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Prescribing issues

· Only prescribe a drug or device you are satisfied you are knowledgeable about.

· A signature on a prescription means the buck stops with you. Think about that when you sign the script.

· Don't be frightened to say No. But have good reasons that are valid, evidence based and seem reasonable. Rule of thumb is that if your reasons appear in the public domain you should not be ashamed of them.

· Check to see if you are obliged to prescribe the drug and make it clear that this is on clinical issues rather than financial.

· Always have more than one prescribing reference resource available, eg the BNF or a few trusted websites such as emc.medicines.org.uk

· The rarer and more unusual a drug is, the less you should rush to prescribe.

· Writing a prescription is not an isolated event. Discuss this with the patient or at least make sure they are aware.

· Therapeutics is a complex, fast-changing area. Always make sure you are up to date. Read widely ­ it could save a lot of time and grief.

· The transfer of secondary to primary care prescribing can be a difficult field. Check on how much the patient knows. Often it can be surprisingly little. Check if there is a shared-care guideline.

· Try to find an information leaflet or disease-related leaflet that is written for the patient, as an adjunct

to a prescription. I find www.patient.co.uk fantastic for this. It is easy to print something off during a consultation.

· Does or should your practice have a policy for dealing with prescriptions suggested by third parties, such as hospitals and district nurses?

· Assuming you prescribe, what facilities are there for monitoring the patient and how will that be communicated to you, the prescriber, in a timely manner?

Communication issues

· How much does the patient know? What did the consultant tell them? How much has the patient understood? This may not be apparent from the consultant's letter and you may have to speak with both patient and consultant.

· Consult widely when facing a thorny issue such as this. A great place to start is an experienced GP, usually in the practice. It's likely they have previously faced this situation.

· There is usually a whole army of resources that you can turn to. Don't forget the PCT prescribing adviser, the local hospital drug information service, your medical defence unions and the LMC ­ and as many GPs as you can think of.

· If there are a number of phone calls to make, delegate some of them to staff such as receptionists and secretaries. Don't forget e-mail. Involve the practice manager in an incident such as this.

· Don't forget the central player in this whole drama is the patient who needs the prescription. It is essential you keep them in the picture the whole time.

· Be truthful, honest and sympathetic at all times. Remember you should be the patient's advocate.

· If communicating to non-health professionals such as MPs, you owe your patient an absolute duty of confidentiality. If you do write to the MP in question make sure your patient sees the letter, and ideally signs a written consent agreeing to send the letter to the MP and that they are happy with the contents.

Pressure on the GP

· GPs are often pressured to perform an action such as writing a prescription, making a referral or signing a form. Be calm and ask yourself, is this reasonable?

· If you feel pressurised, step back and calmly examine the situation. If necessary, stall for time to seek advice.

· Always be calm and never, ever lose your temper.

· Avoid sarcastic, cheeky or insulting comments ­ you will regret them later. Keep them to yourself.

· Don't buckle under the pressure. If you feel you are doing the right thing, stand by your principles.

· Even if a MP is involved, don't be intimidated, but seek advice.

· Don't be afraid to say No but be ready to reconsider.

Dr Harry Brown, a GP in Leeds and a trainer

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