A guide to prescribing in general practice

The BMA GP committee’s prescribing policy group has published guidance to help with the clinical responsibilities on prescribing

CREDIT: This is an edited version of an article that originally appeared on BMA

The below gives an insight into the topics alphabetically.

Charging patients

May GPs charge their own patients?

The GMS contract prevents contractors from charging their patients for most services. There are however limited instances were charges may be made, as set out in schedule 5 of the GMS regulations 2004.

May GPs charge for a private prescription?

GPs may write private prescriptions for patients for drugs not available through the drug tariff. However, GPs normally do not charge their registered patients for providing such a prescription, although a dispensing doctor may charge for dispensing the prescription. GPs may charge:

• For drugs which are being issued 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

Ffor drugs issued for the prevention of malaria.

May GPs charge for a ‘grey/black’ listed drugs?

Prescribing doctors may not charge. Dispensing doctors can supply ‘black/grey’ listed drugs and charge for the supply of the drug as set out in schedule 5, section 24 of the GMS regulations 2004.

Community drug charts

There is no need for a GP to complete a community drug chart (MAR chart) as a prescription is all that is legally required for a nurse or other community worker to administer medication.

MAR charts are a record of administration and not an authority to administer medication. Read more in the full guidance.

 Covid therapeutic prescribing

The current commissioning of Covid Medicine Delivery Units ends on the 27 June 2023. The BMA is clear that it is not appropriate for every GP to be required to start prescribing these medications. This is due to the complexity of the current cohort of eligible patients and the nature of the medications themselves.

Drug switches

Some practices will have received an instruction to change patients on drug X to drug Y to save the PCO (primary care organisation) money. 

If it is reasonable to switch a patient, then practices may agree to do so. However, GPs must always use their clinical judgement. Where they can make a clinical case for not switching a patient, they have every right to continue to prescribe as they feel is clinically appropriate. Read more in the guidance.

Excessive prescribing

Excessive prescribing is defined within the GP contract. Any health professional believed to be prescribing excessively may be challenged by their PCO (primary care organisation).

The choice of most cost-effective drugs changes with time. GPs have historically been involved in ensuring appropriate and cost-effective prescribing.

​Some PCOs provide a list of drugs they wish to stop providing within their area.

We set out how to ensure you are covered for the drugs you choose to prescribe in the excessive prescribing guidance below.

Prescribing incentive schemes

Prescribing incentive schemes are implemented in some areas to reward practices for cost-effective prescribing.

GPs should be aware of the costs involved and ensure ethical consideration when signing up to schemes.

The GPC supports prescribing incentive schemes where they are evidence-based and introduced with the support of local GPs.

Prescribing numbers

Salaried GPs can request their own prescribing number on PCSE online. You will also need to go log onto PCSE online to notify NHS England of any changes to your status if you move practices – see more on how to do this.

The BMA continue to request for all prescribers to have a unique identifier for their prescribing of an individual number combined with a location code.

Prescription charges

The prescription charge in England is £9.35.

People with certain medical conditions, including cancer, can get free NHS prescriptions.

The BMA has long called for a review of the prescription charge system. We believe that prescriptions should be free of charge for all patients in England as they already are in the rest of the UK.

Prescription intervals

How long should an interval be?

Doctors should provide prescriptions for intervals that they feel are clinically appropriate. This should take into account:

• Possible reactions
• The stability of the treatment
• Patient compliance
• Necessary monitoring.

Sometimes a doctor may give six or even twelve months supply on one prescription as this is cost-effective and convenient for patients.

Shorter duration intervals

We have also received requests for GPs to consider shorter duration prescribing (28-day prescriptions).

Prescribing intervals can place significant workload on doctors and surgery staff and should be in line with patients’ medical needs. Pharmacy requests to issue a seven-day prescription should be discouraged.

Seven-day prescribing for MCA dispensing

The request for seven-day repeat prescriptions to defray the pharmacist’s costs for the filling of MCAs has become an increasing pressure for GPs. Our advice is to resist such demands unless there is a clinical reason for restricting supply to seven days.

• Consistency of size, shape and colour of the medication could be more effective than using MCAs (can be confusing for patients).
• There are some storage problems involved in using MCAs, such as possible deterioration of drugs after being taken out of the packet.
• There are alternative ways to support patients taking medication, such as medicine advice charts, which allow the drugs to be retained in their packaging with advice sheets.

The GPC supports the PSNC  in that both pharmacists and dispensing doctors issuing MCAs should be properly reimbursed for the services they provide to patients.

Supplementary and independent prescribing

Supplementary prescribing is a voluntary partnership between an independent prescriber and a supplementary prescriber (a trained nurse, midwife, pharmacist, physiotherapist, diagnostic and therapeutic radiographer, or optometrist). The partnership implements a clinical management plan with the patient’s agreement.

Doctors’ responsibility for independent prescribers

Independent prescribers are professionally responsible for their own actions. However, where a nurse prescribes as part of their nursing duties, the employer may also be held responsible.

All independent prescribers should ensure they have professional indemnity, and the employing GP should be satisfied that any employee has the relevant skills and training.

Non-GP long-term prescribing

When a non-GP prescriber initiates a new drug, they accept responsibility for that prescription. They usually can’t issue repeats.

If the patients wants to repeat their prescription, the GP should review the patient and set up a repeat prescription if appropriate or refer the patient back to initial prescriber.

The patient’s GP should be notified if anything is prescribed long-term. The responsibility for checking interactions is with the prescriber who should take a full drug history if they do not have access to the main clinical record.