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A pharmacist who supplied pharmacy-only medicines to patients on eBay and dispensed private prescriptions through an overseas online prescribing service without carrying out adequate risk assessments has been suspended for three months.

A General Pharmaceutical Council fitness-to-practise committee described Kaleem Ahmad’s failure to verify whether the prescriber at EU Meds Limited, with whom he entered into an agreement in June 2021, was registered in their home country and lawfully able to issue prescriptions online to UK-based patients as “reckless”.

The committee heard Ahmad, the superintendent pharmacist and a director of Richmond Healthcare (Stechford Limited), trading as A+ Pharmacy in Birmingham, failed to ensure EU Meds contacted patients’ GPs before supplying prescriptions and had measures in place to prevent over-ordering of high-risk medicines or repeat requests being supplied to patients.

During a GPhC inspection in July 2021, Ahmad provided invoices submitted to UK Meds showing he dispensed 3,629 prescriptions for high-risk medications including zopiclone, zolpidem, diazepam and modafinil. That, the committee heard, equated to between 50 and 150 prescriptions a day.

No adequate processes to verify identity of patients

The GPhC said it received “anonymous intelligence” from a member of the public who revealed “the ease with which they were able to purchase medication from EU Meds”. The medicine had an A+ Pharmacy dispensing label.

Ahmad told the inspector he started working with EU Meds in June 2021 having been approached by “a third-party introductory company” and insisted he had “done some due diligence” before agreeing to work with EU Meds.

The committee also heard that between April 1, 2021 and June 30, 2021, Ahmad supplied pharmacy-only medicines to patients through eBay without having “adequate procedures or systems in place to ensure the safe supply of the medication”.

He also failed to ensure he had adequate processes in place to verify the identity of patients and information to “assess the suitability of medication” before supply.

The committee heard suspicions were raised when the group operations manager for a company called Testerworld Ltd “became aware of unusually large volumes of pharmacy-only medicines being ordered by the pharmacy” and started an investigation.

The manager typed ‘hydrocortisone cream 1%’ into eBay and discovered A+ Pharmacy was advertising the product for sale as a pharmacy-only medicine. Further investigation revealed the pharmacy was selling other pharmacy-only medicines.

In July when employees of Testerworld visited A+ Pharmacy, Ahmad said he had “various processes in place to protect patients” including warnings and insisted “some medications had quantity restrictions”.

He also claimed a spreadsheet was “used to monitor unusual purchasing patterns” and provided information about his arrangement with eBay.  It revealed 8,884 items were sold on the platform, generating £50,803.99.

According to the committee’s report, Ahmad said a safety warning, dosage instructions and “other information that would be on the medicine packaging” was provided on eBay.

There was also “a limited SOP” in place which stated “at the end of the day, pharmacist to review list of sales and cancel any orders which have requested excessive quantities”, while Ahmad provided an “undated risk assessment for eBay/Amazon/website sale” relating to the sale of GSL and pharmacy-only medicines.

Not able to explain the triggers for his behaviour

The committee heard that on May 28, 2022, Ahmad supplied Fluconazole to a patient via Amazon despite having no information about the individual.

The committee said Ahmad breached six standards covering person-centred care, working in partnership, effective communication, professional judgement, behaving professionally and demonstrating leadership.

Two standards for registered pharmacies were also breached covering governance arrangements and delivery of services when it came to safeguarding patients, while the GPhC’s distance-selling guidance on risk assessment and management of online services was breached.

Deciding what sanction to impose, the committee said Ahmad had “to a large degree, accepted responsibility by making full admissions” and took into consideration his “apology, remorse, reflections, lack of previous regulatory concerns, CPD record, full co-operation with the investigation and the regulatory process and the changes he has made to his practice”.

That included training staff “to adopt a more risk-averse approach within the last four years”. Ahmad also assured the GPhC he had adopted new SOPs for his bricks-and-mortar business and no longer provided any online services.

However, the committee said his “insight was currently not sufficiently developed” and he “was not able to explain in sufficient detail his understanding of the triggers for his behaviour”.

The committee also said he was unable to explain “why, given his significant experience, he acted in the way he did with a disregard for safety of patients and turning a blind eye to the governance and safety aspects of his work”.