FAQS PRESCRIBING
| Prescribing Question | LMC Guidance |
|---|---|
| Clinic BP is high, and practice asked to consider optimising BP treatment | A high BP reading in clinic may be an isolated reading, so it seems reasonable to monitor this using home readings or repeats at the practice (encouraging self-care) |
| Non-prescribing clinicians asking us to start treatment. (eg: chest pain clinic, mental health) | General Practice does not have the capacity to complete prescription requests on behalf of other providers who use non-prescribing clinicians within their pathways |
| Community midwives requesting aspirin or high dose folic acid | This is a contractual requirement for those practices signed up to the supplementary basket of services contract. However, it does not include provision of prescriptions for hospital midwives. |
| Medication advised as part of the Advice and Guidance Service | Patient remains under the care of general practice so prescribing is their responsibility. However, engagement with Advice and Guidance is not mandatory. |
| Sirona wound care service requesting a prescription (eg: antibiotics) | It is reasonable for general practice to complete this request as the patient remains under its care |
| Oviva request for anti-emetics to improve tolerability of Wegovy injection | When patients are referred from primary to secondary care, they are referred for a complete episode of their care, which includes prescribing for all conditions relating to this episode of care. |
| Pre-op nurse asking for antibiotics following a positive MSU in pre-op clinic | We do not have a commissioned pathway for pre-op care, so we are not funded for this |
| Endoscopy clinic asking for H-Pylori eradication treatment | If the patient is referred to an out-patient team, then the prescribing lies with them If you have sent a patient direct to test (endoscopy), it is greyer, because although the investigation hasn’t been requested by you, the patient is still under your care. In these circumstances, it is reasonable for a GP to prescribe the H-pylori eradication therapy. |
| Dementia clinic asking for initiation of medication | If a practice is signed up to the dementia LES, this does include diagnosis and initiation of medications for dementia |
| Inclisiran inititiation by lipid clinic | If practice signed up to inclisiran LES, this is an exception to the trust initiating its own medication because the acquisition cost of medication higher in secondary care |
| Substance misuse clinic has asked GP to do bloods prior to acamprosate prescribing | Substance misuse is commissioned via the local authority and is not part of the core GP contract. As such, there is no contractual obligation to provide a phlebotomy service for this |
| Specialist advice lines (eg: gastroenterology/rheumatology) asking GPs to start a course of treatment | As the patient is under hospital care and has received advise through a telephone consultation, the responsibility would lie with the provider to initiate the required medication. The only possible exception may be a restart of a repeat medication, which would be less common. |
| We receive letters requesting titration of medication which is often longer than a 4-week period. Should we expect the specialist clinic to take responsible for the entirety of this titration? | This will depend on the medication and the complexity of the medical condition. It is reasonable for a GP to titrate blood pressure medication, but titration of specialist medication is likely to require a hospital specialist. |
| If a patient is already on a medication and a provider suggests an amendment to the dose, where would the responsibility lie for this? | This would depend on the nature of the medication and the monitoring required for this. If the medication is within the GP’s clinical competencies and does not require intensive monitoring, it is reasonable for a GP to amend the dose, to avoid the risks of dual prescribing. However, if it is a specialist medication, or it requires close blood monitoring or clinical review, this responsibility lies with the provider. |
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