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GMC tightens rules on self-prescribing as fitness-to-practise cases treble in two years



The number of doctors hauled in front of the GMC for self prescribing has trebled in two years, according to figures released by the regulator.

The GMC said the number of closed fitness-to-practise cases featuring allegations of self-prescribing, self-treatment or informal treatment of family and colleagues had increased from 36 in 2010 to 82 in 2011 and 98 in 2012.

The rise in cases comes as GMC guidance on self-prescribing and treatment of close family or friends is tightened up.

The latest guidance from the GMC, Good practice in prescribing and managing medicines and devices (2013), says GPs ‘must’ avoid prescribing for themselves or ‘anyone with whom they have a close personal relationship’.

It also adds that doctors must immediately make a clear record justifying why there was no other alternative, and also inform their own, or the other person’s, GP about which medicines have been prescribed.

Previous guidance only said doctors ‘should’ avoid self-prescribing and there was no requirement to inform the relevant GP.

Analysis: Accusations of self prescribing can have serious consequences

Medical defence experts warned the strengthened wording puts even greater pressure on GPs to justify their actions, or potentially face fitness-to-practise proceedings.

It comes as the BMA also published new warnings over self-prescribing earlier this month.

The GMC confirmed that the cases of self-prescribing over the last two years had resulted in 13 voluntary erasures, 10 undertakings, 12 warnings and 28 cases referred to fitness-to-practise hearings.

A further 111 cases involved giving advice to the doctors to avoid similar actions in the future. Out of the 28 cases referred to hearings, 10 resulted in suspensions and five in erasure.

The GMC said that while the guidance will only come into effect later this month, it expected that doctors to be ‘aware of’ and ‘familiarising themselves with’ the new guideline. It did not specify why it believed the number of cases had gone up but it told the BMA that it was likely related to an overall rise in fitness-to-practise proceedings.

The GMC told Pulse: ‘With regards to self-prescribing, the guidance is clear. Wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship.

‘The new guidance comes into effect on 25 February 2013, but we would expect doctors to be aware of it and to be familiarising themselves with it.’

The rise in cases statistics comes despite previous warnings to doctors that the problem was on the rise, and after a Pulse survey in 2007 found 43% of GPs self-prescribe.

A spokesperson from the Medical Defence Union said that opiates and benzodiazepines remained the most commonly self-prescribed substances among doctors, and these would be banned under the advice from the GMC that controlled drugs can only be self-prescribed or prescribed to someone close to you in order to save a life, avoid serious deterioration in health, or alleviate ‘otherwise uncontrollable pain or distress’.

Dr Claire Macaulay, MDU medico-legal adviser, said: ‘There may be rare situations where a GP considers there is little or no choice but to self-prescribe, but the GMC expects doctors to comply with the standards of good practice set out in their guidance and any GP who does chose to self-prescribe must be prepared to explain and justify their decision as a failure to do so can lead to their fitness to practise being called into question.

‘Treating friends and family should also be avoided if possible. One exception is in an emergency situation where there is no one else available, in which case a GP has an ethical obligation to provide immediate medical care to anyone who requires it.’

Dr Mary Hawking, a GP in Dunstable, Bedfordshire, said: ‘GPs can always see another GP for antibiotics – and often have odd boxes returned by patients: other disciplines not so fortunate. If there is an increase in benzos (not so easily obtained from colleagues), might the ever-increasing stress produced by the changes in the NHS for all groups of doctors be involved?’

The new guidelines

– Wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship.

– Controlled medicines present particular dangers, occasionally associated with drug misuse, addiction and misconduct. You must not prescribe a controlled medicine for yourself or someone close to you unless:

a. no other person with the legal right to prescribe is available to assess and prescribe without a delay which would put your, or the patient’s, life or health at risk or cause unacceptable pain or distress, and

b. the treatment is immediately necessary to:

i save a life

ii avoid serious deterioration in health, or

iii alleviate otherwise uncontrollable pain or distress.

 

– If you prescribe for yourself or someone close to you you must:

a. make a clear record at the same time or as soon as possible afterwards. The record should include your relationship to the patient (where relevant) and the reason it was necessary for you to prescribe.

b. tell your own or the patient’s general practitioner (and others treating you or the patient, where relevant) what medicines you have prescribed and any other information necessary for continuing care, unless (in the case of prescribing for somebody close to you) they object.

Source: Good practice in prescribing and managing medicines and devices, GMC, 2013