Prescribing - Self Prescribing & Family Members
Over the last year LMC has been made aware of a number of GPs who have been reported to the GMC for self-prescribing. The LMC would strongly advise GPs not to prescribe for themselves or their family, except in exceptional circumstance.
The areas of high risk are controlled drugs, psychiatric medication and drugs for erectile dysfunction.
The GMC Guidelines in “Good Medical Practice” are quite clear:
13. “Doctors should, wherever possible, avoid treating themselves or anyone with whom they have a close personal relationship and should be registered with a GP outside their family.
Controlled drugs can present particular problems, occasionally resulting in a loss of objectivity leading to drug misuse and misconduct.”
14. You should not prescribe a controlled drug for yourself or someone close to you unless:
a. No other person with the legal right to prescribe is available to assess the patient's clinical condition and to prescribe without a delay which would put the patient's life or health at risk, or cause the patient unacceptable pain, and
b. That treatment is immediately necessary to:
i. Save life
ii. Avoid serious deterioration in the patient's health, or
iii. Alleviate otherwise uncontrollable pain.
15. You must be able to justify your actions and must record your relationship and the emergency circumstances that necessitated your prescribing a controlled drug for yourself or someone close to you.
We are aware of GPs who have been reported to the GMC for self-prescribing antibiotics. Pharmacists will often challenge self-prescribed medication and some will refuse to dispense the prescription.
The LMC has been involved in some cases where a GP has prescribed for themselves using a false name.
Prescribing for yourself or your family using a false name is fraud and a criminal offence and your registration with the GMC will certainly be at risk.
Please all remember issuing a prescription for yourself on an FP10 for a drug that should be issued as a private prescription is also fraud.
New GMC guidance relating to prescribing and managing medicines was published on 31st of January 2013 and comes into effect on 25th of February. This strengthens the GMC position on self-prescribing and prescribing for those close to you.
It states that
Wherever possible you must avoid prescribing for yourself or anyone with a close personal relationship to you and that if you prescribe for yourself or someone close to you you MUST
a Make a clear record at the same time or as soon as possible afterwards. This should include relationship and why it was necessary for you to prescribe
b Tell your own or the patient’s GP what medicines you have prescribed and any other information necessary for continuing care, unless in the case of prescribing for someone close to you they object.
The guidance states that you must not prescribe controlled drugs for yourself or someone close to you unless no other person is available with the legal right to prescribe and the treatment is immediately necessary to save a life, avoid serious deterioration in health or alleviate otherwise uncontrollable pain or distress.
A small number of Wessex GPs have been contacted by the NHS Counter Fraud Service about prescriptions written for family members. This is partly because treating family members is not ideal but also because a common way for doctors to obtain drugs by deception is to issue a prescription in the name of a family member.
The Counter Fraud Service therefore target prescriptions written by doctors for patients with the same surname or home address. Although most such prescriptions are innocent (e.g. for antibiotics) the issue can cause embarrassment, as Counter Fraud may inform the GMC of their findings (and this has already happened in some cases).