Follows is some general information on prescribing which the practice follows.
NHS Prescribing at request of private healthcare provider
If individuals opt for private healthcare treatment or assessment, they are still entitled to NHS services. The NHSGGC Central Prescribing Team are often asked by GPs what they should do if a patient requests a medicine following consultation with a private healthcare provider. This blog provides some advice.
When should a GP prescribe a medicine recommended by a private healthcare provider?
Where a patient has a private consultation for a chronic disease or investigations / treatment at a private establishment, the NHS GP may be asked to prescribe on an ongoing basis. Where the GP considers that the medication recommended is clinically necessary, that treatment is an ongoing responsibility for the GP and it is within their competency to prescribe, he or she would be required under the NHS terms of service to prescribe treatment within the NHS.
This does not mean the GP should always follow advice about a specific product; the issues are the same as those where a NHS consultant has asked the GP to prescribe a medicine. Where the recommendation is for a non-Formulary medicine or one not included within local guidelines, the GP may decide to follow local guidance unless there is a clear clinical justification for not doing so.
When should a GP NOT prescribe a medicine recommended by a private healthcare provider?
If the patient is receiving an episode of care from the private healthcare provider that the GP has no clinical input into, it is probably not suitable for the GP to prescribe. An example might be where the medicine is a specialist product which the GP feels they have no competence to prescribe or where the prescribing requires monitoring or assessment that can only be undertaken by the specialist. It is therefore suitable in these cases that the private healthcare provider prescribes this medicine as part of this episode of care. This might include ovarian stimulation for assisted conception or oral systemic anticancer therapy.
What’s the official guidance?
SGHD/CMO(2009)3 http://www.sehd.scot.nhs.uk/cmo/CMO(2009)private.pdf provides details on arrangements for NHS patients receiving healthcare services through private healthcare arrangements. This guidance notes that NHS and private care should be delivered separately and there should be clear separation in legal status, liability and accountability between NHS and private care provision.
Healthcare Improvement Scotland (HIS) recommend that prescribers follow their professional guidance for prescribing and dispensing of medicines. For example, the General Medical Council Good practice in prescribing and managing medicines and devices guidance states:
- If you prescribe at the recommendation of another doctor, nurse or other healthcare professional, you must satisfy yourself that the prescription is needed, appropriate for the patient and within the limits of your competence.
- You will be responsible for any prescription you sign.
- If you are uncertain about your competence to take responsibility for the patient’s continuing care, you should seek further information or advice from the clinician with whom the patient’s care is shared or from another experienced colleague. If you are still not satisfied, you should explain this to the other clinician and to the patient, and make appropriate arrangements for their continuing care.
Generic Prescribing: Guidance for Prescribers in NHSGGC
The GGC Formulary primarily recommends the prescription of generic medicines and the NHS Greater Glasgow and Clyde Area Drug and Therapeutics Committee (ADTC) have previously issued guidance for prescribers to support generic prescribing:
ADTC supports a policy of generic prescribing for the majority of medicines. In some cases, the generic versions of a medicine may not have the exact same indications listed on the market authorisation as the original branded medicine. However, as bioequivalence to the original branded medicine must have been demonstrated as part of the generic market authorisation process, NHS Greater Glasgow and Clyde ADTC considers that any additional risks of prescribing and dispensing the medicine generically are negligible.
Exceptions to the generic prescribing policy are:
- when the pharmacokinetic profiles of different brands of the same medicine differ widely.
- medicines with a narrow therapeutic index where any variation in the drug concentration in the blood increases the risk of toxicity or treatment failure for the patient.
- to prevent confusion between preparations e.g. when prescribing inhaler devices (with the exception of salbutamol metered dose inhalers).
Where formulary medicines should be prescribed by brand name, this will be indicated in the prescribing notes of the GGC Formulary entry. This advice does not override an individual clinician’s decision to prescribe what they believe to be the most appropriate treatment for an individual patient.