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How I manage my business as a non-prescriber

A little bit about me, my name is Shantel Noble and my background is paediatric nursing. I commenced my level 7 qualification in non-surgical facial aesthetics in 2017 with Harley Academy. I transitioned in to full time aesthetics at the end of 2018 whilst simultaneously maintaining a bank and agency contract for security and skill updates.


When I entered aesthetics I was not a prescriber, nor was I eligible to become one. I had only been qualified as a nurse for 18 months when I entered this field. The requirements to commence a v300 non-medical prescribing course conditioned three years post registration within your profession and to have a years experience minimum in the field you wish to prescribe within.


So the question remains, how have I managed my business as a non-presciber?

It is widely known that soft tissue filler (dermal filler) remains to be easily accessible without a prescription, whereas, Botulinum Toxin is a prescription only medication so a prescriber is key for these treatments. Although filler does not yet require a prescription, there is a list of prescriptive medications that should be enlisted as part of your emergency stock prior to commencing such treatments. This is essential for your patients safety.

Firstly, I reached out on a few social media platforms and simply put the following...


'Hello, I am a nurse based in Suffolk wishing to start treating my own aesthetic clients for soft tissue filler and toxin, I am currently studying towards my level 7 with Harley Academy but a non-presciber. Is there anyone that would be happy to meet and discuss the possibility of becoming my presciber for these treatments? Thanks in advance.'

The social media platforms I used initially were the 'Harley Academy community' group, 'Aesthetic Entrepreneurs' and Aesthetics Support Group UK'. I admittedly did not have much luck due to where I lived and finding someone within a reasonable distance.

My next move was to join the British Association of Cosmetic Nurses (BACN), where they list willing mentors and I also joined Aesthetics Associates at the same time. "Aesthetics Associates is a company dedicated to connecting medical aesthetic practitioners with a network of prescribing professionals". Aesthetics Associates not only pairs you with a prescriber, but you are also able to purchase stock through them. My experience taught me this platform was good on a short term basis to get my initial emergency stock so I could commence filler treatments (I will touch upon this and the speculation it arises further down). I had to travel a fair distance for this prescriber and it is more as a one-off basis. The fees were also fairly steep in comparison to other options.


Eventually about 2 months in-to treating my own patients and after continuing to reach out to certain individuals who I admired within the industry I landed a presciber who is now not only my prescriber but also my mentor, work colleague and friend! We have continued to work together successfully for 18 months so far.



How does it work?

I run a Botulinum Toxin consultation clinic on a monthly basis, where I am joined by my presciber. Importantly, I still direct all consultations and my prescriber checks over the medical history to ensure she is happy to provide a script for each patient we see and that there are no contraindications or increased risks. On a seperate date I then independently treat each patient who has attended their face-to-face consultation. I pay a fee to my presciber per prescription she provides. I take a photograph of each of her written prescriptions (the prescriber keeps the original copy). When I come to place my pharmacy order I upload the pictures of each prescription and the prescriber is then directed by the pharmacy to send in the original prescription. On your pharmacy accounts you will need to upload your own registration and information and also include the details of your prescriber (just follow all clear instructions when creating the accounts).

The same occurs for any possible post treatment complications or adverse reactions such as a patient developing an infection. I would meet with the patient and ask my prescriber to attend for a face-to-face review to then prescribe any antibiotics or alternative required treatment. It is important to note each prescriber has their own terms and conditions some wish for a fee per script as well as fuel coverage. This process has worked seamlessly for 18 months now and although some patients do not like having seperate consultations to treatments, many wont mind and once your reputation and clientele builds patients will want to come to you regardless.


SAVEFACE (2020) state that 'Prescriptions should be appropriate for a maximum of two treatment episodes per named patient (no more than 100 units per prescription), valid for a limited time frame, and not post-dated. We have shared evidence of excessive prescriptions, blank prescriptions and lazy (not meeting BNF standards) prescriptions'.

A big ongoing debate is the grey area surrounding holding stock as a non-prescriber. The Aesthetics Complications Expert Group (ACE, 2018) released the following;

An emergency kit is essential for anyone performing aesthetic treatments as in the event of a medical emergency, there is not enough time to prescribe and order the drugs required to treat it. Although this is not a problem for doctors and dentists, this is an obstacle to nurses performing aesthetic treatments who are not able to hold stock drugs. The British Association of Cosmetic Nurses are currently lobbying to have this restriction removed to allow safer practice; however, in the meantime, nurses only have the option of prescribing these drugs on a named patient basis or working in collaboration with a doctor or dentist who can hold these medicines as stock drugs.

As with all decisions within aesthetics, discuss this with your insurance provider. The general consensus is the risk to your patient of you not stock holding to be prepared in the event of an adverse reaction outweighs the legalities of stock holding. As always remain up-to-date with guidance outlined by ACE, the BACN and the JCCP and remain transparent with your insurer.


Although some may see it as a major limitation to enter this industry with an inability to prescribe, I have found it to be the opposite. I am thankful that I required the enlisted help of a presciber, who as I said soon became much more than just a prescriber. I now value her as my mentor, someone who is there for support and reassurance, someone who role models professionalism and how to run successful clinics and someone who has educated me immeasurably. I now feel much more equipped and competent in pursuing the V300 course with underlying knowledge on medications and their interactions and protocols and management of adverse reactions.

I hope those of you who are starting out as I had, feel uplifted that although their is an initial obstacle of securing a presciber, there are many avenues to do so and once found you can continue to have a successful career within non-surgical facial aesthetics. Although recommended to complete your prescribers course when possible, it shouldn't stop your practice as long as you follow guidance and remain safe and competent.

References

- SAVEFACE (2020) 'Risks-of-Non-prescribers-in-Aesthetics', available at: link

-King.M. (2018) 'This month’s guideline: ACE emergency kit v1.2', The Journal of Clinical and Aesthetic Dermatology. 11(4), pp-61-62. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891090/


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