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Limiting drugs prescribed in primary care
  1. Michael Wilcock
  1. Pharmacy, Royal Cornwall Hospitals NHS Trust, Truro, UK
  1. Correspondence to Michael Wilcock, Pharmacy, Royal Cornwall Hospitals NHS Trust, TR1 3LJ Truro, UK; mike.wilcock{at}nhs.net

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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 …

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.