1. Purpose
This policy sets out how the Practice prescribes safely, monitors high-risk medicines, reviews repeat prescribing and responds to prescribing errors or controlled-drug discrepancies.
It applies to private GP and NHS-contracted prescribing activity.
2. Sources to verify before adoption
- Human Medicines Regulations 2012: https://www.legislation.gov.uk/uksi/2012/1916/contents
- Misuse of Drugs Regulations 2001: https://www.legislation.gov.uk/uksi/2001/3998/contents
- Controlled Drugs (Supervision of Management and Use) Regulations 2013: https://www.legislation.gov.uk/uksi/2013/373/contents
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12: https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 17: https://www.legislation.gov.uk/uksi/2014/2936/regulation/17
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 20: https://www.legislation.gov.uk/uksi/2014/2936/regulation/20
- GMC, Good practice in prescribing and managing medicines and devices: https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-practice-in-prescribing-and-managing-medicines-and-devices
- NHS England, Controlled Drugs Accountable Officer alerts and reporting: https://www.england.nhs.uk/contact-us/privacy-notice/how-we-use-your-information/safety-and-quality/controlled-drugs-accountable-officer-alerts-etc/
- GOV.UK, controlled drugs licences, fees and returns: https://www.gov.uk/guidance/controlled-drugs-licences-fees-and-returns
- CQC GP mythbuster 11, Electronic prescribing: https://www.cqc.org.uk/guidance-providers/gps/gp-mythbusters/gp-mythbuster-11-electronic-prescribing
3. Scope
This policy applies to:
- acute prescribing
- repeat prescribing
- high-risk drug monitoring
- prescribing errors and near misses
- contraindicated prescribing
- allergy, interaction and pregnancy checks
- controlled-drug prescribing discrepancies
- prescribing by GP partners, salaried GPs, locum GPs, pharmacist prescribers and other authorised prescribers
- medicines requests handled by reception or administration staff
The Practice verifies each prescriber's professional scope and system access before they prescribe.
4. Prescribing process
The Practice follows a documented prescribing process for every prescription.
4.1 Patient and medicine check
Before issuing a prescription, the prescriber checks:
- patient identity
- allergy status
- diagnosis or clinical reason
- current medicines
- relevant test results
- contraindications
- interactions
- pregnancy or breastfeeding status where relevant
- previous adverse reactions
- whether review or monitoring is overdue
- whether the request is acute, repeat or urgent
The prescriber records the clinical reason where the record does not already make it clear.
4.2 Repeat prescribing
The Practice keeps a repeat-prescribing protocol.
The protocol covers:
- which medicines can be issued as repeats
- who can authorise repeats
- maximum number of issues before review
- review date handling
- overdue review escalation
- medicine synchronisation where appropriate
- patient request routes
- rejected request handling
- communication with community pharmacy
Staff do not issue a repeat prescription where the review status, monitoring status or prescriber instruction makes it unsafe to do so.
4.3 Acute and urgent prescribing
The prescriber records why acute or urgent prescribing is needed.
Where prescribing happens without full routine information, the prescriber records:
- what information was available
- what risk was accepted
- what safety-netting was given
- when follow-up or review is needed
The Practice does not use urgent prescribing to bypass monitoring requirements for convenience.
4.4 Prescribing error response
Where staff identify wrong drug, wrong dose, contraindicated drug, allergy conflict or repeat prescription issued without review, staff:
- make the patient safe
- seek clinical advice immediately where needed
- contact the patient or pharmacy where appropriate
- record the event as an incident
- preserve prescribing and communication records
- inform the Clinical Lead
- consider duty of candour
- consider external reporting where current source material requires it
- assign corrective action
The Practice reviews prescribing errors through the SEA process.
5. High-risk drug monitoring
The Practice keeps a high-risk drug register.
The register includes medicines or medicine groups that need defined monitoring, such as:
- methotrexate
- lithium
- warfarin
- disease-modifying anti-rheumatic drugs
- amiodarone
- any other medicine identified by the Practice, prescriber or shared-care protocol
For each medicine group, the local protocol records:
- monitoring test required
- source of the monitoring requirement
- staff role responsible for checking status
- prescribing stop or escalation rule where monitoring is missing
- communication route with specialist, pharmacy or patient
- review owner
The Practice sets exact monitoring schedules from current prescribing guidance, shared-care agreements, specialist advice and GMC source material. This template does not restate medicine-specific monitoring intervals.
6. Controlled drugs and prescribing review
The Practice treats controlled-drug prescribing discrepancies as high-risk incidents.
Where staff identify a discrepancy, the Clinical Lead:
- checks the prescribing record
- checks stock or issue records where relevant
- confirms whether the discrepancy is clerical, clinical, diversion-related or unexplained
- makes the patient safe
- informs the Registered Manager
- considers NHS England CDAO notification where the Practice is NHS-contracted
- considers Home Office or police routes where current source material or CDAO advice requires it
- records the decision and action taken
The Practice reviews prescribing data at least quarterly as a Verivius default from the GP sector pack. The review covers controlled drugs, antibiotics, opioids, high-risk medicines and repeat prescribing without review.
7. Responsibilities
- Registered Manager: owns this policy, ensures governance oversight and signs off annual review.
- Clinical Lead: owns day-to-day prescribing safety, prescribing incident review and high-risk drug monitoring governance.
- Lead GP or GP Partner: reviews doctor-only prescribing decisions, shared-care concerns and complex clinical risk.
- Prescribers: prescribe within competence, check monitoring and record clinical decisions.
- Practice pharmacist or medicines lead: supports prescribing data review, high-risk register checks and medicine-safety actions where the Practice has this role.
- Reception and administration staff: process requests only within the Practice protocol and escalate clinical concerns.
8. Recording requirements
The Practice keeps the following records:
- prescription record
- repeat-prescribing review date
- high-risk drug register
- monitoring status record
- shared-care agreement where relevant
- prescribing error incident record
- controlled-drug discrepancy record
- CDAO or external reporting decision
- patient communication record
- prescribing data review minutes
- staff competency and access records
Records are kept in the clinical system or Practice governance records according to the local procedure.
9. Audit cadence
The Practice uses the following Verivius default audit rhythm unless current source material requires more frequent review:
- Monthly: the medicines lead or Clinical Lead checks overdue high-risk monitoring and urgent prescribing actions.
- Quarterly: the Practice reviews prescribing data, controlled drugs, antibiotics, opioids, high-risk medicines and repeat prescribing without review.
- Annually: the Registered Manager audits prescribing governance, staff access, incident learning and policy compliance.
Audit findings are recorded as improvement actions with an owner and review date.
10. Version control and review date
The Practice keeps a controlled copy of this policy. The footer or document-control table records:
- policy owner
- version number
- date approved
- next review date
- changes made since the last version
- source material checked during the review
11. Related records
- Incident register
- SEA meeting minutes
- High-risk drug register
- Repeat-prescribing protocol
- Controlled-drug discrepancy log
- Duty of candour policy
- Patient data and information governance policy
- Staff access-control record
- Improvement action register
Review cadence: annual or on regulatory change, whichever sooner. Owner: Registered Manager.