For nurses who have or who are contemplating undertaking botox training and have not completed the V300 nurse independent and supplementary prescribing course, an understanding of how to obtain prescription only medicines (POM) such as BOTOX® and Azzalure® for your clients is important.

If you work within the same legal entity as a doctor, dentist or independent nurse prescriber, they can supply you with stock in advance.  If you are self employed and use a prescriber from another company, you are then not within the same legal entity and therefore cannot receive stock in advance.  In the case of wholesale stock, where the product has not been dispensed from a private prescription, VAT becomes payable on the POM, which will have to be factored into the cost to the patient.

If you are self employed the only way to receive a supply of botox is if it is prescribed on a named patient basis.  In this instance, the prescriber will need to undertake an assessment of the patient before the POM is dispensed by a pharmacy.  The law surrounding medicine dispensed on a prescription means that it can only be used on that particular patient, if you multi use the vial you are breaking the law. The only POM that can be multi used is wholesale stock. 

The same rules apply in hospital wards, during a drug round a nurse will administer medication that has been prescribed on a drug kardex or drug chart.  The nurse will take the medicine from the drugs trolley filled with containers that do not have a pharmacy dispensary label on it, this is wholesale stock, which can be dispensed to multiple patients.

If you have completed the independent nurse prescribing course and are self employed you cannot receive wholesale stock and need to write private prescriptions for each client you see.  If however, you work within the same legal entity as a doctor you can be supplied with and prescribe from stock accordingly.  This method of prescribing reduces product wastage as any prescribed botox that is not used for each patient needs to be discarded in an appropriate manner.

After the airing of BBC 3’s Botox Britain, the researcher contacted Cosmetica Training as they perceive us to be a reputable company who will work with them to provide information on important legislation within the industry.  Cosmetica always welcome the opportunity to assist in reliable, informative documentaries to allow information to be imparted to the public which will enable them to make an informed decision on who they go to for their botox injections.

Due to the time scale of the information that was required and the approach that the new documentary was taking, we were unable to assist and suggested alternative contacts.  The theme of the interview changed from “Botox gone wrong” to Nurses face being struck off the register for administering Botox.  The change was due to the apparent lack of coverage of this topic in light of new NMC changes.  We were pleased to inform the researcher that we have not seen any cases of Botox going wrong as our tutors are all highly experienced, all the delegates we train are all medically trained and during the practical sessions are all closely supervised to ensure their injection technique is undertaken safely and accurately.

The 5 Live interview featured a nurse who asked to remain anonymous stating that she had utilised remote prescribing and had to change her practice accordingly, although did not agree with the new NMC guidelines.  Also featured were Sally Taber from the government’s self regulatory body, IHAS and Dr Mark Harrison a remote consultation service provider.  Sally was in favour of the new guidelines and Dr Harrison opposed them, however stated that it will have an impact on his business.

Sally reported how the GMC are to release new guidelines also to clarify its position on remote consultations for botox treatments.  We can only assume currently that they will concur with NMC guidelines from the information Sally was giving.  We were astounded to hear that the nurse thought it was not as safe for a nurse prescriber to administer botox.  The university level V300 qualifications is intense and covers all aspects of law, pharmacology, takes 6 – 8 months to complete and has a pass requirement of 80% rather than the usual 40% pass rate.

Whilst Sally may not have chosen the most appropriate arguement in support of face to face consultations, to ascertain asthma, we agree that face to face consultations are more appropriate as you can see whether the patient has any muscular atrophy, undiagnosed dermatological conditions or infections in the area and will enable the prescriber to make an informed decision on what is the most appropriate dose for the nurse to inject.  It seems to be a little known fact that if the nurses tells the doctor what he/she is going to inject then the nurse is making an illegal prescribing decision.

Whilst the interview highlighted sensationalised concerns, it is true that if a nurse acts outside of NMC guidelines they do face disciplinary action which could include being struck off the register.  A nurses’ condition of registration is to ensure the safety of the public and to work within all the legal and NMC guidelines.

Cosmetica has written to the NMC asking 8 specific questions on non prescribing nurses who administer botox, we will publish their answers when they are received.

We are currently experiencing a BT landline problem. If you are unable to connect to our 0845 number please e-mail us on info@cosmeticatrainingcourses.co.uk.

They have assured us that the problem on the line, external degradation of the underground wires, should be fixed by 3rd May due to the forthcoming bank holiday.

Botox injections are becoming more popular and are no longer seen as the treatment that only the stars can afford. With its increasing popularity, is there a sudden downfall in standards associated with this?

The first thing we saw was a rise in the number of Botox parties being offered, beauty therapists entering the industry, closely followed by mobile practitioners and mobile therapists offering treatments in the” comfort” of your own home. District nurses offer medical treatments to patients when necessary however, Botox treatments are a cosmetic medical procedure that seems to be seen as a treatment that does not require a clinical environment to healthy, mobile patients. With this association we are now increasingly seeing the presence of cheap Botox being illegally advertised along with a ridiculous pricing structure.  £40 per area on a voucher website, £75 an area in a barber shop in Liverpool, £200 for 3 areas in Manchester city centre all undertaken by practitioners who have trained to undertake this procedure. Cosmetica charge cost price of £40 for each area to models requesting treatment from delegates in a training environment, however, we do not intend to make a profit margin from these treatments and we would question the qualifications and experience of those offering cheap Botox treatments as part of a business venture.

With everything that is happening within the medical aesthetics industry we were intrigued to hear about a BBC documentary researching for a programme about Botox.  It was quite disturbing to see adverts appearing on forums asking for people aged 18 – 25 who have Botox. This is an age group that obviously do not need these treatments and we feared the route this programme would take would be one showing the industry in a bad light.

There was a young girl who had received poorly injected lip enhancement along with unnecessary Botox injections, a woman who lost her house after choosing to pay for treatments, a lady who had unfortunately encountered problems with permanent lip implants that we now know occur, a beauty therapist who shockingly injected her 15 year old step daughter with Botox and a presenter who sought the advice of a respected aesthetics doctor. The presenter decided to have some time with the doctor away from the cameras and emerged from the clinic room stating it was not a treatment that was for her at this time, yet she had rather suspicious swelling and erythema in an area that is frequently injected with Botox. Of course it is her prerogative to keep whether she had treatment confidentially or not.

It was very disappointing that the presenter chose to not explore the illegal nature of the beauty therapist. No sane prescriber, be it a doctor, dentist or nurse would prescribe Botox for a 15 year old child, so we can only assume that this therapist had Botox that had been prescribed for another patient and used this to treat her step daughter. This action is illegal as it is seen as theft. No consultation would have occurred so the therapist would have decided on the dose that again is illegal. She could face imprisonment or a large fine as making a prescribing decision when you are not legally allowed to is a criminal offence. The legislation regarding prescription only medicine is very clear. If you are not allowed to prescribe anything before undertaking Botox training then this will automatically be the case after completing a Botox course regardless of your initial qualifications. We have contacted the BBC to ascertain who this beauty therapist was, who her prescriber was and why they chose not to cover the illegal aspect of her decision-making. We have yet to hear from them although will update our blog accordingly.

The most pleasing aspect of this documentary was the section with Andy Pickett who highlighted the concerns of non authentic Botox and dermal fillers that are available to purchase over the internet.  Botox is a prescription only medicine and as such needs to be prescribed by a doctor, dentist or independent non medical nurse prescriber.  If such products can be purchased from a website claiming to be a pharmacy then they will not be authentic, sterile or safe products suitable for injection.

The same researchers are recording a further documentary being aired on BBC Radio 5 Live, so it will be interesting to see the course that is taken with this programme.