The dilemma: My patient was prescribed medication from an online prescribing service by a registered GP. The patient had been taking the treatment for several weeks before I was notified of the prescription. When I checked his records and assessed him, it was clear that he did not require that medication. How should I manage the situation?
Dr Marika Davies, senior medicolegal adviser at Medical Protection advises:
Good communication with your patient will be key to resolving this situation. If, in your clinical opinion, the medication is not safe and appropriate for your patient, you will need to explain your reasons for this to him, give advice about stopping the medication safely, and advise him that you will not issue any further prescriptions for it. Hopefully the patient will accept this.
But if he does not you may need to further explain that you can only prescribe drugs, including repeat prescriptions initiated by colleagues, if you are satisfied that they serve the patient’s needs (as set out by the GMC in its guidance Good practice in prescribing medicines and devices).
The GMC is clear that you do not have to provide a treatment to a patient that you do not consider would be of overall benefit to them, but you should discuss the issues with the patient, explore the reasons for their request, and explain your reasons for not prescribing the medication.
You should also explain any other options that are available, including the option to seek a second opinion, it says. It may be helpful to offer a follow-up appointment to your patient in order to discuss the treatment options further once he has had an opportunity to consider the matter.
If the patient still remains dissatisfied, you should offer the practice’s complaints procedure, and you can seek assistance from your medical defence organisation in dealing with any complaint that may arise.
The GMC also says that you must protect patients from risks of harm posed by colleagues’ prescribing, administration and other medicines-related errors.
Depending on the specific circumstances of this case, for example if it was a serious medication error, or if you have noticed a pattern of errors, you will need to consider whether there are concerns about patient safety that should be raised with your CCG or NHS England. The GMC sets out guidance on raising concerns, and there will also be local procedures in place that should be followed.
Document your discussions with the patient carefully in his medical records, and keep a note of any steps you take to raise concerns if this is necessary. If you have any concerns, your medical defence organisation will be able to offer advice and support.