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11-02-2013 | Article

Under prescribing pressure

As clinicians with important prescribing privileges, it is critical that we follow any guidance on this area from the GMC, the latest of which - as recently reported in a Univadis Medical News article (click here) - could have a significant impact on practice.

According to the article, the GMC have clarified the rules on when to use unlicensed drugs, restricting "prescribing of unlicensed or off-label drugs to situations where licensed drugs are unavailable or considered inappropriate for the patient".

Interestingly, the GMC had only quite recently laid out plans to make it easier to prescribe unlicensed drugs, but has had to abandon the aspiration after consulting European Law.

The implications could be enormous, potentially limiting therapeutic choices and putting drug budgets under even greater pressure. Indeed, the article highlights circumstances in which we could be tripped up by these guidelines, for example when prescribing amitriptyline for chronic pain instead of pregabalin.

The new guidance, accessible from the GMC website, also provides some updates in other areas (click here). Having read it, I can see that patient safety and good practice are at the heart of the new recommendations. They are precise and make the prescriber justify their decisions. The GMC, quite rightly, want us to practice high quality, safe medicine and is acting in the very best interests of the patient.

However, in the future, we will be under pressure to reduce our drug budget costs, while patients will demand better services and politicians will continue to call for more efficiency. There is always room to improve, but I wonder if we will be squeezed too far, leading to a demoralised workforce. Or has this process started already?

Best wishes,


Dr Harry Brown, editor-in-chief Univadis

By Dr Harry Brown