Remote prescribing risks

Doctors and dentists must satisfy a number of conditions before prescribing remotely.

TECHNOLOGY is becoming an increasingly prominent feature in medical and dental practices, a trend that is likely to increase further as the Government actively encourages the use of telehealth. This entails the use of devices to monitor patients at home, as well as in-practice gadgets that record vital signs such as blood pressure and weight.

A number of medical and dental patient consultations are also being made remotely, using technology such as video-link, online connections, telephone and fax. However practitioners must know the limits of such patient interactions, particularly when it comes to prescribing.

Remote prescribing is generally not encouraged but there are occasionally circumstances where it is appropriate. This might apply to rural practices, and where a delay in providing a prescription would be detrimental to patient care.

Both the General Medical Council (since July 2012) and the General Dental Council have banned practitioners from prescribing Botox and other injectable cosmetics by phone, email, video-link or fax. The GMC explains that, while remote prescribing may be appropriate in some situations, it must not be used in these instances.

Before prescribing Botox or other injectable cosmetics, the GMC instructs doctors to have face-to-face consultations with patients to ensure they fully understand their medical history and reasons for wanting the treatment.

And before prescribing any other drug remotely, the regulator requires doctors to adequately assess the patient’s condition and states they must be confident they can justify the prescription. The GMC’s Good Practice in Prescribing Medicines lists several conditions doctors must meet, including ensuring the treatment and/or medicine(s) are not contra-indicated for the patient, adding: “Where you cannot satisfy all of these conditions, you should not use remote means to prescribe medicine for a patient.”

The GDC takes a similar line, advising dentists in a statement issued in September 2011 that “remote prescribing in dentistry is acceptable in some instances but should only be used in exceptional circumstances. It should not be used in relation to non-surgical cosmetic procedures.” It adds: “Direct examination and diagnosis is preferable to remote prescribing.”

Where a dentist is seeking to remotely prescribe, the GDC says they must have appropriate indemnity cover to do so and have “an appropriate dialogue” with the patient, being sure to explain the processes involved in remote consultations and establish their current condition and history.

When remotely prescribing any drug it is important to make a clear, contemporaneous record of all care provided and medicines prescribed.

Doctors and dentists must also bear in mind that, as the remote prescriber, you retain responsibility for the appropriateness of the prescription and any potential consequences of it, whether or not you have personally spoken to the patient.

Where a practitioner is considering offering remote prescribing services, i.e. to an online pharmacy, they must ensure that, in addition to the above guidance, they are only prescribing to patients in the UK as MDDUS indemnity does not extend to overseas work.

ACTION: Always follow GMC/GDC guidance when prescribing remotely and take all necessary steps to ensure patient safety