An 'outstanding' Northampton GP has been placed under disciplinary conditions after getting caught up in an online pharmacy service which saw him unwittingly prescribe hundreds of opiates to vulnerable patients.
Dr Dalveer Samra, who currently practices as a GP in West Northamptonshire, admitted his misconduct at a tribunal held by the Medical Practitioners Tribunal Service (MPTS) which concluded on January 18.
This came after the General Pharmaceutical Council (GPC) made a surprise inspection of an online medical company, with which Dr Samra had been 'employed' as a contractor from the Medical Independent EU Consultants and Physicians between the end of July 2018 until October 2019.
It found that the company, whose directors were relatives of Dr Samra, was not meeting several key standards required of online pharmacies in the UK. This despite them assuring Dr Samra they were, the tribunal heard.
Infractions included not checking the identities of patients properly, allowing them to choose their own medications and working with a prescribing service that 'deliberately avoids registration with UK regulators by being based in Romania'. That left them unable to be sure if the prescriptions were 'safe'.
Following this, the tribunal found that Dr Samra himself had issued 24 prescriptions of potentially 'dangerous' opiates to 17 patients, without checking important details about them first.
These included not checking their medical histories, the patient's consent to treatment, the state of their mental health and more.
All of this was done online without Dr Samra ever meeting the patients in question.
Andrew Lewis, the MPTS tribunal chair, wrote: "There came a time when Dr Samra ignored the risks inherent in what he was doing.
"He accepted the assurances of the directors rather than seeking confirmation for himself and did not look at the vulnerability of the whole system to abuse, even when the business model did not provide for direct contact with patients and only communication through the administrative staff if he needed further information.
"The sheer volume of his work made it almost impossible for Dr Samra to fulfil his obligations as a prescribing doctor. He continued to work nine sessions as a GP and his colleagues, who are all supportive of him, noted that he did not cut back on his work for the practice.
"He told the tribunal that on some days he was signing over 100 prescriptions so that he was only able to spend a minute or two on each during the early morning or late in the evening. He received between one and two pounds for each prescription he signed.
"Dr Samra accepted in evidence that he signed at least 28,000 prescriptions in about 14 months and the Tribunal concluded that he was not able to give those prescriptions the time they needed, particularly when he was prescribing drugs where particular caution was required and to patients he had never met.
"The way he worked made it extremely likely that that prescribing of the sort that gave rise to the allegation would occur."
However, Dr Samra received near-unanimous support in every other part of his practice.
He had an 'unblemished record' both before and since the incident. His work was also described as 'nothing short of exceptional' by Mr Rayner, the director of a care home where Dr Samra treated patients.
The doctor was found to start working for the company with 'good intentions', being assured that they were compliant with the law 'top to bottom'. He also offered multiple improvements to the online service to improve patient safety.
While he likely trusted his relatives too much, the tribunal found that he was not likely to repeat this behaviour.
As such they placed him under conditions designed to better educate him in the management of pain, as well as to monitor him to ensure no similar incidents happen again.
These conditions will apply for 12 months.