The scene

An endocrinology consultant was overseeing the treatment of a 40-year-old woman who had been diagnosed with mild Graves Disease the previous summer. The patient started a 12-month titration regime of carbimazole, which would be reviewed every six weeks initially. However, shortly afterwards she moved to another part of the country to take up a temporary job and was unable to return because of the pandemic.

The patient was reluctant to register with another GP practice and continued to contact the endocrinologist by email to request repeat prescriptions. She usually did this a few days before her supply ran out. When asked, the patient assured the doctor that she had no adverse reaction to carbimazole and ignored requests to attend her local hospital for thyroid function tests.

After twice sending FP10 prescriptions to the patient, the endocrinologist contacted the MDU because he was worried about the implications of continuing to prescribe, without being able to assess the patient.

MDU advice

The MDU adviser sympathised that the doctor had been placed in a difficult position and agreed he was right to be concerned, as he was responsible for every prescription he signed.

The adviser drew the doctor's attention to the GMC's prescribing guidance, which included relevant sections on safe remote and repeat prescribing. They discussed the difficulties of repeat prescribing safely from a distance without arrangements in place for another suitably qualified healthcare professional to monitor the patient. The doctor recognised this was a particular risk given the drug regimen the patient was on and the fact she was still of child-bearing age.

While it was impossible for the patient to travel back for a face-to-face consultation, the adviser suggested that the doctor talk to his head of department about alternatives, such as transferring the patient's care to another hospital trust or making a shared care arrangement with a local GP practice. The doctor resolved to explore these options and to explain the situation to the patient.

The outcome

After seeking the opinion of his department lead, the endocrinologist contacted the patient to say that it was unsafe for him to issue her further prescriptions without a review, given the potential risks and side-effects of her medication.

The endocrinologist explained that as it was difficult to predict when the patient would be able to return home, she would need to register as a temporary resident with a local GP practice so her condition could be properly monitored.

Once the patient had registered at a practice, the endocrinologist wrote to propose a shared care arrangement. He included relevant details about the patient, her medication and the monitoring required. The practice agreed to this approach and arranged for the patient to have a review and blood test, which was within the normal range.

When lockdown restrictions were eased, the patient returned home and the endocrinologist resumed responsibility for her treatment.

Remote prescribing

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