Common Medication Questions

We are occasionally asked by patients to prescribe sedating medication for flying.

We regret that we are not able to facilitate these requests on the grounds of patient safety and our need to prioritise the delivery of NHS care on the basis of patients’ clinical needs.

Sedating medication, e.g. benzodiazepines such as diazepam, can render someone either unpredictively aggressive, or less able to follow instructions in an emergency, thus putting crew and other passengers at risk.

Sleeping tablets similarly have no indication for flying, and again could make a passenger difficult to rouse or transfer if there was a genuine in-flight emergency. Often passengers mix these medications with alcohol, with deleterious consequences. We would not wish you to to be barred from a flight or face prosecution, or find yourself incapacitated due to the unpredictable effects of said medication. The drug driving legislation which came into effect in recent years would also potentially prohibit onward driving from an airport.

Flight anxiety should be treated by Cognitive Behavioural Therapy – a form of counselling, which has long lasting benefits and is safe. Airline carriers offer excellent courses for free, so do speak with your flight provider to arrange to go on a course well in advance of when you know you will be flying.

It is not within the remit of the NHS to render someone fit to travel on a voluntary holiday or business trip. We acknowledge there may be occasion when you have previously received a prescription for this purpose. We regret that we will be unable to agree to such requests henceforth. This is a joint decision, unanimously made by all senior clinical staff within the practice.

Patients are reminded that they are able to arrange a consultation at a private travel clinic should they wish to pursue the option of in-flight medication further, but we cannot accommodate their request and so would politely ask that they respect this universal practice policy from 25^th April 2023.

We have been supported in the drafting of this policy by Cambridgeshire Local Medical Committee.

Shared care is necessary for ADHD medication management to ensure continuity of care between specialists and general practitioners. This collaboration allows for the safe and effective use of medication by monitoring patient progress, adjusting dosages, and addressing side effects. Shared care agreements streamline the process, ensuring consistent care and reducing the burden on specialist services, ultimately enhancing patient safety and outcomes. For more detailed information, you can visit this link.

If you have recently been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) you will have received an initial diagnosis and treatment plan from a psychiatrist. Many patients are now choosing to attend private psychiatrists. This page provides essential information on the process of St Mary’s Surgery taking over prescribing your ADHD medication for both patients and private clinicians.

For Patients:

Your psychiatrist will be responsible for creating an initial treatment plan; determining the appropriate type, dosage, and monitoring schedule based on your individual needs. Once you are on a stable dose of medication (normally around 3 months), many patients ask if we can take over prescribing.

In order for St Mary’s Surgery to continue to take over prescribing there will need to be a “Shared Care Agreement” between ourselves which follows our local NHS guidelines (please see: https://www.cpics.org.uk/shared-care-guidance/ under title: “Methylphenidate, Dexamfetamine, Lisdexamfetamine for Adults with Attention Deficiency Hyperactivity Disorder”

Before we consider taking over prescribing responsibility we ask for:

• Information from your psychiatrist including date of diagnosis on a headed letter. This should be either posted or emailed to the practice.
• Name and dose of medication and how long you have been stable on this dose for
• We will need a baseline blood pressure, pulse and weight.
• You will need to be responsible for arranging regular follow-ups with your consultant, this is normally annually. Without regular follow-up with your psychiatrist (as agreed by the shared care agreement) we will no longer be able to continue prescribing. 
• Your medication will be reviewed 6 monthly by your named GP/clinical pharmacist. You will need to ensure you have a BP, pulse and weight check every 6 months, which can be booked by our Patient Services Team (01353 663434).  

In case of side effects or urgent matters related to your medication, please seek immediate medical attention. Notify both your GP and the specialist as soon as possible. If you wish to discontinue your ADHD medication or transfer care to a different healthcare provider, please discuss this with your named GP and psychiatrist to ensure a smooth transition.

For private clinicians:

Before we prescribe medication for ADHD, we require a formal diagnosis of ADHD from a psychiatrist on the GMC specialist register practicing within the UK. The psychiatrist will provide a formal diagnosis of ADHD and establish an initial treatment plan, including medication initiation and titrated. The psychiatrist will conduct regular consultations with the patient to assess treatment efficacy and make adjustments when necessary. The GP should be copied into any correspondence regarding patient consultations on a headed letter.

After a minimum of three months on a stable dose, the GP may consider taking over prescribing if asked by the patient and agreed with the specialist. We will require your clinic to meet the standards of shared care as set out by our local NHS Shared Care Agreement (https://www.cpics.org.uk/shared-care-guidance/ under “Methylphenidate, Dexamfetamine, Lisdexamfetamine for Adults with Attention Deficiency Hyperactivity Disorder”).

Specifically you should send us baseline observations (pulse, BP and weight) alongside a copy of the original ECG; along with clear prescription advice and a means to contact you in the event of an issue. We would expect you to provide ongoing annual input for the patient.

Medication reviews with the GP or clinical pharmacist will take place at the six month interval in between your annual reviews. The patient is responsible for arranging appointments for observation monitoring and follow-up appointments with their psychiatrist. Failure in attending appointments may result in their prescriptions being discontinued.

Previously, gluten-free products used to be available for prescribing for eligible patient groups.

However, with the increased availability, it is much easier to purchase a wide range of gluten-free products from the supermarket. As such, the Prescribing Partnership for Cambridgeshire & Peterborough Integrated Care System have changed the policy for prescribing gluten-free products.

GP surgeries have now been advised to cease prescribing of these products and they will no longer be available on repeat. 

