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A pharmacist who acted as independent prescriber for two online pharmacies has been struck off after a regulatory fitness to practise (FtP) hearing that found he routinely approved prescriptions without adhering to relevant guidance, including signing off on numerous prescriptions of modafinil for off-label uses. 

The General Pharmaceutical Council’s FtP committee made the decision to remove Shaeeb Ali from the register following a remote hearing that considered allegations he had made unsafe prescribing decisions while working as clinical lead at UKMeds and as the sole prescriber at MedsOnline247.

Mr Ali was found to have approved approximately 76,096 prescriptions while working at UKMeds between May 2019 and March 2022, more than 16,000 of which were for high-risk medicines or drugs that require ongoing monitoring. 

In some instances, he was found to have approved prescriptions based primarily on the answers provided by patients through online questionnaires, without adequate efforts being made to verify medical histories.  

As well as looking at his prescribing activity in the round, the hearing also focused on a number of individual cases.

These included one instance in 2019 where Mr Ali was found to have prescribed zopiclone and codeine to a patient with a history of “poor mental health and/or opioid dependence” without obtaining adequate information about the patient’s health before prescribing. 

The committee said: “All of the circumstances individually and cumulatively should have alerted Mr Ali to the possibility of medication dependence or misuse.” 

Similar findings were made with regard to another patient who was prescribed 100 codeine tablets in June 2019 despite having placed “six previous orders” with UKMeds between March 2017 and May 2019. 

Mr Ali was also approved amitriptyline for a MedsOnline247 patient who declared they shared the medicine with their wife, without querying this and despite the patient’s GP having refused. 

There were also several findings of off-label prescriptions for modafinil while Mr Ali was working at Meds Online 247, for example patients being prescribed modafinil for ADHD, multiple sclerosis, chronic fatigue or sleeplessness. 

He also failed to ensure appropriate pre-treatment resting in the form of an electrocardiogram took place before prescribing modafinil, and to have prescribed the drug to a patient whose GP had refused to do so. 

A witness who assessed the prescribing data told the committee: “I have been a GP for over 30 years but do not feel competent to initiate medicines for conditions such as sleep apnoea, ADHD or MS. I rely on my secondary care colleagues to initiate patients on some medications and need them to review dosage, frequency and monitoring requirements.”

The FtP committee found that Mr Ali’s approach to prescribing was “transactional” and “characterised by approving a large volume of prescriptions”.  

Mr Ali acknowledged there were “significant shortcomings” in his prescribing practice but argued his fitness to practise was not impaired, explaining that the online sector was “rapidly evolving” at the time in question.

He said that in the last four years, during which time he has been suspended, he has reflected and now has “improved judgement,” meaning there would be “zero risk of repetition”. 

But the committee found his misconduct was “extremely serious” and showed “persistent disregard for fundamental principles of prescribing” as well potentially exposing members of the public to “the highest level of harm”. 

It also found the behaviour was “attitudinal” as Mr Ali “continues to attribute his behaviour to the systems, companies, the GPhC and the regulatory setting” without explaining what caused him “to abandon the fundamental principles of the profession”. 

The committee concluded that “the only outcome that could adequately protect the public was that of removal”. 

Related: Pharmacist who oversaw prescribing of 85,000 drugs without safeguards can continue practising

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‘Dishonest’ online pharmacist who issued prescriptions in under a minute struck off