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In message <[log in to unmask]>, Chris Kear <[log in to unmask]> writes >Hi there, repository of all wisdom! > >Please consider this scenario. All replies apprecicated. When all replies >are posted, I will post what "my friend" actually did. > >GP (non-fundholder) suspects motoneurone disease in one of his Patients, >refers to local Consultant. Local Consultant refers to Neurologist at >teaching hospital. Neurologist does all the tests confirms diagnosis and >starts Patient on riluzole > >Riluzole is a potentially toxic drug with a low therapeutic index. It >requires regular monitoring, both of any therapeutic effect (which may be >slight or not occur at all) and the side effects. It is also very >expensive. > >Neurologist writes to GP begging him to continue the prescribing while >not explicitly describing the management plan. > >What should the GP do? > >Any ideas? > > >Chris > >no sig file as usual > > A chat to the medical advisor at the FHSA may yield interesting results. You may find clear guidelines have been laid down about patients being "stabilised" on the treatment before you can take it over and some drugs fall definately in the hospital budget remit.I got myself out of an awkward spot with erythropoetin in the past in this way. It's hard to believe we're all on the same side sometimes. -- Peter Glover Church View Surgery Rayleigh Essex %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%