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GPs should only prescribe where 'clinically competent', says new guidance

GPs should only prescribe medicines with which they are familiar when assuming the care of hospital patients, NHS England has said.

New guidance aiming to clarify the responsibilities of GPs and other professionals involved in prescribing and commissioning across the NHS set out ways to ensure seamless shared care between GPs and consultants.

The guidance covers medicine supply and medicines optimisation, in-patient and day cases, shared care and people at risk of self-harm.

The NHS England document updates the previous guidance which was issued in 1991 and highlights GPs’ concerns over taking responsibility for unfamiliar treatment and patients having to make special trips to their GP to get a prescription immediately after a hospital visit.

The guidance said that 'when decisions are made to transfer the clinical and prescribing responsibility for a patient between care settings, it is of the utmost importance that the GP feels clinically competent to prescribe the necessary medicines’ with full local agreement if transfers involve medicines they would not normally be familiar with.

It added there should be ‘liaison with the transferring hospital’ if ‘a GP accepts responsibility for prescribing medicines which are not usually dispensed in the community'.

Patients should also be issued with seven days supply of medicine when discharged from hospital, outpatient appointments or emergency attendance, where appropriate, it said.

The guidance, created in partnership with clinical bodes including the BMA, stressed that 'good professional practice requires care for patients to be seamless; patients should never be placed in a position where they are unable to obtain the medicines they need, when they need them'.

NHS England said a 'lack of communication and understanding of responsibilities between primary, secondary and tertiary care and misunderstandings around the responsibilities involved are often cited as reasons for patients not being able to get their medicines in a timely manner, despite effective collaborative working and communication being an important part of patient-centred professionalism’.

BMA GP Committee prescribing sub-committee chair Dr Andrew Green said: ‘This work is a major step forward in clarifying the responsibilities of doctors when one is asked to provide prescriptions on the advice of another and reiterates the basic principles of good prescribing, namely that it should be done by the most appropriate clinician.’

He added: ‘For too long we have seen patients turning up at their GP’s surgery with an expectation of treatment that their GP cannot provide safely, this is an intolerable position for patients to be put in and must now stop.’

As part of the GP Forward View published in 2016, NHS England changed trusts’ standard contract to prohibit them from sending patients back to GPs unnecessarily.

But a Pulse investigation last year revealed that not a single trust had been sanctioned for breaching the new requirement despite 3,600 formal complaints made by GPs to CCGs.

 

Readers' comments (10)

  • 7 days!

    If the nhs was interested in safety and had a clue about real life practice it would issue 14 days.

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  • Why not 28 days? one ‘box’ and time for reports and information to crawl it’s way to us and allow us to try and fill in the gaps on the incomplete discharge summaries.
    Let’s stand up for ourselves and our patients for once, 7 days of meds is nothing on the grand scheme of getting sorted out once discharged. Unless it is believed we are simply sitting waiting to do the work, otherwise twiddling our thumbs....?!

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  • More guidance from people who are not doing the job and recycling old messages. Like we really need this.

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  • my patients won't wait 40 mins at the hospital pharmacy to.get 28 days of an outpatient script.they certainly aren't going to do it for 7 days worth especially if not exempt

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  • 7 days LMFAO. who do they think they are ha ha

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  • Well, I only refer patients when I do not feel competent to handle their conditions myself, so by definition I am not competent to prescribe medicines they have been issued in hospital. Therefore I should not sign any.

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  • much better than most NHSE documents.
    I will be happy to say no until the CCG agree to pay for my time

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  • i'll just change all my patient's repeat meds to 7 days and see how that pans out.

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  • Hang on - guidelines are totally contradictory, and will get us into trouble with GMC and CCGs.
    GMC guidance says we must 'cooperate with our consultant colleagues', which means we MUST issue prescriptions for them when they demand it - which I think is silly.
    Some hospital doctors don't even know what medicines are available from community pharmacies on FP10s.
    Also, NHS regulations and GMS contracts require GPs to issue prescriptions on (an FP10 or country equivalent) for anything that is necesary for their treatment.
    We CANNOT WIN, you can ONLY do it wrong!

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  • 7 days utterly laughable!
    The only way things will ever change is if we stand up and say NO-you are the specialist, you recommended this rx, you prescribe it.
    When the patient has been reviewed by you and stabilised we will take over prescribing.
    Do you think secondary care's over 90% of NHS budget can run to you doing that?
    Or should this come out of our 7% of NHS budget?

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