The scene

A doctor and his family had moved house so that he could take up a new position as a specialty trainee in intensive care medicine.

His wife had run out of her usual repeat prescription for citalopram. She had ordered it from her GP in the usual way, and it had been dispensed to the pharmacy close to their previous home, which was now 25 miles away.

She had taken her last tablet on Friday evening and then realised she had run out, so her husband wrote a private prescription for her usual 28-day supply of citalopram tablets and presented this to a local high-street pharmacy on Saturday.

When the pharmacy assistant asked for some information about the handwritten private prescription, the doctor explained he had issued this for his wife, and about the recent house move. The assistant asked him to return in the afternoon for the medication.

That afternoon, the doctor's wife popped into the pharmacy to collect her medication, but the pharmacist on duty said she was unable to dispense the medication because she had concerns about the prescription.

The doctor was irritated to hear this and went to speak to the pharmacist himself. He explained that because he was a fully registered and licensed doctor, the prescription was valid and the pharmacist was therefore obliged to dispense it.

The conversation became confrontational. The pharmacist said she wasn't obliged to dispense the prescription as she had concerns about the doctor prescribing for a member of his own family.

The doctor replied that that this was an emergency – his wife had run out of her medication, and it was a weekend – but the pharmacist countered that all patients could access medication at the weekend using established pathways, such as the GP out-of-hours service via 111.

The doctor said this wasn't necessary as he was able to prescribe it for her and repeated his request for the prescription to be dispensed. The pharmacist refused, saying she was keeping a copy of the prescription to have a record of the doctor's GMC number. The medication was not dispensed.

The doctor was upset and frustrated following the incident. He felt embarrassed that the confrontation had taken place in front of other customers and was irritated that the pharmacist had refused to dispense a legitimate prescription, which he felt sure he was lawfully entitled to write.

He was also troubled by the focus on his GMC registration number, which he felt was also inappropriate. He felt inclined to pursue a formal complaint with the pharmacy but decided to call the MDU and seek their advice.

Our advice

The MDU adviser shared the doctor's concern about the way the conversation with the pharmacist had ended but acknowledged that pharmacists can exercise their own professional judgement and are not obliged to dispense a medicine if they have concerns. While the doctor was correct in that that he was lawfully¹ able to write a private prescription for his wife, doctors must also be aware of professional guidance relating to prescribing.

The GMC can begin an investigation where it appears that a doctor has prescribed for themselves or anyone close to them in circumstances that did not warrant it. This remains the case despite the prescription being in accordance with the law. It is the MDU's experience that concern can sometimes arise from the issue of a single prescription for a close family member.

The adviser and the doctor discussed the published GMC guidance, which makes it clear that doctors must avoid prescribing for themselves or family members "wherever possible". The adviser explained that to justify prescribing for a family member, it would be important to make sure all other available options for obtaining a prescription from a professional unrelated to the patient had been explored.

If such an exceptional situation arose, then the GMC would expect doctors to ensure they had enough information about the patient's health to be able to prescribe safely. They would also need to make a contemporaneous record, which should include their relationship to the patient and why they needed to prescribe. The patient's own GP should be informed.

The adviser said that in most circumstances where doctors had issued private prescriptions for family members, they had done so with the very best of intentions, and to be helpful – but that it could often be hard to justify these actions when the professional guidance was considered.

The doctor said he had not considered the GMC guidance relevant to this situation, as his wife was already taking the medication and he was in effect issuing a 'repeat' prescription. However, he acknowledged that the guidance is relevant to all prescribing, and that there had been other ways that his wife could have accessed her medication supply at a weekend.

If she contacted the on-call primary care service, an independent prescriber would have had access to her medical records, been able to issue a prescription to the local pharmacy and updated her own GP. He acknowledged that this was the course of action suggested by the pharmacist. While the prescription had not been dispensed, he remained concerned that the pharmacist might raise a concern with the GMC.

The outcome 

The adviser and doctor agreed that further contact with the pharmacy was not likely to be helpful, and whether the pharmacist raised concerns formally was a matter for her discretion.  

The adviser reassured the doctor that the MDU was well placed to support and assist him if he was required to provide an account of events, explaining that it would be important to be able to demonstrate that he had reflected on the GMC guidance.  

He might wish to discuss the events of the weekend with his clinical supervisor and record the outcome and what he had learned in his portfolio. This would serve him well if there was an enquiry from the GMC about the prescription he had presented at the pharmacy. The adviser finished by reassuring the doctor that the MDU would be here to help him if he was contacted by the GMC.