Working with colleagues

Secondary care

Transferring a patient between primary and secondary care can sometimes lead to problems. Typically, this might involve a patient going to see a consultant and being prescribed a specialised drug, and then coming to the GP for repeat prescriptions of the drug.

Successfully managing this transition relies on good communication and clear lines of responsibility. In particular, the doctor who signs the prescription has legal responsibility for prescribing. You should be sure that the treatment is appropriate, in the best interests of the patient, that the benefits outweigh the risks, that any necessary monitoring is in place and that you and your patient understand the possible side effects. If you feel unhappy about prescribing a particular drug, then don’t prescribe it.

Discuss the matter with the consultant, more senior colleagues and your trainer.

One way forward is to develop a shared care protocol. Under this, a GP would normally be invited to participate in a shared care scheme. If the GP does not wish to participate, clinical responsibility for the patient for the diagnosed condition would stay with the specialist.

If the GP decides to participate in a shared care scheme, clear responsibilities are set out for the specialist, the GP and the patient. For the GP, this might include ensuring that systems are in place for the prescribing and possibly administering of any medication, any monitoring that is required, and where to report adverse events or go for advice.

Primary care trusts

Most PCTs will have a prescribing adviser or pharmacist, who is likely to be involved with both the clinical and financial sides of prescribing. There may be local formularies, guidelines and protocols.

They can be a useful source of information and advice – for example, if you face a problem with shared care (when a specialist drug prescribed by a hospital consultant has to be continued in the community).

Nurses

If a nurse queries a particular prescription, make sure that you check it carefully. They may occasionally ask you to write out a particular prescription for a patient.

As you are responsible for the prescription, put yourself in a position to judge whether it is clinically necessary, and record details of the prescription and any consultation in the patient’s notes.

Pharmacist

Local pharmacists can be a valuable resource. If they ring up querying a prescription, check the prescription carefully. Pharmacists can help in a number of other ways. These include:

• Helping patients understand how to take their medication.
• Medication reviews for patients with long-term conditions.
• Filling dosette boxes for patients on multiple medications.

Uncollected prescriptions

Prescriptions that have not been collected from the practice or pharmacy should be returned to the GP for review before they are destroyed, to help monitor patient compliance. Your practice might have a system to review these, eg, indicating on a patient’s records that they have not collected their prescriptions. Sixty eight per cent of practices visited by MPS in 2009 did not monitor uncollected prescriptions.