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'Why I support the Pulse Manifesto for General Practice'

The GPC prescribing sub-committee has protested that GPs were not 'properly represented' during the UK's safety review on SSRIs last year.

It has accused the Committee on Safety of Medicines of failing to recognise the expertise of the generalist GP in dealing with mental health problems.

The sub-committee said it had reacted 'with a degree of disbelief' to the guidance, which appeared to restrict prescribing of venlafaxine to specialists or GPs with a special interest in mental health.

The sub-committee has written to the CSM for clarification on the guidelines, which it said were 'not just unclear but also impractical'. The letter claimed: 'The guidance fails to fully take account of the degree of expertise in primary care.'

The CSM concluded in December that venlafaxine should 'only be initiated by specialist health practitioners, including GPs with a special interest'.

Dr Chaand Nagpaul, a member of the GPC prescribing sub-committee and a GP in Harrow, Middlesex, said: 'When you have decisions that will affect a single group to this degree it would be appropriate to widen GP input. 'Many GPs are not GPs with a special interest but have a lot of experience. There are very few GPs that hold that official title.'

The RCGP's prescribing spokesperson, Dr Jim Kenn-edy, said: 'We fully support that GPs should be able to prescribe venlafaxine. GPs are experts at managing mental health in the community, especially when you consider 30-50 per cent of our patients suffer from mental health-related symptoms.'

CSM's December review of SSRIs

Advice on SSRIs generally:

·Maintain patients on lowest effective SSRI dose

·Monitor younger patients carefully, and all patients during early stages of treatment

·Consider possibilities of adverse reactions

·When patients stop SSRIs, taper doses gradually

Advice on venlafaxine:

·Concerns exist on cardiotoxicity and toxicity in overdose

·Only specialist mental health practitioners, including GPs with a special interest, should initiate treatment

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