Medication

Controlled Drugs

Under the Misuse of Drugs Act (1971) and the Misuse of Drugs Regulations (2001), GPs have a responsibility for controlled drugs (CDs) within their practice. 

The police can enter practices and inspect CD registers. An accountable officer, appointed by the CCG, has the right to visit a practice unannounced to review the storage and records relating to their use. 

The Misuse of Drugs (Safe Custody) Regulations (1973) state that all schedule 2 (eg, opiates) and some schedule 3 (eg, temazepam) drugs should be stored in a cabinet or safe, locked with a key. The cabinet should be made of metal and fixed to the wall or floor. A designated person at the practice should be nominated as responsible for the CDs and appoint key holders. The keys should be kept in a safe place and no unauthorised members of staff should have access to the keys, eg, a locum. For home visits doctors should carry CDs in a lockable bag.

Controlled drugs register

Any practice storing CDs should have a CD register. This can take the form of a bound book or an electronic form. These must be kept for at least two years and, for each drug, you must record:

• the date the supply was obtained
• the name and address from whom it was obtained (eg, wholesaler, pharmacy)
• the quantity of ampoules obtained

• running balances of each drug
• the prescribers identification number and/or the professional registration number of the prescriber (where knwon)  

Repeat prescribing for GPs

Medication errors regularly occur in general practice and many of these are preventable. Extra care must be taken when repeat prescribing, especially if you were not the original prescriber and have not seen the patient. 

The legal responsibility for prescribing lies with the doctor who signs the prescription. This responsibility is the same whether it is a first or repeat prescription. It is important to be aware that the person who signs the prescription will be held accountable should something go wrong.

If you prescribe at the recommendation of a nurse or other healthcare professional who does not have prescribing rights, you must be satisfied that the prescription is appropriate for the patient concerned.

The GMC guidance on Good Practice in Prescribing and Managing Medicines and Devices (2013) states that before signing a repeat prescription you must be satisfied that it is safe and appropriate to do so and that secure procedures are in place to ensure that:

• the right patient is issued with the correct prescription
• the correct dose is prescribed, particularly for patients whose dose varies during the course of treatment
• the patient’s condition is monitored, taking account of medicine usage and effects
• only staff who are competent to do so prepare repeat prescriptions for authorisation
• patients who need further examination or assessment are reviewed by an appropriate healthcare professional
• any changes to the patient’s medicines are critically reviewed and quickly incorporated into their record.

Sessional GPs and prescribing
GPs in a practice will normally take turns to sign repeat prescriptions. One recurring problem with repeat prescribing is that the initial error is repeated, and compounded. A GP with a fresh pair of eyes is in a good position to spot potential problems that a colleague may have skipped.

Suitable drugs
Care should be taken with any drug that is added to a repeat prescribing list. However, some drugs lend themselves more readily to a repeat prescribing approach, such as antihistamines, which require minimal levels of monitoring. Drugs that are not suitable for routine repeat prescribing include hypnotics, antidepressants and disease modifying agents, eg, immunosuppressives.

Informing patients and follow-up

Make sure patients are aware of: