Setting guidance on what not to prescribe would reduce NHS cost, especially the prescription dispensing fees.<1><2> But would it be easier to set up a national formulary on which drugs are covered or not? If a patient's clinical and social conditions warrant coverage for a non-formulary drug, then help the patient to apply for special authority access through the NHS. Now, it appears that the NHS wants the overstretched GPs to play judges, and determine which patient deserves a NHS prescription during their time-limited consultations.
It is difficult to imagine the arguments GPs need to encounter, to explain why some patients have paracetamol covered and some do not. That further recasts GPs’ role from “gatekeepers” to “barrier builders.”<3> Would GPs be legally covered if a patient suffered an ongoing illness due to failure to receive a NHS prescription?
Alternatively, why not purchase a package of paracetamol at cost, and have the salaried primary care pharmacists to dispense and counsel the patients in the GP clinics? This setup would save the NHS dispensing fees, and improve patients' understanding of medication therapies. Unfortunately, these pharmacists may be mainly used as an aid to reduce GP workload, rather than improving patients' quality of care.<4><5>
References
1. Iacobucci G. GPs call for end to “local rationing” of prescribing. BMJ. 2017;359:j5265.
2. Iacobucci G. NHS advises GPs not to prescribe “low value” drugs. BMJ. 2017;359:j5599.
3. McCartney M. Margaret McCartney: Are we reviewing GP referrals for the right reasons? BMJ. 2017;358:j4240.
4. Avery AJ. Pharmacists working in general practice: can they help tackle the current workload crisis? Br J Gen Pract. 2017;67(662):390-391.
5. Yeung EYH. Pharmacists are not physician assistants. Br J Gen Pract. 2017;67(665):548-548.
Rapid Response:
GPs to play Judge Judy
Setting guidance on what not to prescribe would reduce NHS cost, especially the prescription dispensing fees.<1><2> But would it be easier to set up a national formulary on which drugs are covered or not? If a patient's clinical and social conditions warrant coverage for a non-formulary drug, then help the patient to apply for special authority access through the NHS. Now, it appears that the NHS wants the overstretched GPs to play judges, and determine which patient deserves a NHS prescription during their time-limited consultations.
It is difficult to imagine the arguments GPs need to encounter, to explain why some patients have paracetamol covered and some do not. That further recasts GPs’ role from “gatekeepers” to “barrier builders.”<3> Would GPs be legally covered if a patient suffered an ongoing illness due to failure to receive a NHS prescription?
Alternatively, why not purchase a package of paracetamol at cost, and have the salaried primary care pharmacists to dispense and counsel the patients in the GP clinics? This setup would save the NHS dispensing fees, and improve patients' understanding of medication therapies. Unfortunately, these pharmacists may be mainly used as an aid to reduce GP workload, rather than improving patients' quality of care.<4><5>
References
1. Iacobucci G. GPs call for end to “local rationing” of prescribing. BMJ. 2017;359:j5265.
2. Iacobucci G. NHS advises GPs not to prescribe “low value” drugs. BMJ. 2017;359:j5599.
3. McCartney M. Margaret McCartney: Are we reviewing GP referrals for the right reasons? BMJ. 2017;358:j4240.
4. Avery AJ. Pharmacists working in general practice: can they help tackle the current workload crisis? Br J Gen Pract. 2017;67(662):390-391.
5. Yeung EYH. Pharmacists are not physician assistants. Br J Gen Pract. 2017;67(665):548-548.
Competing interests: No competing interests