Good practice in prescribing and managing medicines and devices

Endnotes

1

Good medical practice’ (2013) London, General Medical Council

2

Raising and acting on concerns about patient safety’ (2012) London, General Medical Council

3

Electronic prescribing services can also be used. In England prescriptions can be sent electronically to a pharmacy; in Wales and Scotland, information is held in a barcode on a paper prescription. For more details see Get Started with EPS, Health and social Care information Centre; Prescriptions electronically, NHS Wales Informatics Service; Electronic Transfer of Prescriptions (ETP) , Scottish Government. Electronic prescribing services may be introduced in Northern Ireland in the future.

5

See explanatory guidance on Delegation and referral (2013). See also Supply and administration of Botox®, Vistabel®, Dysport® and other Injectable medicines in cosmetic procedures, Medicines and Healthcare products Regulatory Agency.

6

See Chapter 14 of the Human Medicines Regulations 2012 Number 1916 – SI 2012/1916 and ‘The Blue Guide: Advertising and Promotion of Medicines in the UK’ (MHRA, 3rd edition, 2nd revision, July 2019). The MHRA is an Agency of the Department of Health and Social Care with regulatory responsibility for medicines (for human use), blood and medical devices in the UK.

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.

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.

9

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

10

Decision making and consent’ (2020) London, General Medical Council

11

0–18: guidance for all doctors’ (2018) London, General Medical Council

12

NHS Choices and information bearing The Information Standard quality mark, for example. Also see the electronic medicines compendium.

13

The concept of overall benefit is consistent with the legal requirements to consider whether treatment ‘benefits’ a patient (Scotland), or is in the patient’s ‘best interests’ (England, Northern Ireland and Wales). General Medical Council (2020) ‘Decision making and consent’ London, General Medical Council (paragraph 87).

Also see ‘Confidentiality: Good practice in handling patient information’ (paragraphs 44 to 49).

14

The NICE website includes information, guidance and tools for understanding and improving adherence. See also NICE’s guideline on medicines adherence.

16

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

17

See MHRA safety drug update on opioids and risk of dependence and addiction.

18

General Pharmaceutical Council (GPhC) guidance on providing pharmacy services at a distance, including on the internet (April 2019) provides examples of relevant medicines. These include: opiates, sedatives, laxatives, pregabalin, gabapentin.

19

See ‘The use of antipsychotic medication for people with dementia: Time for action’ (Department of Health, 2009) and NICE’s guideline on dementia. The NICE website, the joint NHS Institute and ‘Dementia Action Alliance’s Call to action: the use of antipsychotic drugs for people with dementia’ also contains guides, case studies and other materials to support good prescribing practice and alternative care strategies for patients with dementia.

20

For further information see GPhC guidance on providing pharmacy services at a distance, including on the internet (April 2019). The Pharmaceutical Society of Northern Ireland (PSNI) provides guidance for pharmacies based in Northern Ireland.

21

For more information about shared care prescribing see resources published by NHS England, Welsh Medicines Information Centre, NHS Scotland health boards and Health and Social Care in Northern Ireland.

22

See the EQUIP (Errors – Questioning Undergraduate Impact on Prescribing) study regarding inappropriate delegation of responsibility for writing up discharge summaries to junior staff with insufficient pharmacology training or knowledge of patients.

23

Raising and acting on concerns about patient safety’ (2012) London, General Medical Council

24

NHS Digital has published ‘The Identity and Verification standard for Digital Health and Care Services’ (2018). For primary care providers, see guidance issued by NHS England and NHS Improvement Digital First Primary Care Team. For guidance on safe and appropriate online and remote provision of sexual health services please refer to Faculty of Reproductive Sexual Health (FRSH) and British Association for Sexual Health and HIV (BASHH) Standards for Online and Remote Providers of Sexual and Reproductive Health Services.

25

You should anonymise or code the information, or seek consent, if practicable. If necessary, see our explanatory guidance ‘Confidentiality: good practice in handling patient information’ (2017) for more advice.

26

You must make sure dangerous occurrences and accidents are reported to the Health and Safety Executive in accordance with the ‘Reporting of Injuries, Diseases and Dangerous Occurrences Regulations’ 1995. You must follow local procedures for reporting and learning from similar issues.

27

The MHRA collects data on licensed and unlicensed prescription-only, pharmacy and over-the-counter medicines.

28

MHRA guidance on the lawful supply and use of unlicensed medicines is set out in the MHRA publication ‘The supply of unlicensed medicinal products (“specials”)’, MHRA Guidance Note 14.

29

We cannot foresee every circumstance in which it may be necessary to prescribe an unlicensed medicine to meet a particular patient’s assessed needs. If you are in any doubt, consult the MHRA or seek legal advice.

30

Regulation 174 of the Human Medicines Regulations 2012 allows the MHRA (the licensing authority) to permit a temporary authorisation for the supply of an unlicensed medicinal product for use in response to specific types of public health threat. This includes the suspected or confirmed spread of pathogenic agents, toxins, chemical agents or nuclear radiation.

31

The Medicines for Children leaflets on unlicensed medicines, produced by the Royal College of Paediatrics and Child Health/Neonatal and Paediatric Pharmacists Group Standing Committee on Medicines, may be helpful in explaining to children and parents why such practice is common in caring for children. The British Pain Society publishes ‘Using medicines beyond licence: Information for patients’.