GPs warned over prescribing beyond their competence as hospitals shift workload

GPs must resist pressure to prescribe medication outside their competence and push back against work dumped on them by hospitals, a senior GP has warned.

GPonline reported last month that GPs are facing a 'tsunami of extra work' because the COVID-19 pandemic has forced them to deliver care, tests and prescribing that would usually be carried out in hospitals.

Polling by the BMA has shown that 52% of GPs have seen an increase since the pandemic began in demands for them to carry out work that would normally be delivered in hospitals.

However, BMA GP committee member Dr Peter Holden said GPs should not be prescribing medications they are unsure about. His warning comes after he was asked by a hospital to prescribe medication to a young patient ‘on the basis of a telephone description’.

Increased clinical risk

The Derbyshire GP warned that family doctors are taking on increased responsibility and clinical risk as they pick up work dumped on them by hospitals.

He said: ‘The hospitals know damn well that the patient is piggy in the middle. If they ask me to prescribe an antibiotic, of course that’s within my capabilities. But if they want me to prescribe something weird, and rare and wonderful, it’s not and you shouldn’t.

‘What you can’t get past is the fact that whoever signs the prescription carries the responsibility for that prescription, its follow-up and its monitoring - and you must not do it if it’s beyond your abilities. A lot of risk is being shifted.’

Dr Holden questioned why hospitals were unable to send electronic prescriptions to chemists, or put prescriptions in the post - asking why GPs had to get involved.

GP workload

Doctors' leaders have long campaigned against workload dumped on GP practices by hospitals. The BMA has warned that 15m appointments a year are lost to work inappropriately transferred from hospitals.

Dr Holden said it was vital for GPs to push back against a rise in workload passed on from hospitals during the pandemic, saying that practices had to be ‘properly resourced’ if they took on extra work.

‘There’s a very real need to say no to work because otherwise what’s happening is that the hospitals are taking the tariff but aren’t delivering the goods. Meanwhile, the GPs are delivering the goods at their own personal expense.

'We are not mainstreaming [secondary care work] without a properly negotiated, properly resourced, and properly rewarded contract.'

Risk of harm

In April, the Medical Protection Society (MPS) called on the government to introduce emergency laws to protect doctors making difficult decisions about patient care during the coronavirus pandemic.

MPS medical director Dr Rob Hendry said many doctors had been required to depart from established duties during the pandemic. He said: ‘We have reassured GP members that if they are carrying out additional NHS work due to COVID-19 or are asked to work in a different NHS clinical setting to normal, they do not need to inform us.

‘If, however, a doctor is asked to perform a duty that they would not normally undertake they need to assess whether they have the skills and competence to proceed and be willing to seek professional advice and clinical supervision from colleagues if necessary.

‘If they do not feel it is safe to proceed and that to do so would place the patient at greater risk of harm than not undertaking the duty that has been requested, they should explain their concerns to a senior colleague or manager. ‘It would be wise to record the details of this deliberation in case it becomes necessary to explain the reasoning behind the decision to act or not to act in the future.’

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