Monitoring the situation

The scene

A 63-year old council worker was being treated by his GP for diabetes mellitus, first diagnosed when he was in his early 50s. He had last been seen for a diabetic review over two years earlier when he had reported reduced sensation in a glove and stocking distribution. Meanwhile, he had continued to request and receive his regular medication.

His GP practice regularly added messages to the repeat prescriptions, and had contacted him by phone, asking him to make an appointment for a diabetic review. Indeed, the patient had made an appointment but had not kept it. His GP was concerned about the implications of continuing to prescribe for him without review and rang the MDU for advice.

MDU advice

The MDU adviser agreed that this was a difficult situation. The GP had no medical concerns regarding the patient except for his diabetes, and it was reasonable to assume that he was competent and could therefore consent to or decline treatment.

GMC guidance in Good Practice in Prescribing (2008) states that ‘arrangements for issuing repeat prescriptions should include suitable provision for monitoring each patient’s condition and for ensuring that patients who need a further examination or assessment do not receive repeat prescriptions without being seen by a doctor.’

A patient who repeatedly defaults from review must be followed up, the adviser explained. The patient’s capacity to decline treatment should also be assessed and documented, and sufficient information provided to ensure that they are fully informed of the risks and benefits of monitoring.

In this case, the adviser suggested that in the first instance the GP contact the patient herself to discuss the management of his diabetes, and to explain the benefits of attending for a regular review and the risks involved in both the short and long term if he chose not to attend.

She could also consider writing to him if she was not able to speak to him directly. Importantly, she should make a detailed entry in the patient’s medical record of her attempts to contact him and the content of any discussions which did take place.

Ultimately, if the patient still declined to attend for review then the GP should consider whether she wished to continue to prescribe for him. It would be necessary to conduct a risk assessment balancing the risks of continuing to prescribe for the patient in the absence of any monitoring against the risks of withdrawing treatment.

This page was correct at publication on 01/08/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.