BMA leaders back GPs declining to prescribe specialist medication
Doctor leaders have voted in support of GPs declining to prescribe specialist medication in certain circumstances, including if initiated by non-prescribers, and demanded electronic prescribing is rolled out across the UK.
At their annual representative meeting (ARM) in Liverpool today, BMA leaders passed a motion arguing that requests from secondary care clinicians asking GPs to initiate medications for them ‘carry an increased risk’.
BMA leaders voted in favour of supporting GPs in declining ‘all initial prescriptions requested by secondary care non-prescribers’ as they should be prescribed within the speciality or specialist service.
They also voted in favour of motions demanding the BMA to lobby the Government for full reimbursement of national insurance increases as a result of the autumn Budget, and for a new regulator and statutory register for all NHS managers, including practice managers.
The motion on specialist prescribing supported GPs in declining the prescribing of specialist indicated medication ‘unless and until there is adequate evidence that the patient has been safely counselled’, and the medications initiated, titrated and the patient stabilised.
Proposing the motion, YOR LMC medical secretary Dr Brian McGregor said: ‘From a general practice perspective, it is a workload transfer – a decision is made in a secondary care service, and then a responsibility is passed to a general practitioner to actually initiate and generate the prescription. And it carries an increased risk.
‘GPs should be supported to decline that secondary care work. If it’s a non-prescriber, if they’re a registered professional they can do a prescribing course.
‘There’s no reason you should have a non-prescriber advising prescribers or telling prescribers do particular prescriptions.’
He said that the solution to this is electronic prescribing and that there is ‘no reason for it not to go ahead’ since the software is available.
Liverpool LMC chair Dr Annie Farrell, who spoke in favour of the motion, said that it is ‘mad’ that the Government is talking about AI in healthcare and ‘analogue to digital’ when ‘we don’t even have the basics of a working IT system in secondary care’.
She added: ‘Electronic prescribing from hospital clinics must be mandated. It would save endless inappropriate transfers of work into general practice and make access to medications much better for patients.’
Speaking against the motion, Dr Jenny Day, a psychiatrist from Cornwall, said: ‘I think recently, working with GPs has become more difficult as both their resources and our resources have declined.
‘If I am again to prescribe – because I have come from a time when I did do all my own prescriptions, often blind, not knowing what other medications the patients were on or what other conditions they had, which is obviously risky for the patients – electronic prescribing is absolutely essential, but it mustn’t be just any sort of electronic prescribing. It must link with the GP prescribing.’
Stockport GP Dr Zahra Youssef, also in favour of the motion, said: ‘We’re seeing a worrying trend towards de-doctorification of the NHS with little regard for medicolegal and patient safety implications. GPs are left trying to navigate this minefield.
‘They are asked to initiate medications by clinicians who lack prescribing competencies, and often it’s not clear who that person is, what their position is, or even who their supervising consultant is. It’s a ludicrous situation.’
This morning, BMA representatives also voted in favour of lobbying the Government for ‘appropriate reimbursement’ for current cost increases relating to increases in employers’ national insurance contributions.
They also called on the BMA to lobby the Government for ‘an immediate exemption’ for all general practices to increases in NICs, which the GPC had already called for following the Budget.
Cardiff GP Dr Om Aggarwal, who proposed the motion, said: ‘General practices in crisis. We face mounting pressures from every direction, excessive workload, difficulties in recruitment and retention, and a growing demand that far exceeds our capacity.
‘And now we have been hit with another blow, increases in employers National Insurance contributions imposed on us without any additional funding.
‘We are repeatedly told that general practice is an essential part of the NHS, yet when it comes to funding and cost pressures, we are treated differently.
‘Every unfunded increase attacks our already limited resources, damaging our ability to retain staff, sustain services and stay afloat.’
The conference also demanded a new statutory register is ‘promptly formed’ for all managers, as well as a separate regulator, ensuring ‘adequate training and revalidation is completed to perform these roles to a demonstrable standard’.
It also voted in favour of a ‘robust investigatory and tribunal service’ to be established, which may erase managers from the register to ‘protect the public and NHS’ from acts including but not limited to: misconduct, incompetence, negligence, and failure to staff healthcare facilities safely.
In his speech at the ARM this morning, the BMA’s chair of council called for a new professional regulator for doctors, arguing that the GMC is failing to support doctors and patient safety.
The motions in full
Motion by CONFERENCE OF LMCS: That this meeting believes that secondary care clinicians asking GPs to initiate medications for them is a transfer of workload and carries an increased risk and:
i) supports GPs in declining the prescribing of specialist indicated medication unless and until there is adequate evidence that the patient has been safely counselled, and the medications initiated, titrated and the patient stabilised;
ii) supports those GPs in declining all initial prescriptions requested by secondary care non-prescribers as they should be prescribed within the speciality or service;
iii) mandates GPC UK to explore all options for the data flow of outpatient medication advice and prescribing, including the option of automating the “writing back” the medication prescribed in secondary care, into the GP / primary care records;
iv) demands a roll out of electronic prescribing to all prescribing organisations across the UK PASSED IN ALL ITS PARTS
Motion by CARDIFF AND VALE OF GLAMORGAN DIVISION: That this meeting believes that increases in employers’ national insurance contributions threaten the viability of general practice. It calls on the BMA to:
i) lobby the Government for an immediate exemption for all general practices to increases in employers’ national insurance contributions;
ii) lobby the Government for appropriate reimbursement for current cost increases relating to increases in employers’ national insurance contributions. PASSED IN ALL ITS PARTS
Motion by RESIDENT DOCTORS CONFERENCE: That this meeting recognises that NHS and broader healthcare managers including those in non-clinical roles (hereafter referred to as “managers”) should have a responsibility to enable delivery of safe and effective healthcare provision, and at present make decisions that significantly impact upon the public’s health and wellbeing with relative impunity. It also recognises that resident doctors are often put in high-risk positions through dangerous staffing practices by managers and through contraventions of their working rights and terms and conditions. We therefore insist that the BMA lobbies relevant stakeholders, including lobbying for legislative change, to ensure that:
i) a new statutory register is promptly formed for all managers not on the medical or dental registers; PASSED
ii) a new and separate regulator is formed for all such managers so as to constitute the requirements of statutory regulation, including ensuring adequate training and revalidation is completed to perform these roles to a demonstrable standard; PASSED
iii) it would become an offence to perform in these manager roles whilst not registered; PASSED
iv) a robust investigatory and tribunal service is established, which may erase managers from the register to protect the public and NHS from acts including but not limited to: misconduct, incompetence, negligence, and failure to staff healthcare facilities safely; PASSED
v) managers are appropriately scrutinised, and held directly accountable for their actions in post by a regulatory body and the public whom they serve; PASSED
vi) the CQC or another appropriate body directly determines the definition of safe staffing levels in hospitals and healthcare settings to which managers must adhere; TAKEN AS REFERENCE
vii) significant penalties would be incurred by managers who do not take reasonable steps to ensure safe staffing, including adequate recruitment, use of bank or agency staff, and where required, closure of units and facilities. PASSED
Source: BMA ARM
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