GPs would be in breach of their contract if they refused to issue a prescription for treatment that they had recommended, GP leaders have warned.
BMA’s GP Committee made the point in its official response to NHS England’s consultation on restricting the prescribing of 18 over-the-counter and ‘low value’ items.
The GPC’s consultation response said: ‘GPs can advise patients that treatments are available without prescription, but were a GP to refuse to issue an FP10 for treatment that they had recommended they would clearly be in breach of paragraph 14.2.2 and open to complaint and possible financial redress.
‘This would also place GPs in an invidious position with inevitable detrimental effects on GP/patient relationships. We would not support a change from the current wording unless alternative provision for NHS supply, such as through a minor ailment scheme, were provided.’
The GMS contract says that ‘a prescriber shall order any drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under the contract by… issuing to that patient a non-electronic prescription form or non-electronic repeatable prescription; or… creating and transmitting an electronic prescription’.
The GPC also said it was ‘concerned that if prescribing of medicines that are available without prescription is to be restricted, there will be an increase in prescribing of prescription-only medicines that treat the same condition, and that might result in increased prescribing of more expensive antihistamines, or analgesics/NSAIDs with worse safety profiles’.
‘This is of particular concern with regard to the increasing numbers of patients with dependence on prescribed analgesics,’ it added.
It said a blanket ban on OTC prescribing would also ‘disadvantage vulnerable patients such as older age groups, patients with capacity problems including dementia and learning difficulties, people living in poverty or those needing help from carers’, as well as pregnant women, and widen health inequalities.
Also, echoing points made to Pulse earlier this year, the GPC said the changes proposed by NHS England are too fundamental to pass decision-making onto CCGs.
The document said: ‘The right of patients to receive treatment free at the point of delivery (but subject to specific charges as defined in regulation) is a fundamental principle of the NHS, and if this is to be changed it should be done so by legislation on a national basis by those people elected to represent the population and answerable to them for their actions.
‘This is too important a change from established practice to happen on a local basis after local consultation, even if that consultation is nationally co-ordinated.’
But the GPC went on to say that some treatments, including homeopathy, should be on a blacklist of items which should not be prescribed by the NHS.
This was also the case for glucosamine and chrondroitin – food supplements that claim to aid arthritis; the antidepressant dosulepin; and the painkiller co-proxamol – which was withdrawn from the market in 2007 because of safety concerns.
The GPC is not supporting an outright ban on immediate-release fentanyl, but said the ‘extremely effective’ painkiller should be put on an ‘amber’ list of medicines which should only be prescribed in primary care for palliative care.
BMA’s stance on the 18 medicines on NHS England is proposing to restrict
Immediate-release fentanyl – should be ‘amber drug’ suitable in prescribing in primary care only for palliative patients under shared care arrangements;
Lidocaine plasters – inappropriate to deprescribe to patients with good response to treatment where other treatments were ineffective;
Oxycodone and nalaxone combination product – should be an ‘amber drug’ only prescribed in primary care for palliative patients under formal shared care arrangements;
Rubefacients (excluding topical NSAIDs).
Liothyronine – should be a ‘red drug’ not prescribed in primary care. Patients should be under the care of a consultant who should be responsible for any deprescribing. CCGs should support secondary care referral and ongoing prescribing;
Co-proxamol – or restricted to specialist prescription only;
Glucosamine and chondroitin;
Lutein and antioxidants – patients will only be taking this on advice of their ophthalmologist.
Omega-3 fatty acid compounds;
Paracetamol and tramadol Combination Product;
Once daily tadalafil;
Trimipramine – decision to seek advice from other HCP should depend on individual doctor and patient factors and not as a requirement of on-going prescribing. Consider putting it on blacklist
On the fence
Prolonged-release Doxazosin – decision to seek advice from other HCP should depend on individual doctor and patient factors and not as a requirement of on-going prescribing.
Travel vaccines – GPC wants a ‘unified system’ that is more consistent, as currently some vaccines free to patients and others not.