A local pharmacy has provided a dressing that a community nurse needed for a named patient and asks you for a prescription so it can be reimbursed the cost.
Or a hospital nurse or dietician has chosen a nutrition product which has been supplied by mail order and which the patient has started to take. Should you as the patient's GP belatedly provide a scrip for it?
From time to time GPs are put under pressure to sign retrospective scrips for products like these that are not prescription-only items. The correct response is to 'just say no'.
Prescribing retrospectively for such products might seem harmless. However it is not permitted under the GMS regulations except in special circumstances.
If you do choose to provide prescriptions in situations like those described above, bear in mind that the clinical responsibility is yours.
Remember that it might be the case that the person who chose the product is being incentivised directly or indirectly by its manufacturer.
You might find that refusing to help out the health professional concerned is difficult. But if you say 'no' a couple of times, the out-of-pocket pharmacist or mail order foodstuffs and appliances company will soon learn to stop asking you.
Consult the regulations
If need be you can refer them to the NHS (General Medical Services Contracts) Regulations 2004, Schedule 6, part 3, paragraph 39 (1) which states 'a prescriber shall order drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under the contract by issuing to that patient a prescription form or a repeatable prescription, and such a form or repeatable prescription shall not be used in any other circumstances'.
Paragraph 39 also states that in a case of urgency a prescriber may ask a pharmacist to dispense a drug, medicine or appliance before a prescription is issued.
This applies as long as the item is not a scheduled or controlled drug and provided you supply the prescription to the pharmacist within 72 hours.
You may need to point out that only a GP - and not a community nurse, pharmacist or other healthcare professional - can make such a request.
You might also have to make clear that delivering prescribable food or drink items to the patient's home cannot be classed as urgent.
If the nurse or the pharmacist is in fact the prescriber then responsibility lies with them and the GP is not required to sanction the prescription.
They are, however, obliged to offer their patient a choice of provider if directing their scrips to a remote pharmacy or agent who then delivers the items.
By complying with requests for retrospective scrips, GPs not only breach the GMS regulations. They also do a disservice to the patient and to the NHS.
Dr O'Connor is a dispensing GP in Salisbury
- Under the GMS regulations GPs are barred from signing prescriptions retrospectively, except in an emergency.
- If a drug, medication or appliance is urgently needed, a GP can arrange for this to be dispensed but must supply the prescription within 72 hours.