PDA opposes DiCE guidance on online prescribing for GLP-1 agonist

PDA has withheld its endorsement of the DiCE guidance due to concerns over patient safety

The Pharmacist's Defence Association (PDA) has raised concerns over the adoption of Digital Clinical Excellence (DiCE) guidelines for online prescribing of GLP-1 receptor agonists for weight management in adults.

This follows a clash with expert recommendations commissioned by the General Pharmaceutical Council (GPhC) as the PDA "believes the final guidance conflicts with the expert opinion underpins the GPhC’s prosecution strategy towards pharmacist prescribers under investigation."

In a recent statement, the PDA highlighted the discrepancy between DiCE's guidance and the expert report employed by the GPhC to prosecute pharmacist prescribers using a questionnaire-based consultation model.

This conflict has prompted the PDA to withhold its endorsement of the DiCE guidance as it differs from an expert report commissioned by the GPhC.

The PDA's reservations stem from the inherent risks associated with questionnaire-based prescribing.

Their concerns include the absence of patient-prescriber interaction, potential for commercial rather than clinical transactions, and the susceptibility to false information provided by patients seeking medication.

Moreover, the lack of access to patients' clinical records and failure to inform their GPs further compound safety issues.

Central to the debate is the efficacy of GLP-1 receptor agonists, which necessitate regular diet and exercise support alongside medication, elements that asynchronous models often fail to provide comprehensively.

A clinical expert consulted by the GPhC unequivocally dismissed online questionnaire-based prescribing as unsuitable for weight loss medications, citing the inability to establish a complete clinical picture or engage in meaningful therapeutic dialogue.

In contrast, the DiCE guidance acknowledges the challenges of safeguarding against misuse but refrains from prescribing specific actions to mitigate risks, leaving such decisions to individual clinicians.

The PDA contends that pharmacist prescribers operating under an asynchronous model risk regulatory action from the GPhC, highlighting the urgent need for clear guidance on online prescribing standards for improving "routine inspection, complaint, or patient safety incidents."

"Our view is that this guideline cannot be regarded as ‘best practice’ when it promotes a questionnaire-based prescribing model which is described as unsuitable in a GPhC clinical expert’s report specifically commissioned to consider online pharmacist prescribing," the PDA said.

The association has also called upon "the GPhC to issue unambiguous guidance about its expectations of prescribers who use questionnaire-based/asynchronous models to provide online prescribing services".

The DiCE network, established in March 2019, aims to bolster the burgeoning digital healthcare community in primary care by establishing benchmarks for quality, safety, and best practices.