Updated GMC guidance limits remote prescriptions of controlled drugs

Doctors should avoid remotely prescribing controlled drugs unless they have access to a patients’ records, according to new GMC guidance.

The guidance, published today, is aimed at supporting doctors who are increasingly seeing patients via remote and virtual consultations.

The guidance makes clear that ‘the same standards remain’ when prescribing remotely as they do when seeing patients face to face – including being satisfied that adequate assessments have been made and establishing a dialogue.

It also toughens up advice on information sharing, stating that it ‘may be unsafe to prescribe’ where a patient refuses consent to share information with other relevant health professionals.

However, the main change centred on the prescribing of controlled drugs. The new guidance says: ‘If you don’t have access to relevant information from the patient’s medical records you must not prescribe controlled drugs or medicines that are liable to abuse, overuse or misuse or when there is a risk of addiction and monitoring is important.’

The exception is when no other person with access to that information is available to prescribe ‘without unsafe delay’ and it is necessary to ‘avoid serious deterioration in health or avoid serious harm’ or ‘ensure continuity of treatment where a patient is unexpectedly without access to medication for a limited period’.

Theguidance also highlights new advice for doctors prescribing remotely with patients in nursing homes or hospices.

It states that ‘you should communicate with the patient, or if that’s not practicable, the person caring for them, to make your assessment and to provide the necessary information and advice’. 

It adds: ‘You should make sure any instructions, such as how to administer the drug or monitor the patient’s condition, are understood. And you should send written confirmation to them as soon as possible.’

The updated guidance advises that before prescribing remotely to patients who are overseas, GPs should consider how they or another healthcare professional will monitor their condition and ‘differences in a product’s licensed name, indications and recommended dosage’. 

GPs should also consider whether they have adequate insurance and indemnity arrangements to cover their practice overseas and regulatory membership requirements, it adds.

GMC medical director Colin Melville said: ‘We understand the particular pressures GPs face as the pandemic continues and the vaccination programme is rolled out across the UK. GPs are increasingly using remote technology, but the principles of good practice apply whether a consultation is face to face or by phone or video. 

‘We hope this guidance will support GPs as they continue to care for their patients in these incredibly challenging times.’

Following the announcement of the guidance, the Medical Defence Union (MDU) has advised its members to ‘proceed with caution’ when prescribing remotely. 

MDU head of advisory services Dr Caroline Fryar said: ‘With many consultations moving online during the pandemic, doctors have become even more adept at assessing patients virtually. 

‘Prescribing as part of a remote consultation is often entirely safe and reasonable as long as the prescribing doctor has enough information about the patient, can make an adequate assessment and have a proper dialogue with the patient. 

‘However, as ever, doctors need to apply their judgement and remain alert to situations in which a face-to-face consultation may be needed.’