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GPs are only ‘best placed’ to be GPs

Dr Zoe Norris

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Medication, medication, medication. It makes up a huge part of our job, and our increasing workload. Questions about prescriptions, repeat ordering, issuing acutes, ‘What am I taking? Should I be taking? Aren’t I taking?’

When the Daily Mail spins its ‘GP failure’ wheel, it frequently lands on prescribing. We give too many antidepressants, painkillers, antibiotics and hormones. We simultaneously don’t give enough antidepressants, painkillers, antibiotics or hormones.

We issue social prescriptions, exercise prescriptions, actual prescriptions, things we don’t really understand (stoma bags, anyone?) and things we don’t want to understand (Galsulfase? Sure no problem…)

Confused? You’re not the only one.

Come on Jeremy – stick your head above the parapet and tell patients what they can’t have

We still prescribe things patients could choose to buy themselves (although I don’t prescribe things that don’t work, so if you want to buy cough medicine, knock yourself out. At £9 a pop, I’d rather self-medicate with a different kind of bottle and one that doesn’t taste like toilet cleaner).

But now we’re being handed the unenviable task of trying not to prescribe things that can be bought over the counter.

We are – you guessed it – ‘best placed’ to have the not-at-all awkward conversation with patients: ‘You want a prescription for that? It only costs three quid in Asda. Blimey, you must be really tight.’ I don’t remember that being covered in the MRCGP.

The awful mantra ‘GPs best placed’ smacks of a complete abdication of responsibility by ministers and everyone else in the whole NHS. I’m no psychologist but I know that in this case blanket rules and population-level messages will work a hell of a lot better than an individual discussion.

When NICE makes recommendations about drugs, do members of its expert panel have one-to-one discussions with patients who will be directly affected? Aren’t they best placed to do this? Of course they don’t, they make decisions based on the available evidence. Nobody wants to be the one to say no, and if the person you’re being told to say no to is someone you’ve cared for throughout their life, it’s a damn sight harder still.

Why doesn’t someone else stick their head above the parapet for a change? Let Mr Hunt tell patients what medications they can’t have. He can’t trot out the ‘local problem’ argument; there isn’t a CCG in the country that doesn’t need cash freeing up. So come on Jeremy, show some leadership. I’m not best placed to sort out the mess you made by not funding the NHS. Just like I’m not best placed to check immigration status, repair boilers or get embroiled in issuing ‘fit notes’.

Mr Hunt could look at the simple, commonsense approach in the rest of the UK, where there are no prescription charges – although I’m some patients consult in order to get a free prescription rather than paying 26p over the counter.

But at least it allows doctors to be doctors. I’d love to have time for a bit of preventive medicine instead of patching people up and firefighting. Who knows, I might even have time to explain why cough medicines don’t work, and save everyone a bit of cash.

Dr Zoe Norris is a GP in Hull

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Readers' comments (9)

  • If politicians/DOH were really serious about the OTC meds issue then they would legislate. But because they want the blame laid at somebody else's door, they don't.
    Either they are cowards or useless b@@@@@ds.

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  • Or useless cowards?

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  • It’s worse here in NI because everybody gets free prescriptions so there is no barrier at all for patients sticking their medicine cabinet or foreign trip with a trolley load of free meds that they could buy at the local supermarket for pennies .
    Legislation is needed to ban gps from signing all scripts for GSL items!

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  • The Legislation is there, it is one of the schedules in the Drug Tarriff, anyone remember the black listing of Distalgesic, Valium, Xanax, a multitude of cough linctuses and numerous other "useless" drugs the NHS thought we should not prescribe - all they have to do is add to the list. (it might need hundreds of brands of Paracetamol etc - but that's what the admindroids are good at!)

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  • I just say you can no longer get that on prescription from the NHS. You can buy it otc. Simples. Rarely have a problem. Any rare wingeing goes over my head. Be firm and there is no problem. (Of course this only applies to otc for short term self limiting problems and hay fever)

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  • Patients who are entitled to free prescriptions should not have to buy medication which is prescribable.The NHS is meant to be free at the point of access.
    It should not be up to general practitioners to deny that freedom

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  • ... and there's no politician brave enough to stick a knife into that sacred cow

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  • I don't see the problem with this. Patients are entitled to an NHS script if you feel the need to prescribe. If the government wants to limit prescribing it can blacklist the drugs just as it did in the 1980's. I couldn't give a stuff about local initiatives

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  • bit stingey not prescribing hay fever pills. I understand re cold meds and mmoisturised for people who don't have a skin condition etc but why shouldn't people have a prescription for hay fever pills just because they can buy its not a brief self limiting condition

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