice guidance for the online prescribing of GLP-1 receptor antagonists for weight management in adults, published by the Digital Clinical Excellence (DiCE) UK Forum, because it conflicts with an expert report commissioned by the General Pharmaceutical Council.

The Association says the report is currently being used to prosecute significant numbers of pharmacist prescribers who use a questionnaire-based model of consultation. It is calling on the GPhC to “issue unambiguous guidance about its expectations of prescribers who use questionnaire-based models to provide online prescribing services”.

The PDA has previously highlighted what it sees as the pitfalls associated with online prescribing when using a questionnaire model (also known as asynchronous prescribing) and has provided detailed feedback about this guidance to DiCE network participants.

The DiCE network was set up in March 2019 to support the growing community of digital healthcare providers within primary care, and to set standards for quality, safety and good practice. However, the PDA believes its guidance conflicts with the expert opinion that underpins the GPhC’s prosecution strategy towards pharmacist prescribers under investigation.

The PDA’s concerns about questionnaire-based prescribing include:

• In most cases, there is no interaction between the patient and prescriber
• In some cases, prospective patients can select the medicine they want at the start, making the interaction more of a commercial transaction rather than a clinical consultation
• False information can be provided to ensure a supply is obtained when the patient does not fit the supply criteria, without sufficient safeguards to detect this
• The lack of access to the patient’s clinical record means that prescribers cannot be assured that a supply is safe and appropriate
• The failure to inform patients’ GPs about the medicine that has been supplied exposes patients to potential harm
• To optimise the efficacy of GLP1-RA medicines, NICE guidance and marketing authorisations require patients to receive regular diet and exercise support and monitoring in addition to the medication – the asynchronous model can usually only provide leaflets and further periodic online supplies.

Pharmacists prescribing 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 because of a routine inspection, complaint or patient safety incident, the PDA says.

“Our view is that this guideline cannot be regarded as ‘best practice’ when it promotes a questionnaire-based prescribing model which is described as unsuitable in a GPhC clinical expert’s report specifically commissioned to consider online pharmacist prescribing.”