Am I right, that as an NHS patient my GP must prescribe for me whatever I want?
Under the NHS regulations your GP must prescribe for you any drugs that he or she feels are needed for your medical care. A patient is entitled to drugs that the GP believes are necessary, not those which the patient feels should be prescribed. GPs are responsible for all prescribing decisions they make and for any consequent monitoring that is needed as a result of the prescription given.
The Department of Health lists all drugs that the NHS is prepared to pay for in a list called the Drug Tariff. It is likely that most, if not all, the drugs you need are available through the NHS, however the Drug Tariff does have exceptions. Some drugs, listed in Schedule 11 will only be offered on the NHS to patients suffering from specified conditions.
Similarly, some products other than drugs, such as gluten free foods or sunblocks, are listed as ‘Borderline Substances’ and may only be prescribed at NHS expense in defined circumstances. Other drugs or substances, listed in Schedule 10, cannot be prescribed at all on the NHS, these include Evening Primrose Oil, many vitamins, bath preparations, cough syrups and expensive brand names of some drugs.
If a drug is not available on the NHS, can my GP write me a private prescription for it?
Any doctor can write a private prescription for a patient if they feel it is clinically appropriate and they are happy to take responsibility for that prescribing decision. Under the NHS regulations, a GP or his deputy can write a private prescription for a patient but cannot charge the patient for writing a private prescription if the patient is registered for NHS care with that GP or any other GP in the same practice.
The only exceptions to this rule are when an NHS GP writes either a private prescription for:
- Drugs which are being issued solely in anticipation of the onset of an ailment whilst outside the UK, but for which the patient does not require treatment when the medicine is prescribed.
- Drugs issued for the prevention of malaria.
Can my GP supply me with drugs directly rather than going to a pharmacist?
The supply of drugs in the NHS is highly regulated. NHS prescriptions must be dispensed at pharmacies except where a doctor has been granted permission to be a dispensing doctor. This is most likely to happen when there are few, if any, pharmacies in a rural or semi-rural area. The area is then known as a ‘Controlled Area’ and a dispensing doctor is allowed to supply drugs to named patients who live more than one mile from a pharmacy.
Many dispensing doctors can only dispense to some of their patients depending on the position of a pharmacy. All patients have the right to take their prescription to a pharmacy of their choice if they wish to do so.
Malaria chemoprophylaxis - The Department of Health has issued guidance that medication for malaria prophylaxis may not be reimbursed under the NHS and so this should be prescribed privately. A GP may make a charge for the provision of prescriptions for malaria tablets if these are not available ‘over the counter’ at a pharmacy.
A GP, even a dispensing GP, is not allowed to sell any ‘over the counter’ medicines.
Can my GP refuse to give me a prescription that my consultant asked them to provide?
Yes, your GP may refuse because the person who signs the prescription is legally liable for the prescribing and the consequent effects of that drug.
Some drugs which may be very familiar to consultants in a specialised area of medicine can be potent drugs of which a GP will have little experience (for example many cancer drugs or specialised treatment for diseases such as rheumatoid arthritis – the group called ‘biologicals’). Where a GP considers that it is inappropriate for them to issue a prescription on the advice of a third party, responsibility for provision will rest with the doctor making the recommendation.
As part of the 2017-18 NHS standard contract for secondary care trusts, new requirements on hospitals has been placed to reduce inappropriate bureaucratic workload shift onto GP practices. As a result, the GPC has published template letters in the event that hospitals are not implementing the changes, as well as template letters to CCGs to highlight where there has been a breach of the standard contract, for the CCG to take action.
A friend’s GP wrote them a similar prescription on a consultant’s advice, why won’t mine? I think this is discriminatory.
Each GP will make prescribing decisions based on what they are or are not prepared to take clinical responsibility for. Some doctors might have special training or knowledge of a particular area of medicine which makes them comfortable to prescribe and monitor a drug where many GPs would not.
Clearly, a GP should be aware of their limitations as well as their skills and must ensure that they are not prescribing beyond their knowledge or their ability to ensure patient safety.
GPs are not obliged to provide every possible medical service to their patients, only those for which they have been contracted for, and these contracting arrangements may vary between practices.
What is a shared care agreement?
Sometimes the care of a patient is shared between the two doctors, usually a GP and a specialist. There should be a formalised written agreement/protocol setting out the position of each, to which both parties have willingly agreed, which is known as an ‘shared care agreement’. It is important that patients are involved in decisions to share care and are clear about what arrangements are in place to ensure safe prescribing.
In some cases, a GP may decline to participate in a shared care agreement if he or she considers it to be inappropriate. In such circumstances the consultant would take full responsibility for prescribing and any necessary monitoring. Guidance covering these issues was published in 2018, on the NHS England website.
I live abroad for six months of the year and my GP has refused to give me a prescription.
The NHS accepts responsibility for supplying ongoing medication for temporary periods abroad of up to three months. If a person is going to be abroad for more than three months then only a sufficient supply of his/her regular medication should be provided to enable them to get to the destination and find an alternative supply.
NHS prescriptions must never be obtained by relatives or friends on behalf of patients who are currently abroad, irrespective of such factors as owning a house in the UK or paying UK taxes. Patients are responsible for ensuring that any drugs they take into a country conform to local laws.