Donnington Medical Partnership - Medication Policies

Duration of prescriptions

The Oxfordshire Integrated Care Board (who sets policies for Oxfordshire GPs) has instructed GP practices that prescriptions should normally be provided for one month at a time. Sometimes a slightly longer supply may be appropriate at the discretion of the GP.

Certain medications that are “Controlled drugs” (including ADHD medication and opioids such morphine) or medications such as Methotrexate can only be prescribed for 1 month at time.

The maximum amount of medication that can be issued to patients travelling abroad is 3 months’ worth. This is for stable medications that do not require monitoring and is also at the discretion of the GP.

Specialist medications

Doctors working in other settings (i.e. hospitals, Mental Health teams) frequently suggest the use of specialist medications which they may ask GPs to prescribe. Following a specialist appointment, they may send a letter to the practice. The practice then has 14 days to review the letter and decide whether the medications recommended are suitable for GPs to prescribe. 

Medications that need to be started urgently (within 14 days) are the responsibility of the hospital.

There is no obligation for GPs to prescribe a medication that was recommended by or started by another clinician. A GP must be satisfied that any prescription is safe and appropriate, in line with NHS guidelines and their prescribing competencies. 

Some specialist medications (e.g. stimulants for ADHD and immunosuppressants) require a “shared care agreement”. This allows GPs to prescribe specialist medications under the oversight of a specialist, who continues to review the patient’s treatment on an ongoing basis. 

Although there are established local shared care agreements with NHS specialists, these are not in place for private prescribers and so we do not accept shared care agreements with private specialists. This means that any medication requiring a shared care agreement that is initiated by a private clinician will need be prescribed directly by that private clinician.

If specialist care is accessed privately, it is the responsibility of the private clinician to provide prescriptions. Medications started privately will only be continued to be prescribed by a GP if they are:

a) in line with NHS treatment guidelines
b) in line with the local prescribing policy
c) are deemed to be safe and appropriate for the patient being treated
d) might normally be prescribed by a GP (i.e. not a specialist medication or one requiring Shared care)
e) The GP feels it is within their competency

Stimulants for Attention Deficit Hyperactivity Disorder (ADHD) in adults

Stimulants (e.g. lisdexamphetamine [Elvanse] and methylphenidate [Medikinet/Xaggitin/Concerta/Delmosart]) are specialist medications used to treat ADHD. 

These medications are always started by an ADHD specialist and require continued monitoring and review by specialists in accordance with national guidelines. GPs sometimes prescribe these medications as part of a “Shared care agreement” where a GP agrees to provide a prescription for a medication that is monitored by a specialist.

GPs in Oxford have previously had shared care agreements with the NHS Oxfordshire ADHD services, but patients are now not being regularly reviewed in clinic, as is required by national guidelines. This means that these are effectively no longer shared care, and that GPs take on the risks of prescribing medications that are outside of their competencies.
Because of these issues Donnington Medical Partnership is not taking on shared care agreements for stimulant medications for any new patients starting these medications with local NHS services. We also do not take on shared care agreements with private providers (see above). This means that stimulant medication prescriptions must be provided directly by specialist services (either NHS or private).

Prescriptions started abroad

As with private prescriptions, prescriptions started abroad will only be issued by a GP if they are: felt to be in line with NHS treatment and local prescribing rules, safe and appropriate for the patient, and suitable for a GP to prescribe.

Benzodiazepines and Z-drugs

Benzodiazepines (diazepam [Valium], alprazolam [Xanax], lorazepam, clonazepam temazepam etc) and Z-drugs (zopiclone and zolpidem) were previously commonly used for sedation, anxiety and insomnia. However, medical treatment has now moved away from these medications because of the risk of dependence, addiction, abuse and overdose. 

Alternative medications or non-drug treatments are usually more appropriate. These will only be considered in exceptional circumstances and are only suitable for short term use. Any such prescription is at the absolute discretion of the prescribing clinician. We do not replace lost prescriptions for these types of medications.

Sedation for procedures

We do not prescribe sedation for procedures performed elsewhere (e.g. dentist or hospital treatment). The appropriateness of sedation must be assessed by the clinician performing a procedure, and any prescription required must be prescribed by them.

Sedation for flying

We do not prescribe sedation for flying. This is a common policy in GP practices and is due to the risks involved (sedation makes it difficult to respond to emergencies and increases the risk of blood clots). It also goes against prescribing (BNF) and treatment (NICE) guidance. Cognitive behavioural techniques are the recommended treatment for fear of flying, this website provides some of the resources available https://thefearofflying.com/

Domperidone for breast feeding

Domperidone is recommended by some breast-feeding services to increase milk production. Domperidone is “block listed” in the Oxfordshire formulary due to lack of evidence of benefit and an association with potentially fatal heart rhythm problems. This means that it should not be prescribed by GPs and we do not prescribe it at the surgery.