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GPs should only prescribe where ‘clinically competent’, says new guidance

GPs should only prescribe medicines with which they are familiar when assuming the care of hospital patients, NHS England has said.

New guidance aiming to clarify the responsibilities of GPs and other professionals involved in prescribing and commissioning across the NHS set out ways to ensure seamless shared care between GPs and consultants.

The guidance covers medicine supply and medicines optimisation, in-patient and day cases, shared care and people at risk of self-harm.

The NHS England document updates the previous guidance which was issued in 1991 and highlights GPs’ concerns over taking responsibility for unfamiliar treatment and patients having to make special trips to their GP to get a prescription immediately after a hospital visit.

The guidance said that ‘when decisions are made to transfer the clinical and prescribing responsibility for a patient between care settings, it is of the utmost importance that the GP feels clinically competent to prescribe the necessary medicines’ with full local agreement if transfers involve medicines they would not normally be familiar with.

It added there should be ‘liaison with the transferring hospital’ if ‘a GP accepts responsibility for prescribing medicines which are not usually dispensed in the community’.

Patients should also be issued with seven days supply of medicine when discharged from hospital, outpatient appointments or emergency attendance, where appropriate, it said.

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The guidance, created in partnership with clinical bodes including the BMA, stressed that ‘good professional practice requires care for patients to be seamless; patients should never be placed in a position where they are unable to obtain the medicines they need, when they need them’.

NHS England said a ‘lack of communication and understanding of responsibilities between primary, secondary and tertiary care and misunderstandings around the responsibilities involved are often cited as reasons for patients not being able to get their medicines in a timely manner, despite effective collaborative working and communication being an important part of patient-centred professionalism’.

BMA GP Committee prescribing sub-committee chair Dr Andrew Green said: ‘This work is a major step forward in clarifying the responsibilities of doctors when one is asked to provide prescriptions on the advice of another and reiterates the basic principles of good prescribing, namely that it should be done by the most appropriate clinician.’

He added: ‘For too long we have seen patients turning up at their GP’s surgery with an expectation of treatment that their GP cannot provide safely, this is an intolerable position for patients to be put in and must now stop.’

As part of the GP Forward View published in 2016, NHS England changed trusts’ standard contract to prohibit them from sending patients back to GPs unnecessarily.

But a Pulse investigation last year revealed that not a single trust had been sanctioned for breaching the new requirement despite 3,600 formal complaints made by GPs to CCGs.



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