If you would like to discuss this further, I recommend speaking with the Cambridgeshire formulary team:

• Email: cpicb.contact@nhs.net 
• Phone: 0800 279 2535

We understand that the NHS dental care is under immense pressure but GP’s are not qualified or insured to deal with dental matters. We have a strict practice policy that all dental related requests will be declined.

Please contact either your dentist or the emergency dental services on 0300 555 6667, option 1 to access urgent dental care in Cambridge, Huntingdon, Peterborough and Wisbech.

Weekday evenings, Weekends and Bank Holidays: please call NHS 111

28 Day Repeat Prescribing Information Sheet

Why is repeat medication issued for 28 days?

If you are being prescribed a ‘repeat medication’ you will be prescribed enough of each of your medicines

to last you for 28 days.

For example:

If you are taking 2 tablets a day you will receive 56 tablets: 3 tablets a day you will receive 84 tablets and so

on…

However, there are some medicines which are packaged in 30 day amounts and some in 3 monthly

amounts, e.g. HRT and contraceptive pills and they will continue to be supplied in these packs. So, 28 day

repeat medication is not appropriate in these type of situations.

What are the benefits of repeat medication for 28 days?

Regular opportunity for review

Prescribers will be able to review your medicines regularly which is especially important if you have a long

term condition such as diabetes. Regular review can also help you to take your medicines as prescribed by

providing regular checks and reminders.

GP dispensaries and Community Pharmacies also undertake reviews on the usage of medications and this is

another opportunity to discuss any queries you may have with how you take your medication.

28 day calendar packs

Companies manufacture most medicines in 28 day packs. These have patient information leaflets inside

and ideally they should be supplied to you as a complete pack. These packs also allow you to check that

you have taken your medication.

Less waste

By ensuring that when medicines are stopped, (for example, if there are side effects or doses changed) only

the remainder of the 28 days pack will be discarded. It will also reduce the amount which is wasted when

partly filled containers are thrown away.

Less confusing

Keeping fewer partly filled containers of medicines at home will avoid confusion and could prevent

mistakes with doses.

Convenience

Most people should only have to visit their GP Practice once a month to collect their prescription or ‘repeat

medication’. At present many people make several visits to their practice each month because their

medications run out at different times.

To order your repeat medications once a month, speak to your GP or pharmacist to help you match the

ordering dates of your medicines, so that you only need to order once a month.

This will help you to avoid running out of your medicines during the weekend.Page 2 of 2

Will it cost people more?

The majority of people who collect repeat prescriptions hold prepayment certificates or do not pay

prescription charges. Many people are exempt from prescription charges on the grounds of age, income or

medical condition.

You may be able to save money with a Prescription Payment Certificate.

For more information contact the NHS Business Services Authority https://www.nhsbsa.nhs.uk

Tips for Patients

• Find out from your GP practice the different ways to order repeat medication and how much notice

they require to get your prescription ready (often this is 48 hours).

• Do not allow yourself to run out of medicines before you order more.

• Only order medicines you need for the next 28 days.

• Use the name of the medicine when ordering your prescription.

• If any of your repeat medication has changed recently or you have recently been discharged from

hospital and your medicines have been changed, please check your prescription has been updated.

• When collecting your prescription from the pharmacy/ dispensary, check that your medicines are

correct and you still need them as once medicines have left the pharmacy/ dispensary they cannot

be changed or issued to other patients.

• Return any medicines in the bag that you don’t need before you leave the pharmacy/ dispensary.

• Do not stockpile medicines at home.

• If you have any difficulties with your medicines, please discuss them with your surgery or pharmacy.

• Some medicines require regular blood tests or other monitoring and you may be asked some safety

questions or to show your monitoring book by the pharmacist.

Summary

All the GP practices within NHS Cambridgeshire & Peterborough have been advised to issue 28 days as the

standard treatment length for ‘repeat’ prescriptions.

There are many benefits when Repeat Medicines are prescribed in amounts which last for 28 days

including:

• Regular review

• Less waste

• Better co-ordination of treatment

• Convenience

• Safety

For further information, contact:

NHS Cambridgeshire & Peterborough – Patient Experience Team

Gemini House

1 Bartholomew’s Walk

Cambridgeshire Business Park

Angel Drove

Ely

CB7 4EA

Email: cpicb.pet@nhs.net

Freephone: 0800 279 25

In recent times, medication shortages have become a significant issue across the UK, affecting a wide range of medicines. These shortages are due to factors like manufacturing disruptions, supply chain complexities, increased demand, and global events such as the COVID-19 pandemic and Brexit. At St. Mary’s Surgery, we are doing our best to manage the situation, though these shortages are beyond our control.

We are working closely with local pharmacies to find suitable alternatives and minimize treatment disruptions. If you experience difficulty obtaining your medication, please contact us or your pharmacist for guidance. Further information can be found here

We do not prescribe diazepam for patients having MRI scans or other investigative procedures. We have a duty of care to provide safe, consistent, and appropriate care for our patients.  We have outlined our reasons for this below: 

·         Small doses of benzodiazepines such at 2mg diazepam are probably sub-therapeutic for most adults for any effective sedation. Conversely anxiolytics can have an idiosyncratic response in patients, and even very small doses can cause increased agitation in some subsets of patients.

·         A patient may take a sedative ‘an hour’ before their assumed procedure, to then attend the hospital to find their procedure has been delayed, therefore the timing of the anxiolytic being sub optimal.

·         GPs are not regularly involved, skilled, trained or appraised in sedation skills.

·         All hospital consultants, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs. If a patient needs a certain medication to enable an investigation to go ahead, they are just as well positioned to provide a prescription, either through the hospital pharmacy or a hospital FP10.

You may wish to discuss next steps with your radiologist or consultant.