A pharmacist has received a four-month suspension order after a fitness to practise committee heard he had prescribed medicines outside of his competence in an ‘irrational and unsafe’ manner while working for an online pharmacy serving overseas patients.

Munawar Iqbal confessed to a number of serious breaches of the GPhC’s professional standards during a principal FtP hearing in London from May 3-9 this year. He had a part-time role working for Medimart, a company that provided him with around 7,000 overseas prescriptions a month, which he then rewrote as private prescriptions that could be dispensed in the UK.

A review by an expert witness of prescriptions written by Mr Iqbal between June and early July 2019 identified a number of serious issues. These included writing prescriptions in “highly specialised” areas such as cancer, childhood epilepsy, heart failure patients requiring careful monitoring, HIV and patients taking potentially cardiotoxic antipsychotics.

This witness also considered that in a number of instances Mr Iqbal had prescribed excessive amounts of some medicines, including medicines such as lanoxin that are potentially fatal if not monitored appropriately.

Mr Iqbal was also found to have written prescriptions for pet medicines, which may legally only be written by a registered vet.

Mr Iqbal, who was able to access some information regarding patients’ age and medical history, told an inspector he was “co-prescribing” medicines and that in his view the onus for carrying out clinical checks was on the original overseas prescribers.

Medimart acted as a “business services provider” posting these prescriptions to Stevenage-based Medix Pharmacy, which opened as a community pharmacy during the day but also operated an online pharmacy service at night. Concerns were first raised around Mr Iqbal’s prescribing during an inspection of Medix Pharmacy. 

‘Indiscriminate, irrational and unsafe’

In the words of the expert witness, Mr Iqbal “prescribed indiscriminately, irrationally and unsafely” and without carrying out the necessary clinical checks and patient monitoring.

“I would further contend that no prescriber, medical or otherwise, could fulfil all the specialist competencies required to safely and effectively prescribe the breadth and variety of medicines prescribed by the registrant,” the witness continued. There is no evidence that patients came to harm as a result of Mr Iqbal's prescribing. 

Mr Iqbal admitted to all of the allegations against him, acknowledging under cross examination that he had “no specific competence or expertise in many of the health conditions for which he issued prescriptions for Medimart”.

He said he had raised concerns with colleagues about the nature and volume of the prescriptions the pharmacy was processing, but acknowledged that he continued to work within a system that was seriously flawed. 

He said that subconsciously he had “avoided raising too many questions because I was worried that it might jeopardise my position within Medimart”.

Standards breached

The GPhC found that Mr Iqbal’s fitness to practise was impaired, and that he had breached six core professional standards, including providing person-centred care, using professional judgement and communicating effectively.

It imposed a four-month suspension, as well as an interim suspension until the sanction proper comes into force. Mr Iqbal has worked as a pharmacist in the three years since concerns were first raised against him, but has not written prescriptions during that time.

In August 2019, the GPhC placed conditions on Medix Pharmacy preventing it from undertaking any further dispensing work for overseas patients until it could show it was able to manage the risks involve and comply with regulatory standards and UK law.