BMA GPC - General Practitioners Committee - Prescribing in General Practice

[helvella]

I was looking for some information about the legal and ethical duties of everyone involved in prescription medicines and found this document:

BMA

GPC - General Practitioners Committee

Prescribing in General Practice

May 2013

bma.org.uk/-/media/Files/Wo...

Or, in short form:

tinyurl.com/TUK-HU-BMAP

It refers to many of the issues that have arisen here on HU/TUK.

Drug switching would appear to include changing a patient from T3 to T4. Which can ONLY be done in the patient's best interests. So how come we have seen so many stories of patients being denied T3 and effectively forcibly switched when it has been purely a funding issue?

Drug switching

The GPC is aware that in some areas practices are being encouraged by their PCO to switch patients from one drug to a less expensive drug. The prescriber must assess each patient individually when taking the decision to change a patient’s medication. Any changes must be made in the patient’s best interests and must be fully explained to the patient.

We have also seen quite a number of cases where an endo has prescribed something (T3 or even desiccated thyroid) but the GP has refused to prescribe it. Clearly it is the duty of the GP to refer back to the specialist. And absolutely NOT to point blank refuse the patient without doing so.

Non-GP prescribing

When a non-GP prescriber initiates a new drug they accept responsibility for that prescription, but they usually have no method of reissuing repeats and that responsibility invariably falls on GPs. When faced with a request from the patient for a repeat prescription, GPs should review the patient and set up a repeat prescription if appropriate or refer the patient back to initial prescriber.

Good working practice would advise that anything prescribed for long term prescription should be notified to those likely to continue the medication (i.e. the GP). The responsibility for checking interactions remains with the prescriber who should take a full drug history if they do not have access to the main clinical record.

And this old chestnut. In the example they even mention thyroxine specifically as being suitable for 6 month prescribing!

• Is there a standard prescription interval?

Doctors provide prescriptions for intervals that they feel are clinically appropriate, taking into account such factors as possible reactions, a possible need for a change in prescription and consequent waste of NHS resources, patient compliance, and any necessary monitoring. Sometimes a doctor may give six or even twelve months supply on one prescription (for example the contraceptive pill, or thyroxine with a regular review in surgery once the patient is safely stabilised). This is cost-effective and patients often prefer it. A recent report on prescribing durations recognise that blanket instructions to only give 28 days supply are associated with significant increases in dispensing and other transaction costs, together with reductions in compliance in previously stable patients, and an increase in dissatisfaction amongst patients because of travel costs and time to obtain regular medicines. It can also place significant and unnecessary workload on the doctor and surgery staff.

I do wonder how many GPs have even read this document? Or followed the links from it?

Rod

[Coastwalker]

Hi Helvella,

Have noticed that you are very good at finding out links,documents important and medical information.

Is there any chance you could help us please by taking a look at a posting I posted yesterday and recently updated today - under post -

'Is this Child's symptoms Thyroid related please' ?

After reading it could you suggest any 'safe' avenues to go down to get this child the help it needs to get proper medical help. We just don't know what to do next or where to go for help.

Bone Doctor made an urgent referral onto paeds team at hospital because he wrote in his letter to child's local Doctor that he is concerned there maybe a connection to a Pituitary abnormality causing both increased overgrowth or part of the obesity. No appointment was ever sent through, what followed is more unbelievable.

Could you kindly read the story and advise us further if you can please Helvella. ?

[helvella Administrator in reply to Coastwalker]

I have commented there.

[Coastwalker in reply to helvella]

Thank you Helvella, well done and thanks.

[Hidden]

A very interesting read.... I am due for a long awaited T3 test in February and was hoping it might be that a little T3 may be what is needed to help me feel better.

However,still have a while to wait yet to find out and also the inevitable question......If It is recommended,will I get it?

I also read an article this evening via NHS Choices..........Under Active ( Hypothyroidism) - Treatment.

I was interested in the line....You will initially have regular blood tests until the correct dose of levothyroxine is reached.

I wondered how many this happens for,when so many report being under treated for many years?

[RedApple Administrator in reply to Hidden]

The problem is with the interpretation of until the correct dose of levothyroxine is reached. Typically, the average GP thinks that simply getting your TSH 'within range' is when the correct dose has been reached. Whereas the proper interpretation should be that the correct dose is reached when the patient no longer has symptoms.

[Hidden in reply to RedApple]

Thanks for this Red Apple,.........I take your point.

In my own case .....I was diagnosed " Yes,you are slightly underactive " ....given 50mcgs Levo and not tested for another year!.......At the annual check up and each year was told there was nothing wrong with my thyroid even though I didn't feel good.....this began in 2002.

Of course, I didn't have the support and knowledge of TUK then so don't know what those readings were.

All this makes me grateful for what I have learned since joining this group. X

[Polaris]

Very many thanks for this Rod.

My daughter has just been given 'warning' by her GP that she may not be continuing to prescribe T3 in the future. My daughter was prescribed T3 years ago after careful consideration by Dr Skinner as being the very best best option for her in her battle to return to optimum health.

My daughter, a much calmer personality than me, did not react - probably wise - but this information will, hopefully, help to build a case if they do try to change her medication to T4.

[edysia2]

Who does DIO2 tests ? Are they accurate?

Ex

[RedApple Administrator in reply to edysia2]

thyroiduk.org.uk/tuk/testin...

[edysia2 in reply to RedApple]

Thank you for the link . E x

[edysia2]

Thanks. Just asking.

[Polaris]

Have only just seen this. Many thanks for this advice.