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Mary Hawking wrote "I have just refused to prescribe heparin" ....... ......"Can anyone tell me, *is* this part of "usual medical services"? How many of you have been asked to do this? and how many have done it? Just curious - I'll still say no..;-)" This seems to me to fall outside GMS. I agree that it is reasonable to refuse to do it. You could try to negotiate payment for the service. There are other tasks which hospitals like to delegate again which fall outside GMS At Western Road we have identified a number of these; 1. administration and monitoring of drug treatment in Rheumatoid Arthritis 2.monitoring of warfarin therapy 3. administration of Zoladex for Ca prostate 4. annual review of diabetic patients It would be reasonable to refuse to do these things without appropriate payment. I have come across the surgeon's argument before. A paediatrician asked me to prescribe testosterone to a boy with retarded growth. The cost of the drug is peanuts. In prescribing it I take legal responsibility for a drug the use of which is clearly out of my experience. I agreed to do it for this one but not in the future. He told me I was the ONLY local GP to refuse. I think as GPs we should commit to providing excellent GMS services and to take on those non core services we choose and be paid for it. Ian %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%