Hundreds of nurses are risking their registration by bending prescribing rules to deliver facelifts on the cheap, Nursing Times has discovered.
The Nursing and Midwifery Council has confirmed it is aware that nurses who are not qualified prescribers have been administering injectable cosmetic medicines such as Botox as “remote prescriptions”.
The remote procedure, under which a prescription is generally issued by phone, fax or email, is designed only for emergencies. However, its use is believed to be widespread among nurses working in locations such as privately run clinics, beauty salons and nail bars.
Remote prescribing: the rules
- Only administer injectable cosmetic medicinals - including botulinum, which has trade names including Botox - after a comprehensive assessment by a prescriber who has completed a prescription or direction to administer.
- An exception in NMC standards, which allows non-prescribers to issue a repeat dose of preprescribed drugs without another assessment in “exceptional circumstances”, does not apply to cosmetics.
- The NMC states: “Should a nurse or midwife decide to administer an injectable cosmetic medicinal product from a remote prescription or direction to administer, they will be accountable for their action.”
- The advice is backed by guidance from the General Medical Council and Medicines and Healthcare products Regulatory Agency.
Source: NMC, GMC and MHRA advice
The practice has forced the NMC to clarify that the emergency exception in the prescribing rules does not apply to cosmetics. It says nurses breaching the rules can expect fitness to practise cases to be taken against them.
Nursing Times understands some salons are now looking at whether prescription consultations carried out by video would be within the rules.
A voluntary self regulation scheme for the industry is due to be launched in September. As part of that scheme, nurses found breaching the remote prescribing rules will be referred to the NMC.
Chief nursing officer for England Dame Christine Beasley has written to the NMC asking it to support the voluntary scheme and be ready to receive information about nurses breaking the rules from the Independent Healthcare Advisory Services, the private healthcare industry body which will run it.
Botox is a drug made from a toxin produced by the bacterium Clostridium botulinum. It is used in beauty treatments to paralyse facial muscles and temporarily remove wrinkles. The main risk from nurses administering the drug without the necessary prescribing training is adverse reactions that have not been anticipated as a result of a full consultation and medical history check with the recipient.
The extent of the problem is unknown because the industry is unregulated and developing very quickly. But there are estimated to be 3,000 to 4,000 nurses working independently in cosmetics, with others working for private firms or GPs.
Many cosmetic nurses are thought to be NHS nurses supplementing their income by working part time.
IHAS director Sally Taber, a former nurse, said the rules mean prescribers need to have a face to face consultation with the person receiving the injection. She said the NMC had been clear nurses relying on remote prescribing to administer cosmetic drugs could be “disciplined or struck off”, yet the IHAS had “found a lot of practice that doesn’t meet NMC standards”.
Liz Bardolph, a nurse practitioner who runs her own beauty business in Hampshire, said poor practice would only be stopped if the public demanded their practitioner was qualified and followed the rules. She said: “Most meet the standards but there are always going to be people who operate under the radar.”
Matt Griffiths, University Hospitals of Leicester Trust senior medicines management nurse, and Royal College of Nursing prescribing adviser, warned nurses against working under the emergency exception.
He said: “These rules are not there for convenience. If you are bending the rules and something goes horribly wrong, then you are going to have to answer not just to your regulator and employer, but to a coroner. And it is going to be a very hard thing to justify.”
Professor Griffiths said employers in the beauty industry should stop cutting costs and should instead train nurses as prescribers. He said: “If employers want services to be delivered they need to look at supporting their staff through training.”
Unison head of nursing Gail Adams said: “No registrant should be pressured into prescribing or administering Botox. It is a technical procedure and they should not do it without training on the technique and rules. The whole area needs tighter control.”