PATIENTS AND PRESCRIBING: RIGHTS AND RESPONSIBILITIES
- Am I right, that as an NHS patient my GP must prescribe for me whatever I want?
Under the NHS regulations your GP must prescribe for you any drugs that he or she feels are needed for your medical care. A patient is entitled to drugs that the GP believes are necessary, not those which the patient feels should be prescribed. GPs are responsible for all prescribing decisions they make and for any consequent monitoring that is needed as a result of the prescription given.
The Department of Health lists all drugs that the NHS is prepared to pay for in a list called the Drug Tariff. It is likely that most, if not all, the drugs you need are available through the NHS, however the Drug Tariff does have exceptions. Some drugs, like phosphodiesterase inhibitors (e.g. Viagra) listed in Schedule 11 will only be offered on the NHS to patients suffering from specified conditions. Similarly some products other than drugs, such as high energy or gluten free foods, are listed as ‘Borderline Substances’ and may only be prescribed at NHS expense in defined circumstances. Other drugs or substances, listed in Schedule 10, cannot be prescribed at all on the NHS, such as Evening Primrose Oil, many vitamins, bath preparations, cough syrups and expensive brand names of some drugs.
- If a drug is not available on the NHS, can my GP write me a private prescription for it?
Any doctor can write a private prescription for a patient if they feel it is clinically appropriate and they are happy to take responsibility for that prescribing decision. Under the NHS regulations, a GP or his deputy can write a private prescription for a patient but cannot charge the patient for writing a private prescription if the patient is registered for NHS care with that GP or any other GP in the same practice.
The only exceptions to this rule are when an NHS GP writes either a private prescription for:
- Drugs which are being issued solely in anticipation of the onset of an ailment whilst outside the UK, but for which the patient does not require treatment when the medicine is prescribed.
- Drugs issued for the prevention of malaria.
- Can my GP supply me with drugs directly rather than going to a pharmacist?
The supply of drugs in the NHS is highly regulated. NHS prescriptions must be dispensed at pharmacies except where a doctor has been granted permission to be a dispensing doctor. This is most likely to happen when there are few, if any, pharmacies in a rural or semi-rural area. The area is then known as a ‘Controlled Area’ and a dispensing doctor is allowed to supply drugs to named patients who live more than one mile as the crow flies from a pharmacy. Many dispensing doctors can only dispense to some of their patients depending on the position of a pharmacy. All patients have the right to take their prescription to a pharmacy of their choice if they wish to do so.
Out of hours (OOH) doctors may supply a patient with immediately necessary emergency drugs when the pharmacy or dispensary is likely to be closed (following the ‘Carson Report’, instead of limited supply or a ‘starter pack’ plus a prescription, an OOH doctor can now supply a complete course of any necessary emergency medicine to the patient, and charge a prescription charge where the patient is not exempt).
Malaria chemoprophylaxis - There is no NHS Regulation that prevents a GP prescribing drugs for the prevention of malaria at NHS expense. However, the Department of Health has issued guidance that medication for malaria prophylaxis may not be reimbursed under the NHS and instead advise that this should be prescribed privately.
A GP, even a dispensing GP, is not allowed to sell any ‘over the counter’ medicines.
- Why can’t my GP give my child single vaccines for measles, mumps and rubella?
The Department of Health believes that on the basis of currently available evidence the MMR vaccine is the most effective and safe means of ensuring protection against measles, mumps and rubella, and therefore this is the only treatment it will provide for on the NHS. The three vaccines combined in MMR boost the effects of one another, whilst there are doubts about the efficacy of single vaccines.
- Can my GP refuse to give me a prescription that my consultant asked them to provide?
The person who signs the prescription is legally liable for the prescribing and the consequent effects of that drug. Some drugs which may be very familiar to consultants in a specialised area of medicine can be potent drugs of which a GP will have little experience (for example many cancer drugs or specialised treatment for diseases such as rheumatoid arthritis – the group called ‘biologicals’).
If a consultant feels a drug is appropriate there is no reason why they cannot prescribe it themselves; they can also post a prescription to you.
There may be circumstances where in spite of a specialist opinion a GP is still unhappy to prescribe a drug, there may be some disagreement on the necessity of the drug or your GP may feel that there are other aspects of your medical condition that have not been considered and would make that prescription inappropriate.
- A friend’s GP wrote them a similar prescription on a consultant’s advice, why won’t mine? I think this is discriminatory.
Each GP will make prescribing decisions based on what they are or are not prepared to take clinical responsibility for.
Some doctors might have special training or knowledge of a particular area of medicine which makes them comfortable to prescribe and monitor a drug where many GPs would not. Clearly, a GP should be aware of their limitations as well as their skills and will want to ensure that they are not prescribing beyond their knowledge or their ability to ensure patient safety.
The fact that highly specialist drugs are often the most expensive can give the wrong message. Expense should not limit a patients access to good quality treatment from their GP, safety and lack of knowledge of specialised drugs which could affect that safety should.
- What is a shared care agreement?
Sometimes GPs will come to an arrangement with a consultant regarding a patient’s care where in essence the clinical responsibility is shared between the two doctors. There will usually be a formalised written agreement/protocol setting out the position of each, to which both parties have willingly agreed, which is known as an ‘effective shared care agreement’. This could also be an enhanced service that the GP provides. There are some drugs (e.g. certain growth hormones, Erythropoetin, Methotrexate, Ritalin and Memantine) which it would not be appropriate for a GP to take sole responsibility for without sharing the care with a consultant. A GP can refuse a shared care agreement if he or she is not happy with the burden of responsibility it puts on the GP, and then the consultant must take full responsibility for prescribing and any necessary monitoring. Pressure on a GP to prescribe, where a GP does not agree, is not acceptable.
- I live abroad for six months of the year and my GP has refused to give me a prescription.
The NHS accepts responsibility for supplying ongoing medication for temporary periods abroad of up to three months. If a person is going to be abroad for more than three months then all that the patient is entitled to at NHS expense is a sufficient supply of his/her regular medication to get to the destination and find an alternative supply of that medication.