MPS Warns Junior Trainee Doctors To Tighten Good Practice When Administering Botox

Main Category: Cosmetic Medicine / Plastic Surgery
Article Date: 22 Jun 2009 - 1:00 PDT

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Junior trainee doctors are being warned about the medicolegal implications surrounding the administration of anti-wrinkle treatments such as Botox.

The Medical Protection Society (MPS) reports, in the latest edition of its member publication, New Doctor, that it has received a number of queries from Foundation Programme doctors about professional indemnity cover and the administration of Botox and other anti-wrinkle treatments. Junior trainee doctors - who supplement their NHS income by working in private cosmetic clinics - should take care when undertaking cosmetic treatment as the medicolegal issues involved are not straightforward.

Newly qualified doctors - ie Year 1 of the Foundation Programme - have provisional registration which means that they can only prescribe when working in a supervised NHS training post and, therefore, cannot prescribe these treatments in private clinics. Year 2 Foundation Programme doctors, being fully registered with the GMC, can prescribe outside a hospital setting. However, any doctor prescribing medication must be able to demonstrate an appropriate level of clinical experience and competence. MPS questions whether many Year 2 Foundation Programme doctors will have sufficient expertise to prescribe medications such as Botox, which are rarely encountered in an NHS setting.

MPS medicolegal adviser, Dr Chris Godeseth, said: "MPS has real concerns about whether Foundation Programme doctors should be prescribing or administering Botox and other anti-wrinkle treatments. Unlike Year 1, Year 2 Foundation Programme doctors can prescribe these treatments; however, they should ensure that they are competent to do so. We are concerned that many private cosmetic clinics may lack robust mechanisms for clinical supervision and support, and may inappropriately delegate to junior medical staff.

"The purpose of the foundation years is to gain experience in a supervised environment in specialties that will underpin your career in medicine. Foundation Programme doctors must be aware of the limitations placed upon them and, like in any job, make sure they have the suitable skills, training and competence to undertake this kind of work."

Foundation Programme doctors should bear in mind the following best practice points when considering administering Botox and anti-wrinkle treatments:

- Are you competent? The same principles apply as with any other job â€" make sure you have the suitable skills, training and competence to undertake the work. You have a responsibility to be honest about your competence and to stay within your area of expertise.

- Is it in the patient's best interests? When prescribing or administering any drug you must be satisfied that you have assessed the patient, counselled them of the risks and benefits and prescribed the medication in the best interests of that individual patient.

- Be mindful of the risks: As a doctor working outside your usual environment you should ensure there is suitable equipment at hand and that you are able to deal with any side effects or complications. It is easy to become blasé about the use of anti-wrinkle treatments but you should always be mindful of the risks, however minor.

- Check GMC guidance: Familiarise yourself with the GMC's Good Practice in Prescribing Medicines (2008), especially paragraph 5b. The guidance warns against group prescriptions and instead recommends patient specific prescriptions. The guidance also states that patients who have Botox, Vitabel or Dysport or similar treatments require an assessment of individual suitability.

- Don't just rely on your supervisor: Relying on a prescription of your supervisor or other suitably qualified practitioner does not exonerate you from responsibility of assessing the patient and their suitability for the treatment.

- Don't overstretch yourself: Make sure you do not take on too many commitments over and above those of the "day job". Over-tired doctors are at risk of making errors and this may not only impact on your training but also leads to patient safety concerns.

- Check that you have indemnity: Check that you have appropriate indemnity in place. Earning extra income outsider your NHS work - even through assisting consultants in private practice - should be appropriately indemnified.

Dr Godeseth also warned: "Foundation Programme doctors, like all doctors, should also observe the GMC's guidance. The GMC's Good Practice in Prescribing Medicines clearly states that anti-wrinkle treatments, such as Botox, Vistabel or Dysport, are not appropriate for Patient Group Directions (PGDs) and require an assessment of individual patients' suitability."

"Failing to observe GMC guidance could leave junior doctors, and their supervising doctors, vulnerable to a GMC investigation. MPS reminds junior trainee doctors that they will be judged against the GMC's professional standards in all their work, including private cosmetic practice. Any complaint to the GMC, whether with merit or not, is distressing and may compromise career progression. The doctor's employing NHS Trust and his or her consultants are notified about any complaint and it is unlikely to be helpful for a fledgling career."

"Our message to Foundation Programme doctors is to think carefully before undertaking work outside their training which involves prescribing or administering Botox and other similar treatments. Foundation Programme doctors must ask themselves if it is really worth jeopardising their careers to earn extra money when there are other valuable skills that could be pursued in those early years. "

"Members who have any queries regarding the administering or prescribing of anti-wrinkle drugs in a private setting should contact an MPS Medicolegal Adviser for advice."

Notes

1. New Doctor is published by MPS twice a year and is available on our website. The latest edition will be published on our website and sent to members in the Foundation Programme in the week commencing 15 June 2009.

2. Good Practice in Prescribing Medicines (2008) can be found here.

Source
Medical Protection Society