At the LMC we receive queries relating to prescribing which cover a number of aspects.
The contractual requirement to prescribe as specific medication as well as the suitability for prescribing in general practice. Below is our stance and advice regarding some of the issues which have come up recently.
This will not in all cases be the same as the TAG stance. If you have any queries please do email us to understand more.
Prescribing is complex and one answer does not fit all scenarios so please email us for advice on how to deal with the specific situation you are faced with.
In most circumstances you should be making a patient specific decision rather than having a blanket practice policy.
These drugs have been discussed at TAG and have been given the classification of
Green Advice - GP prescribable after Consultant/specialist recommendation where the specialist is a Smoking Cessation Adviser (Level 2 or 3).
Specialist is a Smoking Cessation Adviser (Level 2 or 3), as an option for use as monotherapy in smoking cessation in adults, for a 12-week treatment period only, with no return to the Smoking Cessation Service within 6 months.
The advice of the LMC to TAG was that these should have been Green as GP’s do not need the advice of a ‘specialist’ to prescribe these drugs.
The use of the term ‘specialist’ in this case is also not in line with other drugs classifications as Smoking Cessation Advisors Level 2 or 3 will not be prescribers and therefore not qualified to give prescribing advise.
Practices providing Smoking Cessation under a Public Health Contract
If you provide smoking cessation services within your GP practice under the Public Health enhanced service, it is likely that the patient will be seen and assessed by an HCA or Nurse who is trained to as a Smoking Cessation Advisor to Level 2 or 3.
They may request you prescribe and highlight that they believe (following their smoking cessation training and consultation with the patient) that it is a suitable therapy for the patient. This does not mean that you will be prescribing solely based on their advice.
They are not a prescriber and therefore it is your responsibility as the prescriber to review any contraindications and interactions before prescribing.
This is completely acceptable where it is part of a service you are commissioned by Public Health to provide to your patients.
Practice not providing Smoking cessation and requests from other providers
However, there should be no expectation that if any other primary care / community smoking cessation provider reviews the patient you will carry out any prescribing on their behalf.
We would encourage all practices to push these requests back to the alternative provider, as they are an uncontracted transfer of workload.
The TAG classification does not change this. The TAG classification means that you are able to, if you so wish, prescribe when suggested to do so by your own staff (or a hospital clinician for patients started on treatment as an inpatient) but you have NO obligation to do so. If you do so, you would need to satisfy yourself that the prescriptions can be provided as part of a required behavioural support programme.
Patients seen by Reed Wellbeing, Smokefree Norfolk or a Community Pharmacy, under their contracted services should be issued the medication by that provider, not under a prescription issued by a GP on their behalf. Any request for the GP to prescribe should be politely returned to them, with the advice that this request return should be advised to their Service Leads for further discussion with the Commissioner. We have been advised that some advisors are stating that the practice receiving the request ‘are the only one’ not undertaking their requests – this is incorrect information designed to achieve the practice cooperation with their request.
to follow