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Specialists 'dumping' risky scripts on GPs

Hospital doctors are 'dumping' prescriptions on GPs as pressure grows to stay within drug budgets, the GPC is warning.

The committee has received a series of reports of incidents where hospitals have attempted to force GPs to take on 'clinically unsafe' or off-licence prescribing. In some cases, GPs have been issued with 'badly scribbled' instructions for prescribing of secondary care drugs.

New GPC guidance sets out exactly when it is appropriate for GPs to take on hospital work, and recommends a traffic light system for shared-care prescribing (see right).

Dr Peter Fellows, chair of the GPC prescribing subcommittee, told Pulse: 'There's a feeling secondary care is trying to dump prescribing onto primary care. Many consultants have a tendency to treat GPs as housemen.

'It's sensitive because of the financial difficulties. We're wary of GPs having work dumped on them for cost reasons.'

The guidance identifies problems in all four areas of

secondary care work that can impact on GP prescribing – in-

patient discharge, outpatient requests, continuing care and shared-care agreements.

One unnamed GP in Cleveland featured in the guidance found four of six treatment

recommendations received were 'clinically unsafe' and 'contained significant errors'.

Dr John Canning, secretary of Cleveland LMC, said hospital proformas had been a problem. 'This is something we have been rather distressed by. I'd be happy to consider a request – such as with rheumatology drugs – where there was an enhanced service in place. If there wasn't I'd feel less happy.'

On some occasions GPs were being asked to prescribe drugs 'completely outside what they are licensed for', he said.

Dr Nicholas Norwell, medicolegal adviser for the Medical Defence Union, said questions from GPs about these issues were common. 'It can't be in the interests of the patient for GPs to deal with things outside their competence.'

The GPC guidance urges use of shared-care agreements, with traffic light systems to clarify which drugs GPs can prescribe. It says local enhanced services can address issues such as who is responsible for continuing care. Problems with inadequate forms should be raised with PCO leads or the hospital.

Traffic light system for shared care

• Red – drugs suitable for secondary care only

• Amber – suitable for shared care

– GP must agree via proforma to accept clinical responsibility for patient

– Agreements should clarify what monitoring is required and when further advice should be sought

• Green – appropriate for use in either primary or secondary care

• Not recommended – drugs not generally recommended in primary or secondary care, but there may be some circumstances where they can be used

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