The decision regarding which medication to prescribe ultimately lies with the prescribing clinician. It is essential to recognise that, in line with best practice standards, this decision should be made collaboratively with the patient, ensuring that their preferences, values, and concerns are considered throughout the process. This partnership approach fosters shared decision-making, empowering patients to take an active role in their healthcare.
However, it is also crucial to acknowledge the broader ethical and contractual responsibilities that clinicians face when prescribing medication. There is a moral duty to consider not only the clinical effectiveness and appropriateness of a drug but also its cost implications. Clinicians must balance these factors with the best interests of the patient, making informed choices that promote the most effective and sustainable care.
Prescribers should be prepared to justify their decisions if required. This includes being able to account for the selection of a particular medication, particularly in circumstances where cost or other non-clinical factors may influence the choice. A thorough understanding of both clinical guidelines and the economic context in which prescribing occurs ensures that clinicians can make well-rounded decisions and defend their choices if necessary.
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GMC (Good Medical Practice 2013)
1.
16. In providing clinical care you must:
b. provide effective treatments based on the best available evidence
18. You must make good use of the resources available to you.
3. You are responsible for the prescriptions you sign and your decisions and actions when you supply and administer medicines and devices or authorise or instruct others to do so. You must be prepared to explain and justify your decisions and actions when prescribing, administering and managing medicines.
GMS Contract
14.9. Excessive prescribing
14.9.1. The Contractor shall not prescribe drugs, medicines or appliances whose cost or quantity, in relation to any patient, is, by reason of the character of the drug, medicine or appliance in question, in excess of that which was reasonably necessary for the proper treatment of that patient.
14.9.2. In considering whether a Contractor has breached its obligations under 14.9.1, the Board must seek the views of the Local Medical Committee (if any) for the area in which the Contractor provides services under the Contract