The prescription saga

A circular appeared in the hospital email inbox, indicating that in future consultants would not issue prescriptions but would fill in a recommendation form for the patient to take back to their GP. There was no clear indication of what this new process was supposed to achieve except to transfer the cost of drugs from the hospital to the community budget. It certainly was not going to cost less overall.


I have some understanding of how this would work.


The patient would not be able to go straight to the chemist and start the medication the same day. Instead they would have to book an appointment with their GP, which might take 5 days. Their GP might then decide that the prescribed drugs were not right – for example, a recent GP edict suggested that enteric-coated prednisolone should never be used because it was too expensive, notwithstanding good evidence that when steroids are used with non-steroidal anti-inflammatory drugs the risk of gastro-intestinal bleeding was markedly increased. Or they would refuse to prescribe because they “didn’t know enough about the drug”. You may think I am joking but I had a GP who refused to prescribe hydroxychloroquine on this basis. So the patient would either be delayed, or would have to come back to the specialist, or both. And inevitably they would be subjected to a grumbling tirade from the overworked GP who could see no reason why he was being imposed upon to do the consultants’ work for them. So the whole experience would be extremely negative. For everyone.


From my own point of view I was incensed that my ability to practise was being interfered with and wrote to the General Medical Council seeking an opinion. It replied that the new procedure seemed to be driven by cost alone, and was unacceptable in principle. I relayed this to the Trust management, who took no notice.


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