The Prescription Dilemma

Kathryn Davis – Medical Directions – The Accreditation Specialists

Nearly 5000 GPs received letters recently from the Department of Health regarding their prescribing of opioids.

Your practice may face a similar dilemma…

The practice could receive an email from AHPRA requesting medical records for a number of patients.  A doctor’s name may be mentioned in the email but not as the specific doctor in question, though you may have a good idea which doctor is involved.

The email may state you have 24 hours to send the requested records. Failure to comply could cost your practice a $10,000.00 fine! They are serious about that deadline. The first thing to do is forward the email to your medical defence for clarification.  You typically receive clarification that yes, you do need to comply.

Get your skates on and email those medical records off to AHPRA!

After a week you may receive clarification that your GP now has an undertaking that they can’t prescribe Schedule 8 or Schedule 4 drugs of dependence medicines. If the GP does not agree to comply with the undertaking, a condition could be placed on their registration.

This leaves your practice in a bit of a pickle.  What happens to the GP’s patients who now cannot receive scripts for their medication from their usual GP?  This GP may have been the patient’s family doctor for many years. What happens next?

Do the other GPs in the practice see the patients? What if the other GPs are already fully booked with their own patients and cannot take on these patients? How do you then manage these patients? The doctor may also not want to take on more patients on S8 or S4 medication as this increases their percentage of patients on opioids and can risk getting a letter themselves. This situation impacts the practice as a whole.

You might tackle this situation by meeting with each GP at the practice or hold a clinical meeting, explaining what has happened, and putting together an action plan to continue the care of the affected patients.  The GP with undertakings/conditions could explain to his/her patients that they are no longer able to prescribe certain medicines.

Some patients may see the other GPs in the practice. However, the other GP prescribing practise may not have been in line with the original GP. You could have angry, upset and disgruntled patients. Unfortunately, some patients may decide to attend other practices.

What can your practice do to prepare if this happens to you? These questions and answers could form part of your business plan.

In your business plan you might have an item for a GP leaving, so why not include if a GP can no longer prescribe certain medicines? It certainly falls under risk management. Risks can include that patients may not receive the medicines they need, your practice may have patients leave, leading to loss of income for both the practice and the GP. And does it become an ethical dilemma?  Is it an ethical dilemma if other GPs in your practice refuse to see patients?

On an ongoing basis should you perform audits on your GP prescribing habits?  How would they feel about that? At what threshold level do you base the targeting?

Would this situation impact on your need to recruit additional GPs?

How is the situation affecting the GP’s mental health? Depending on the age of the GP they might decide to retire. If not, how will it affect the GP’s future career?

These questions could be suggested to your practice manager and/or directors to help guide your practice towards a solution.

This situation can occur unexpectedly, however with risk management strategies in place you can be prepared.

Leave a Reply

Close Menu