Ensuring safe prescribing standards in the cosmetic sector: The JCCP supports NMC’s determinations on a recent Fitness to Practice case relating to remote prescribing and delegation

 

This month, the NMC Fitness to Practise Committee addressed (and published) misconduct allegations against Registered Nurse Heather Hazzard, including improper prescribing, failure to verify qualifications, and dishonesty. The Registrant admitted to all charges in a Consensual Panel Determination (CPD) agreement and did not attend the hearing. The panel, chaired by Lucy Watson, imposed a striking-off order, citing the misconduct's severity and its impact on public trust and safety.

 

The JCCP welcomes the robust response from the Nursing and Midwifery Council (NMC) relating to the expected standards when prescribing for cosmetic procedures. As a professional statutory regulator, this is an authoritative determination which we believe has important implications for safe and legal practise across the cosmetic sector. We take this opportunity to highlight several key findings in this case, reminding those who prescribe and delegate Prescription Only Medicines (POM’s) in the cosmetic sector, and those to whom the procedures are delegated, of their duties and responsibilities. This outcome should also assist those with a responsibility for enforcement in relation to public safety, including Environmental Health Officers, regarding the standards they should expect to find.

 

The JCCP has long held concern about the standard of prescribing in the cosmetic sector and the inappropriate supply of POM’s. We have engaged with the professional regulators widely and the NMC specifically to reach a consensus across all prescribing professions to identify the common ground for prescribing standards, particularly in relation to remote prescribing. The JCCP prescribing guidance (2019) has already benefited from professional regulator review, and we believe that it represents this common ground. Its focus on prescribing for cosmetic procedures provides important direction for prescribers and non-prescribing practitioners to practise safely, to protect those in their care and to avoid personal and professional sanction. It has further formed the basis of the JCCP’s engagement with the professional regulators, including NMC, with a view to restricting remote prescribing for cosmetic procedures.

 

The following determinations (italics) set out by the NMC align with the advice provided by the JCCP. We re-publish a number of key findings here, alongside the JCCP’s headline guidance, as a reminder for those dealing with prescriptions in the cosmetic sector.

 

Remote prescribing is unacceptable for cosmetic procedures

9. The consultation should take place face-to-face to allow the prescriber to examine the patient’s skin and muscles to determine suitability. The NMC’s publication entitled ‘Useful information for prescribers’ states that remote prescribing is unlikely to be suitable for injectable cosmetic treatments. The NMC’s publication is also supported by the Joint Council for Cosmetic Practitioners – Responsible Prescribing for Cosmetic Procedures -2019 (‘JCCP’) which advises that remote consultations are not acceptable, and highlights that it is good practice for face-to-face consultations to take place before prescriptions are issued.

 10. Guidance set down by the Royal Pharmaceutical Society, framework adopted by the NMC, the JCCP and the Cosmetic Practice Standards Authority (‘CPSA’) sets out their decision not to endorse or permit the remote prescribing of any prescription medication when used for specifically non-surgical cosmetic treatments.

 

The prescriber retains overarching and ongoing responsibility.

11. The JCCP states that when the prescriber delegates treatment to other practitioners, the patient remains under the oversight of the prescriber, requiring the prescriber to be familiar with the patient through an initial fact to face consultation and diagnostic assessment of the patient’s suitability for treatment.

 

The prescriber must only delegate a procedure after an assessment of competence.

13. Prescribers are responsible for the decision to supply medication and remain responsible and accountable for any prescription signed, or any subsequent adverse event or complication. Before prescribing for a non-prescriber, the prescriber has a responsibility to ensure that the non-prescriber is trained to the appropriate standard i.e., competent and proficient to administer the medication prescribed. They should do this by e.g., requesting a copy of the non-prescriber’s insurance policy and training certificate(s) for the treatment, and physically overseeing the first few treatments completed by the non-prescriber.

 

The prescriber must prescribe (and provide directions for) only what is required for the individual’s needs to meet the indications specified in the consultation.

17. Patient Specific Directions (‘PSDs’) are a legal method of prescribing and detail what a prescriber is required to do when they delegate the administration of POMs to non-prescribers. PSDs are individually tailored to the needs of a single patient and must be produced each time a prescriber prescribes for a non-prescriber. They should include information to enable safe supply and/or information of medicines and manage identified risks.

18. Prescribing nurses should only be prescribing enough medication for each individual patient. If there is leftover Botox after treatment it is permissible to retain it for use on the same patient, before expiry. Retaining Botox that has been prescribed for one patient and using it on another, and/or using single-use prescriptions for more than one patient negates the need for an additional PSD. Without a separate PSD, it indicates that the patient for whom the Botox had not been prescribed has not had the mandatory consultation with and/or assessment by the prescriber to confirm that the patient is suitable for treatment and/or if there are any contraindications that need to be managed.

 

The JCCP is familiar with prescribing platforms that serve to introduce prescribing and non-prescribing practitioners. The activity that arises from their use is found d to be too frequently the source of concern and challenge by Environmental Health Officers nationally. We remind prescribers that operate through such platforms that their first responsibility remains with their professional regulators, irrespective of the policies and procedures implemented by the platform.

 

We advise those who are concerned with the use of prescription medicines in the cosmetic sector to review the full NMC publication which includes additional detail and important information relating to, for instance, the importance of manufacturer recommendations.