No, particularly in respect of controlled drugs. It poses serious risks of dual prescribing, clash of prescribing, it increases the potential for a patient to misuse prescriptions and risks confusion in the event a patient attends hospital. There are therefore likely to be very few cases where this is justifiable.
Good Medical Practice includes paragraphs that are likely to arise in any such situations. Paragraphs 16 and 35 require doctors who prescribe drugs or treatment to do so effectively and to consult colleagues and ensure that the treatment provided is compatible with any other treatments the patient is receiving. Paragraph 44 of GMP requires a doctor to share all relevant information when they are transferring patients and this applies within and outside any care team. The GMC Guidance ‘Good practice in prescribing and managing medicines and devices’ also includes explicit reference to ensuring a doctor is fully apprised of a patient’s history and (at paragraph 32) that a GP must be informed at the end of an episode of care about changes to medicines.
There may however be relevant issues in relation to protecting a patient’s privacy. A patient may object or there may be considerations which override a patient’s sensitive information being shared. In those circumstances the guidance is that a doctor must consider whether they can safely prescribe and should speak with the patient about consents.
Some of these issues arose in the case of Dr W who over a period of 5 years issues more than twenty prescriptions to one patient without informing the patient’s GP. Dr W promptly and fully admitted that he had done so and admitted related failures in relation to not availing himself of proper information about current prescriptions, relying on a questionnaire and not a diagnostic test, and not considering the possibility of abuse or addiction by the patient.
The expert evidence in the case from two GP’s largely agreed that most of Dr W’s conduct fell ‘seriously below standard’ and ‘below standard’ in the remaining matters. Dr W had previously been issued with Rule 8 advice from the GMC about prescribing only months before the start of incidents in question. Dr W was a very experienced doctor in private practice and was highly regarded and respected for his work. Though he knew the patient’s relations with her GP were at a time poor he only acted with the patient’s best interests at heart. The patient had major symptoms for many years and he was desperate to find a solution. He explained that this was why he acted below the required standards.
In terms of sanction Dr W’s registration was made subject to conditions which included his having a work place reporter and a personal development plan to improve his safe prescribing and colleague information sharing practices. He had already undertaken significant remediation and enacted improvements by the time of the hearing but the Tribunal found his fitness to practise was still impaired. A review hearing was also listed, the conditions were amended some 4 months after the first hearing because of a lack of a reporting officer, they were extended by agreement over a year later and then revoked altogether some 1 year and 10 months later.
Please contact us for any direct advice on any fitness to practise matter, the general comments in this case review cannot be relied on as specific legal advice.
