The following case is fictitious but based on the types of calls we receive to the MDU advice line.
A GP was concerned about her father, who lived in Turkey. He had heart disease and had run out of his losartan medication. A Turkish doctor had prescribed the losartan but the pharmacist had not been able to dispense it because of supply issues.
The GP recognised that her father was not eligible for NHS treatment and so planned to write a private prescription for a 12 month supply of losartan, which her brother could deliver when he travelled to Turkey for his annual holiday. One of the GP's partners at her practice had expressed some reservations about the plan and had suggested she contact the MDU for advice.
The MDU adviser explained that while writing a private prescription for the medication was not unlawful, the GP should consider the GMC's guidance on prescribing, which says that, "wherever possible, you must avoid prescribing for yourself or anyone you have a close personal relationship with."
The adviser acknowledged that the father's own doctor had recommended the medication but explained that ultimately the GP would be prescribing for her own father. If she chose to prescribe, she would need to make a careful record that included mention of her relationship to the patient and the reason it had been necessary to prescribe. The adviser noted that the GP was proposing to prescribe a quantity of medication that would last a year and not simply an emergency supply.
The adviser also pointed out that the GP would be prescribing remotely for a patient living outside the UK. The GMC guidance stipulates that if the GP did prescribe in this situation, she would need to consider how she or the local doctor would monitor her father's condition - and given that her father was resident in Turkey, she would need to consider whether she had adequate indemnity in place, or whether she needed a licence to practice in Turkey. She would also need to follow UK and Turkish legal requirements with regard to any issues that might arise around import and export of medicinal products.
Dispensing pharmacists might question prescriptions written for large quantities of medication or for patients who appeared to be family members, and could raise any concern with the GMC. The adviser explained it was therefore important the GP felt able to justify her decision to prescribe in line with GMC guidance.
After discussing the dilemma with the MDU adviser, the GP decided that she ought not to prescribe for her father in this situation. She decided instead to encourage him to speak to his own doctor about alternative medications that could be sourced locally and therefore prescribed, dispensed and appropriately monitored in Turkey.
For more member dilemmas and to find out how we helped, read this year's Cautionary Tales on the MDU website.