Good practice in prescribing and managing medicines and devices
Remote prescribing via telephone, video-link or online
Before you prescribe for a patient via telephone, video-link or online, you must satisfy yourself that you can make an adequate assessment, establish a dialogue and obtain the patient’s consent in accordance with the guidance at paragraphs 20 - 29.
In Consent: patients and doctors making decisions together we say:
Together with the patient,7 you should make an assessment of their condition before deciding to prescribe a medicine. You must have or take an adequate history, including:
- any previous adverse reactions to medicines
- recent use of other medicines, including non-prescription and herbal medicines, illegal drugs and medicines purchased online, and
- other medical conditions.
You should encourage your patients to be open with you about their use of alternative remedies, illegal substances and medicines obtained online, as well as whether in the past they have taken prescribed medicines as directed.
You should identify the likely cause of the patient’s condition and which treatments are likely to be of overall benefit to them.
You should reach agreement with the patient on the treatment proposed,8 explaining:
- the likely benefits, risks and burdens, including serious and common side effects
- what to do in the event of a side effect or recurrence of the condition
- how and when to take the medicine and how to adjust the dose if necessary, or how to use a medical device
- the likely duration of treatment
- arrangements for monitoring, follow-up and review, including further consultation, blood tests or other investigations, processes for adjusting the type or dose of medicine, and for issuing repeat prescriptions.
The amount of information you give to each patient will vary according to the nature of their condition, the potential risks and side effects and the patient’s needs and wishes. You should check that the patient has understood the information, and encourage them to ask questions to clarify any concerns or uncertainty. You should consider the benefits of written information, information in other languages and other aids for patients with disabilities to help them understand and consider information at their own speed and to retain the information you give them.
You should also provide patients’ carers with information about the medicines you prescribe, either with the patient’s consent or, if the patient lacks capacity to consent, if it is in their best interests.
It is sometimes difficult, because of time pressures, to give patients as much information as you or they would like. To help with this, you should consider the role that other members of the healthcare team, including pharmacists, might play. Pharmacists can undertake medicines reviews, explain how to take medicines and offer advice on interactions and side effects. You should work with pharmacists in your organisation and/or locality to avoid the risks of overburdening or confusing patients with excessive or inconsistent information.
You should also refer patients to the information in patient information leaflets (PILs) and other reliable sources of relevant information.9 PILs are useful supplements to the information you give patients about their medicines, but they are not a substitute for that information.
Some patients do not take medicines prescribed for them, or do not follow the instructions on the dose to take or the time medicines should be taken. You should try to understand the reasons for this and address them by providing reassurance and information, and by negotiating with the patient to reach agreement on an appropriate course of treatment that they are able and willing to adhere to.10
You may prescribe only when you have adequate knowledge of the patient’s health, and are satisfied that the medicines serve the patient’s needs. You must consider:
- the limitations of the medium through which you are communicating with the patient
- the need for physical examination or other assessments
- whether you have access to the patient’s medical records.
You must undertake a physical examination of patients before prescribing non-surgical cosmetic medicinal products such as Botox, Dysport or Vistabel or other injectable cosmetic medicines. You must not therefore prescribe these medicines by telephone, video-link, or online.
If you are prescribing for a patient in a care or nursing home or hospice, you should communicate with the patient (or, if that is not practicable, the person caring for them) to make your assessment and to provide the necessary information and advice. You should make sure that any instructions, for example for administration or monitoring the patient’s condition, are understood and send written confirmation as soon as possible.
If the patient has not been referred to you by their general practitioner, you do not have access to their medical records, and you have not previously provided them with face-to-face care, you must also:
- give your name and, if you are prescribing online, your GMC number
- explain how the remote consultation will work and what to do if they have any concerns or questions
- follow the advice in paragraphs 30 - 34 on Sharing information with colleagues.
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, including when you hand over care as you go off duty, when you delegate care or refer patients to other health or social care providers. This should include all relevant information about their current and recent use of other medicines, other conditions, allergies and previous adverse reactions to medicines.
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.11
If you prescribe for a patient, but are not their general practitioner, you should check the completeness and accuracy of the information accompanying a referral. When an episode of care is completed, you must tell the patient’s general practitioner about:
- changes to the patient’s medicines (existing medicines changed or stopped and new medicines started, with reasons)
- length of intended treatment
- monitoring requirements
- any new allergies or adverse reactions identified,12unless the patient objects or if privacy concerns override the duty, for example in sexual health clinics.
If a patient has not been referred to you by their general practitioner, you should also:
- consider whether the information you have is sufficient and reliable enough to enable you to prescribe safely; for example, whether:
- you have access to their medical records or other reliable information about the patient’s health and other treatments they are receiving
- you can verify other important information by examination or testing
- ask for the patient’s consent to contact their general practitioner if you need more information or confirmation of the information you have before prescribing. If the patient objects, you should explain that you cannot prescribe for them and what their options are.
If you are the patient’s general practitioner, you should make sure that changes to the patient’s medicines (following hospital treatment, for example) 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.13
You should not collude in the unlawful advertising of prescription only or unlicensed medicines to the public by prescribing via websites that breach advertising regulations.21
See The Medicines (Advertising) Regulations 1994 and The Medicines (Monitoring of Advertising) Regulations 1994, both as amended, and The Blue Guide: Advertising and Promotion of Medicines in the UK (MHRA, 2005).
If you prescribe for patients who are overseas, you should consider how you or local healthcare professionals will monitor their condition. You should also have regard to differences in a product’s licensed name, indications and recommended dosage regimen. You may also need to consider:
- MHRA guidance on import/export requirements and safety of delivery,
- whether you will need additional indemnity cover
- whether you will need to be registered with a regulatory body in the country in which the prescribed medicines are to be dispensed.