Medication, medication, medication. It makes up a huge part of our job, and our increasing workload. Questions about prescriptions, repeat ordering, issuing acutes, ‘What am I taking? Should I be taking? Aren’t I taking?’
When the Daily Mail spins its ‘GP failure’ wheel, it frequently lands on prescribing. We give too many antidepressants, painkillers, antibiotics and hormones. We simultaneously don’t give enough antidepressants, painkillers, antibiotics or hormones.
We issue social prescriptions, exercise prescriptions, actual prescriptions, things we don’t really understand (stoma bags, anyone?) and things we don’t want to understand (Galsulfase? Sure no problem…)
Confused? You’re not the only one.
Come on Jeremy – stick your head above the parapet and tell patients what they can’t have
We still prescribe things patients could choose to buy themselves (although I don’t prescribe things that don’t work, so if you want to buy cough medicine, knock yourself out. At £9 a pop, I’d rather self-medicate with a different kind of bottle and one that doesn’t taste like toilet cleaner).
But now we’re being handed the unenviable task of trying not to prescribe things that can be bought over the counter.
We are – you guessed it – ‘best placed’ to have the not-at-all awkward conversation with patients: ‘You want a prescription for that? It only costs three quid in Asda. Blimey, you must be really tight.’ I don’t remember that being covered in the MRCGP.
The awful mantra ‘GPs best placed’ smacks of a complete abdication of responsibility by ministers and everyone else in the whole NHS. I’m no psychologist but I know that in this case blanket rules and population-level messages will work a hell of a lot better than an individual discussion.
When NICE makes recommendations about drugs, do members of its expert panel have one-to-one discussions with patients who will be directly affected? Aren’t they best placed to do this? Of course they don’t, they make decisions based on the available evidence. Nobody wants to be the one to say no, and if the person you’re being told to say no to is someone you’ve cared for throughout their life, it’s a damn sight harder still.
Why doesn’t someone else stick their head above the parapet for a change? Let Mr Hunt tell patients what medications they can’t have. He can’t trot out the ‘local problem’ argument; there isn’t a CCG in the country that doesn’t need cash freeing up. So come on Jeremy, show some leadership. I’m not best placed to sort out the mess you made by not funding the NHS. Just like I’m not best placed to check immigration status, repair boilers or get embroiled in issuing ‘fit notes’.
Mr Hunt could look at the simple, commonsense approach in the rest of the UK, where there are no prescription charges – although I’m some patients consult in order to get a free prescription rather than paying 26p over the counter.
But at least it allows doctors to be doctors. I’d love to have time for a bit of preventive medicine instead of patching people up and firefighting. Who knows, I might even have time to explain why cough medicines don’t work, and save everyone a bit of cash.
Dr Zoe Norris is a GP in Hull