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Introduction
The rights of general practitioners (GPs) to prescribe medicines to their patients in the context of the National Health Service (NHS) in England have been well described.1 2 There are, however, competing demands that prescribers in primary care are required to balance. A GP’s terms of service impose a duty to prescribe on the basis of need (‘a prescriber must order any drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under the Contract’).3 On the other hand, the General Medical Council (GMC) acknowledges that doctors ‘must make good use of the resources available to you, and provide the best service possible, taking account of your responsibilities to patients and the wider population’.4 This article explores how primary care prescribers in England are being encouraged to address resource management issues by limiting prescribing of certain drugs.5 I do not consider parallel guidance on the restriction of over-the-counter items.6
Background
An early example of restricting the availability of medicines in primary care came in November 1984 when the Secretary of State announced his intention to limit the range of drugs that GPs could prescribe.7 Opposition to this proposal, from the medical profession and the pharmaceutical industry, resulted in a Limited List that restricted prescribing of expensive brands of medicines within seven categories of symptomatic remedies (antacids, laxatives, analgesics used for mild-to-moderate pain, cough and cold remedies, bitters and tonics, vitamins, benzodiazepine tranquillisers and sedatives).8 9 Following this, a Green Paper on primary healthcare suggested further measures to address GP prescribing including extending the range of products available without a prescription, promoting the use of local formularies and encouraging GPs not to prescribe when unnecessary.10
These and other attempts to restrict prescribing in primary care have resulted …
Footnotes
Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).
Provenance and peer review Commissioned; externally peer reviewed.
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