I was looking for some information about the legal and ethical duties of everyone involved in prescription medicines and found this document:
GPC - General Practitioners Committee
Prescribing in General Practice
Or, in short form:
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?
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.
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?