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Secondary prescribing for patients being treated for substance misuse

You will be aware that services for patients with substance misuse ( drugs and alcohol) have been re-commissioned by the local authority public health department, with a single contract now being held by an organisation called CRI, rather than through individual contracts with the Mental health Trustand with each practice( although practices will continue to provide services under subcontracts with CRI).

This issue is, however, a matter which of courseaffects every practice, not just those providing substance misuse services. One major concern which has been brought to the LMC’s attentionrelates to those patients with complex secondary mental health issues who may have been historicallyprescribed various psychotropic medications ( eg. hypnotics, other benzodiazepines, anti-depressants, anti-psychotics and other mood stabilisers etc. ) under psychiatric care, by the mental health trust. It is apparent that with the termination of the pre-existing arrangements a number of patients requiring ongoing specialist prescribing of these treatments have been inappropriately discharged to general practice with an expectation that GPs will now pick up this prescribing, as CRI are not currentlydoing so. Furthermore this has oftenbeen done without any consultation with the practices concerned. Many of these patients have complex issues where it is not appropriate for GPs to prescribe, and they may therefore legitimately decline to do so.

Dr. Martyn Hull, on behalf of all practices providing substance misuse services, recently attended a meeting with themental Health trust, CRI and Swanswell, and has advised me that the meeting was very productive, with the trust accepting the issue that prescribing was being inappropriately shiftedinappropriately onto general practice, clearly something which must cease immediately , and agreement was reached thatthis prescribing to be accommodated by CRI oncethe new arrangements commence on 1st .March . Thereafter every case must be reviewed on an individual basis and no prescribing must be shifted onto general practice without a clear indication and plan, and with appropriate communication.

It remains the case, of course, that no GP can be obliged to take on any prescribing transferred from secondary care unless they feel it is clinically appropriateand that they have the requiredcompetence and experience to take full clinical and medico-legal responsibility for the patient’s condition, in line with GMC guidelines on good medical practice, and legal responsibilities, as CQC-registered organisations, to provide safe care. Needless to say we all need to continue to monitor this situation both between now and March, and alsounder the new arrangements thereafter. If any practice is concerned about any continued examples ofinappropriate shifting of prescribing, please bring the matter to the LMC’s attention.

I am very grateful to Dr. Martyn Hull forhisinput intothis matter.

Click here to download the document "Secondary prescribing for patients being treated for substance misuse".

Dr. Robert Morley
Executive Secretary
Birmingham Local Medical Committee

36 Harborne Road, Edgbaston, Birmingham B15 3AF

Tel. 0121-454 5008, Fax. 0121-455 0758
Office email:
Birmingham Local Medical Committee
Supporting the Business of General Practice


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