Good practice in prescribing and managing medicines and devices

Deciding if it is safe to prescribe

20

You should only prescribe medicines if you have adequate knowledge of the patient’s health and you are satisfied that the medicines serve the patient’s needs. You must consider:

  1. the suitability of the mode of consultation you are using, for example face to face or remote, taking account of any need for physical examination or other assessments (see paragraphs 21 to 26)
  2. whether you have sufficient information to prescribe safely, for example if you have access to the patient’s medical records and can verify relevant information (see paragraphs 27 to 33)
  3. whether you can establish two-way dialogue, make an adequate assessment of the patient’s needs and obtain consent (see paragraphs 34 to 38)
  4. whether you can share information appropriately after an episode of care (see paragraphs 53 to 58).

Does the mode of consultation meet the individual needs of the patient and support safe prescribing?

21

Patients may prefer to access healthcare services face-to-face or through remote consultations via telephone, video-link or online, depending on their individual needs and circumstances.7  Where different options exist, and when it is within your power, you should agree with the patient which mode of consultation is most suitable for them.

7

The doctor will zoom you now: getting the most out of the virtual health and care experience’ insight report, July 2020, Healthwatch, Traverse, National Voices.

22

Circumstances in which a face-to-face consultation may be more appropriate than a remote consultation include when:

  • you are unsure of a patient’s capacity to decide about treatment (see paragraphs 41 to 44)
  • you need to physically examine the patient
  • you are not the patient’s usual doctor or GP and they have not given you consent to share their information with their regular prescriber; this is particularly important if the treatment needs following up or monitoring, or if you are prescribing medicines where additional safeguards are needed (see paragraphs 59 to 66)
  • you are concerned that a patient does not have a safe and confidential place to access healthcare remotely, for example due to domestic abuse
  • you are concerned that a patient may be unable to make a decision freely because they are under pressure from others (see paragraphs 69 to 75 of ‘Decision making and consent’).
23

If you are not the patient’s regular prescriber, such as a GP, you should:

  1. tell the patient your name, role and, if online, your GMC registration number
  2. explain how the consultation is going to work and what they should do if they have any concerns or questions
  3. follow the advice in paragraphs 27 to 33 and 53 to 58 on sharing information.
24

Before you prescribe, you must be satisfied that you can make an adequate assessment, establish a dialogue and obtain the patient’s consent through the mode of consultation you are using (see paragraphs 34 to 44).

25

You must also consider and respond to the patient’s communication needs and make reasonable adjustments to your practice, where necessary, so they can receive care that meets their needs.8 

8

Our ethical hub has resources on applying our guidance in practice to help you decide if face-to-face or remote consultations are appropriate in other situations.

26

You must carry out a physical examination of patients before prescribing non-surgical cosmetic medicines, such as Botox, Dysport, Vistabel or other injectable cosmetic medicines. Therefore, you must not prescribe these medicines remotely.

Do you have enough information about the patient to prescribe a treatment that meets their needs?

27

You must only prescribe if it is safe to do so.

  1. It’s not safe to prescribe if you don’t have sufficient information about the patient’s health or if the mode of consultation is unsuitable to meet their needs.
  2. It may be unsafe if relevant information is not shared with other healthcare providers involved in the patient’s care – for example because the patient refuses consent.
28

Before prescribing, you must consider whether the information you have is sufficient and reliable enough to enable you to prescribe safely.

For example, whether:

  1. you have access to the patient’s medical records or other reliable information about their health and other treatments they are receiving
  2. you can verify other important information by examination or testing
  3. the patient would be at risk of death or serious harm if they are also obtaining medication from other sources.
29

If you are not the patient’s regular prescriber, you should ask for the patient’s consent to:

  1. contact their GP or other treating doctors if you need more information or confirmation of the information you have before prescribing
  2. share information with their GP when the episode of care is completed.9 
9

In some circumstances, such as in the provision of sexual health services, privacy concerns may override the need to share information.

30

If the patient objects to information being shared with you, or does not have a regular prescriber, you must be able to justify a decision to prescribe without that information.

31

If the patient refuses to consent to you sharing information with their GP, or does not have a GP, you should explain to the patient the risks of not sharing this information. This should be documented in their medical records.

32

If failing to share information could pose a risk to patient safety, you should explain to the patient that you cannot prescribe. You should outline their options and signpost them to appropriate alternative services. You should clearly document your reasons for any decisions made.

33

When treating vulnerable patients in any setting, such as children’s homes, care homes or prisons, take particular care to follow relevant national protocols. You should support appropriate and effective information sharing between the setting and the community in order to ensure continuity of care.

Sharing information after providing care

53

You must contribute to the safe transfer of patients between healthcare providers and between health and social care providers. This means you must share all relevant information with colleagues involved in your patient’s care within and outside the team. This includes when you hand over care as you go off duty, when you delegate care, or when you refer patients to other health or social care providers. You should include all relevant information about the patient’s current and recent use of medicines, as well as any other conditions, allergies and previous adverse reactions to medicines.

54

It is essential for safe care that information about medicines accompanies patients, or quickly follows them, for example on emergency admission to hospital, when they transfer between care settings.15 

55

If you are the patient’s GP, you should make sure that changes to the patient’s medicines, for example following hospital treatment, are reviewed and quickly incorporated into the patient’s record. This will help to avoid patients receiving inappropriate repeat prescriptions and reduce the risk of adverse interaction.16 

16

NICE’s guideline on Medicines optimisation provides relevant recommendations, including in relation to medicines reconciliation.

56

If you are not the patient’s GP, when an episode of care is completed, you must tell the patient’s GP about:

  1. changes to the patient’s medicines along with reasons, including if existing medicines are changed or stopped, and new medicines are started
  2. length of intended treatment
  3. monitoring requirements, including who will carry this out
  4. any new allergies or adverse reactions identified.
57

If a patient refuses to give consent for their information to be shared, or if the patient does not have a GP, you should follow the guidance at paragraph 31.

58

In some circumstances, such as in the provision of sexual health services, privacy concerns may override the need to share information.