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CPD: Hot topics in prescribing – part 1

Learning Objectives

To update you on:

  • Prescribing issues for patients who are transgender
  • Regulatory changes for women of child-bearing potential who are taking valproate
  • Prescribing in pregnancy and breastfeeding


Dr Toni Hazell is a GP in North London

Prescribing medicines is an important part of what we as GPs do all day and yet it is a long time since most of us studied pharmacology at medical school. Prescribing is a key responsibility of doctors and some other healthcare professionals (such as nurse practitioners and clinical pharmacists) and it is important to keep up to date about which medicines can do harm as well as good. Adverse drug reactions (ADRs) are common and are thought to be the cause of at least 3% of hospital admissions1; they can be predictable or idiosyncratic, immediate or delayed. This module will discuss some hot topics in prescribing, including GMC or other regulatory advice when relevant.

Case Study 1 – Miss P

Miss P is a 30 year old trans woman. She is biologically male and first presented to you around 18 months ago to tell you that she identifies as female. You have referred her to a gender identity clinic (GIC) and have been supporting her with mental health issues while she remains on their long waiting list. Her first appointment there is still six months away. She has come to see you today to tell you that she has been buying oestrogen on the internet but is concerned about the safety of her supply – would you consider prescribing before she sees the GIC? You are aware that this is known as a bridging prescription.

Which of the following is true about bridging prescriptions?

  • Prescribing for a patient who has not seen a GIC specialist should never be done
  • Prescribing for a patient who has not seen a GIC specialist can be done under certain parameters laid down by the GMC
  • There are only two preparations of oestrogen which are licensed for use in trans women and so one of these should be used if you do prescribe
  • The BMA has stated that GPs are obligated to provide a bridging prescription if the patient is suicidal

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