-----Original Message-----
From: Graham Balin <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 03 October 1998 20:32
Subject: Re: viagra yet again
>
>
>On Tue, 2 Mar 1999 21:22:28 -0000
>"John A. Charlton" <[log in to unmask]> wrote:
>
>> If I write a private prescription then I'm in breech because it is not
>> black listed only "not advised"
>
>This one keeps on going (or is it coming?)
>
>Surely you are not in breach if your patient *insists* on their right to
>have a private Rx.
>Same principle as when mine *insist* on a private Rx for paracetamol
>etc. [And they do, because there is a notice in the waiting room
>informing them of their *right* to insist. Remember to say *I insist*, it
>says.]
>
>Is Peter Fellowes out there to confirm or deny?
This is getting repetetive.
You may not charge a fee for writing a private prescription except for
malaria prophylaxis and "just in case" drugs for foreign travel. ( para 38,
Schedule 2, terms of service for doctors). Perhaps your notice could point
out that if say Viagra is requested by the patient "just in case" for a trip
abroad, then you are allowed to deal with it as a private consultation and
charge a fee for prescribing! There is an E.L. suggesting that you may write
private prescriptions without charging a fee, if the drugs supplied will
cost the
patient less than the prescription charge. ( unlikely even with one tablet
of Viagra)This was never incorporated in
Regulations. A test case against a pharmacist in S.Wales, Alan Sharpe, was
dropped, probably for political reasons. He was apparently supplying the
drug privately if it was going to cost the patient less than the
prescription charge, and tearing up the prescription.( That actually makes
more sense,since only the pharmacist can know what he will be charging!)That
could, however, be construed as defrauding the Treasury, since the
prescription charge is a tax on prescribing, and is not meant to relate to
the cost of the drug. BMA advice is not to issue private prescriptions
unless Regulations are changed, or if you do so issue an FP10 at the same
time. You have no control over what the patient will actually have to pay
(you may not make arrangements with any particular pharmacy/pharmacies). If
the patient complains because he is charged more than a prescription
charge, then
regardless of the EL, you are technically in breach of Regulations as you
are required to provide all necessary treatment on the NHS. The HA could
also
complain, on behalf of the Treasury, as happened in the Alan Sharpe case. So
even if the patient signs that he/she insists on a private prescription, you
are not legally protected, however unlikely an actual complaint would be.
You are permitted to write private prescriptions ,without charge, for drugs
that are formally black-listed under schedule 10 or 11. Viagra is not
black-listed, and cannot easily be:- a) It is not within the current 17
categories of black listable drugs which we don't want to see extended, b) A
drug can be blacklisted only if there are more cost effective comparators,
and the pharmaceutical company has been able to present it's arguments and
scientific data, c) everything must comply for commercial reasons with EU
requirements for "transparency". Viagra is unique. I had to explain that to
John Chisholm and Ian Bogle at the last GPC meeting.
It's not surprising this is so difficult to
understand. The whole of the rule book, along with our archaic contract
needs rewriting ( and repricing)!
I'm very glad Tim Paine ( my trainer of 23 years ago) is still so enamoured
with general practice. He always had an infectious enthusiasm, some of which
I retain . I still enjoy seeing patients, but it's all the other dross which
is killing the job. Methinks Tim is very much in the minority. I need to
know if he is not. I try to represent what I believe to be the general view
when it comes to morale and pay.
Regards,
Peter Fellows.
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