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GPs go forth

Two GPs suspended for 'inappropriately' prescribing opioids online

Two GPs have been suspended from the GMC register for prescribing opioids online to multiple patients through an online pharmacy without appropriate safeguards in place.

Following a decision by the Medical Practitioners Tribunal Service (MPTS), Dr Dharson Dharmasena and Dr Edward Pooley were suspended for six and three months respectively after inappropriately prescribing opioids to patients, including those with histories of drug addiction.

There have been growing concerns over online prescribing providers handing out opioids to patients without informing their GPs or consulting their medical records.

In May 2017, the CQC referred Dr Dharmasena and Dr Pooley to the GMC regarding their treatment of a number of patients.

The GMC also received complaint letters from GPs whose patients had been prescribed opioids by Dr Dharmasena and Dr Pooley at private online companies White Pharmacy and The Online Clinic, based in the Waverley area.

The regulator accused Dr Dharmasena of failing to obtain an ‘adequate medical history’ from patients’ GP records while working at White Pharmacy.

After reviewing the evidence, the MPTS found Dr Dharmasena had referred to a patient questionnaire, filled in when patients place their orders for opioid medication.

The tribunal said Dr Dharmasena did not assess patients properly and in some cases issued 'a number of online prescriptions of opioid medication' when the drugs had 'habit forming potential'.

Dr Dharmasena inappropriately prescribed opioids such as dihydrocodeine, codeine, solpadol, and gabapentin on 14 different occasions, concluded the tribunal.

In his witness statement, Dr Dharmasena said he ‘felt that the patient questionnaires were able to capture adequate information’ and the questions were similar to what he would ask in a face-to-face consultation for him to prescribe opioid medication.

Evidence presented during the hearing included the example of one patient, identified as patient K, who was prescribed dihydrocodeine, which can cause respiratory problems and possibly even death. Their GPs’ complaint letter stated patient K has a history of depression and an addiction to prescription medication.

Dr Dharmasena also added that at the time he believed his actions were appropriate and adequate, but that he can now see why it was not. In a further statement, he continued to apologise for his actions and omissions and clarified that his intentions were ‘never to encourage medication misuse or abuse, nor to circumvent the hard work and effort of the respective GPs’.

The tribunal said: 'Dr Dharmasena can now see that his actions were wrong but he has not yet accepted that he should have known at the time that they were wrong'.

It decided there was a risk Dr Dharmasena would repeat his actions and that he should be suspended from practice with immediate effect, for six months.

Dr Pooley was also practising at White Pharmacy on an ad-hoc basis between 2015 and 2017, and for another online service, The Online Clinic.

The tribunal found Dr Pooley had inappropriately prescribed opioid medication over a 15-month period to 19 patients.

Dr Pooley was accused, along with others, of prescribing one patient, named patient P, over 20 prescriptions of dihydrocodeine before their GP was informed.

In his submission to the tribunal, Dr Pooley provided a reflective statement saying he accepted and regretted his mistakes, which ‘placed patients at risk of developing or exacerbating opioid dependency’.

The tribunal decided Dr Pooley had shown insight, that there was no significant risk of repeating the behaviour and it was not in the public interest to remove a competent GP from practice for ‘any longer than necessary’.

The GP's lawyer stated Dr Pooley no longer undertakes online prescribing and therefore there was no continuing risk to the public.

Dr Pooley will be suspended from the GMC register for three months - including a ban on issuing private prescriptions during the period - following a 28-day window for appeal, starting from 18 July.

The CQC has previously reported that online prescribing providers are ‘unsafe’, finding 43% prescribe high volumes of antibiotics, inhalers, and opioids without consulting patients’ own GPs.

The health secretary announced earlier in April that all opioid medicines in the UK will now carry addiction warnings on the labels, and a national review of addictive prescription drugs is due later this summer.


Readers' comments (24)

  • Probably no different from what many GPs do in daily practice.

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  • Reckless prescribing of addictive drugs is widespread in GP. Hopefully some of the worst offenders might change their ways following this case.

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  • You can find instances of "inappropriate prescribing" (a very loose and subjective endpoint, dependent largely on someone's attitudes to prescribing, their experience with certain medications, medical background, how they interpret a patient's symptoms as well as the pressures put on them by individual patients and the system in general) every day in general practice if you went looking for it. Government agency kangaroo court panels should have no business suspending or even issuing physician licenses.

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  • Whilst it sounds as if these GPs had room for improvement, I think if we apply the same rule to all of the GPs, most of us would be suspended.

    How many GPs will refuse opiates to COPD patients? How many will warn patient opiates could kill them? How many will fully interrogate the record from start to finish every time to ensure there are absolutely no contraindications at all??

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  • sounds like they have been made a scapegoat for practice that we all would do

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  • I think there is more to this story. What happened to supporting our colleagues when they are at the wrong end of something that could happen to any of us, rather than being judgmental? GPs need to look after each other and get off their high horse.

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  • over the top. of course avoid prescribing to addicts and inform the regular GP but if they are in pain it is hard to refuse sometimes and patients lie about their history and thats their responsibility as is getting addicted provided we inform them the meds are addictive

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  • DrMightyRed

    It would seem an inappropriately and excessively harsh outcome for one of these GPs, to have a seemingly lengthy suspension when he has shown insight and remorse continuously through this case. I echo the sentiments of colleagues above - “there but for the grace of God go we” - and feel this is another example of GMC heavy-handedness, resulting in a very able and respected GP being thrown under a bus.

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  • Nhsfatcat

    How fast would action against these GPs if they refused to prescribe at all ‘leaving the patients in distress?’
    As GP is de-funded further by allowing online access for NHS patients this issue will become more prominent.
    Is there any mention of action being taken against the organisation that these GPs worked for? Or is it the clinician being the fall-guy?

    We are having to work harder longer and faster thanks safe under increasing scrutiny to be perfect.
    9 months of these GPs expertise is now denied to the public when both have been deemed safe to work again.
    I await my turn!

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  • What about CMHT services that routinely commence patients on inappropriate addictive drugs without teling them they are addictive, and do not write to GPs, except, perhaps late, to say "we have commenced 4 addictive drugs, and now discharge the patient as they are not fitting the criteria for drug serrvices"
    At least these 2 GPs prescribed to patient already addicted!

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