Posted by: First 53 March 2016
As we all know, general practice is sinking from a combination of poor workforce planning and ever-escalating workload, and yet the Government is keen to see a seismic shift of work from secondary care to primary care. NHS England has organised a series of workshops across the country helping GP surgeries to reduce their workload. The BMA has produced a document with handy template letters to try and redirect inappropriate work back to secondary care. This week I got really wound up by a cardiology nurse specialist asking me to refer a patient to a cardiologist at the same hospital. But that isn’t my biggest bugbear. My biggest frustration is: why don’t hospitals prescribe on FP10s?
Primary care has been using electronic interaction checking for over a decade. Why is secondary care allowed to continue being so dangerous?
Why should GPs face the bottomless pile of prescription requests from hospital clinics? These ‘non-urgent’ requests clearly state that the GP has up to seven days to provide the prescription, but of course patients (reasonably) want to start their new medication today. I assume this tradition is because GPs are more cost-effective prescribers than their secondary care colleagues, and the PCTs (may they rest in peace) didn’t trust secondary care clinicians to prescribe appropriately. Also, there may be a safety issue with hospital paper records being so unreliable that it’s simply not safe to prescribe any medication in case of dangerous interactions.
I am offended to be relegated to the status of a prescribing clerk for my hospital based colleagues. The solution to secondary care prescribing expensive drugs is to tackle secondary care prescribers, not outsource the task, unfunded, to GPs.
The solution to dangerous prescribing is to consign paper based prescription charts and medical records to the waste bin and instead have proper IT solutions which link to the local GP records. Primary care has been using electronic interaction checking for over a decade. Why is secondary care allowed to continue being so dangerous?
Last year, I tried to take this fight to the next stage. I contacted our CCG complaining about the single most irritating example of this: dexamethasone eye drops. As I’m sure most GPs know (from prescribing countless bottles), everyone who has cataract surgery needs dexamethasone eye drops for one month after. The hospital gives each patient one bottle. Now, if you use a pipette and have the steadiest of steady hands, one bottle may be enough. However, patients undergoing cataract surgery tend to have slightly shakey hands. One bottle doesn’t last.
So I wrote to the CCG and they asked me to audit how many times we have to prescribe dexamethasone eye drops to post-surgery patients. Within a week or two I had covered an A4 sheet with patients and I promptly shared my results with the CCG. The result? Nothing! The consultants stated one bottle is sufficient and so it is up to the GP surgeries to continue making up the shortfall.
In a practice with one patient having cataract surgery per week, this can create an hour’s extra workload per year (assuming it takes just over 60 seconds to generate a prescription). I’m quite tempted to redirect patients who run out to contact their consultant to get another prescription.
And I now know what I’m going to give my local hospital for Christmas next year: a guide on how to prescribe on an FP10.
Dr Phil Williams is a First5 GP in Lincoln, and former RCGP National Lead for the First5 initiative