The GPhC has struck off a pharmacist who, while working for a series of online pharmacies, approved huge numbers of prescriptions in less than a minute each – and who approved a prescription request for 100 dihydrocodeine tablets used in a suicide despite the presence of red flags. 

Over a 12-day hearing in July, the GPhC’s fitness to practise committee (FTPC) considered allegations against Naureen Amirali Walji, who worked remotely for three online pharmacies – UKMeds Direct, MedsOnline 247 and Medexpress – between November 2018 and May 2022, with gaps in between each role. 

At the first company she was paid £2.50 for every patient she assessed, whether or not she approved their medication request; at the second she received £5 for every request she approved; and at the last company she was paid a salary. 

The FTPC heard that Ms Walji, who became a pharmacist independent prescriber (PIP) in 2018, had approved huge numbers of prescription requests in short timeframes, with data from her role at MedExpress showing that 78 per cent of the prescriptions she issued were processed in under a minute. On one day she was found to have approved 39 prescriptions for drugs including zopiclone, naproxen, codeine and pregabalin in 13 minutes, the equivalent of one every 36 seconds. 

GPhC lawyers argued that it was “impossible” to complete all the appropriate steps in that time, such as checking a patient’s clinical background and contacting them or their GP regarding the prescription request if necessary. 

Similarly, while working at Medexpress for just over a month in early 2020 she prescribed or approved 16,140 prescriptions, including some for medicines that require ongoing monitoring. 

The FTPC was presented with evidence concerning a number of individual patients, including one identified as Patient 4, who was described as having had a history of suicidal thoughts and opioid dependency.  

On May 24 2019, Patient 4 died as a result of mixed drug toxicity with alcohol shortly after Ms Walji had approved a prescription for 100 dihydrocodeine tablets – despite the patient having obtained drugs from UK Meds “on eight prior occasions”. Records did not show that any attempt was made to contact the patient’s GP regarding the request. 

Other patients cited in the hearing included Patient 5, a 16-year-old girl who used ibuprofen supplied by UK Meds in a suicide attempt. Ms Walji said the patient had identified herself as over the age of 18 and that there were no clinical notes on her file raising concerns.

There was also an allegation of dishonesty with regard to a patient identified as Patient B, for whom Ms Walji prescribed Co-codamol despite her knowing the patient’s GP had previously refused this. Documents that Ms Walji provided to the GPhC outlining her rationale “set out a much more detailed consultation” than she actually recorded at the time of prescribing, which the GPhC’s lawyers described as “actively attempting to deceive her regulator”. 

GPhC lawyers argued that the number of prescriptions issued by Ms Walji at all three pharmacies and the pace at which she had prescribed them showed she was “operating in a wholly transactional manner which was unsafe”. 

Asked why she prescribed in this why she said “it was a model widely in practice at the time” and that she “relied on doctors and other pharmacists who had drafted the questionnaire and SOPs”. 

She “maintained throughout that at UK Meds she did read and consider each questionnaire, though she accepted she did not do so at MedExpress”, according to the GPhC report of the hearing, which added that she “accepted that her actions had in part led to serious consequences for patients, including in the case of Patient 4 contributing to his death” – something she described as “horrific”. 

Ms Walji admitted to the majority of the allegations against her, but denied that her approach to prescribing has had been motivated by financial gain over and above patient welfare, as well as a desire to please employers such as those at UKMeds, who over the course of the hearing were described as “mean” individuals who have “swanned off to Dubai” since concerns were raised about their business model. 

Although Ms Walji has undertaken remedial steps since the offending behaviour, including completing training courses and shadowing senior pharmacists, the FTPC found that the concerns relating to the public interest and public confidence in the profession were too great to allow her to go on practising. It decided to remove her from the register and impose interim conditions barring her from working as a pharmacist during the 28-day appeal period.