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Opinion Taking Stock

Rammya Mathew: Prescribing isn’t a single act—getting it right requires time and effort

ݮƵ 2024; 384 doi: (Published 06 February 2024) Cite this as: ݮƵ 2024;384:q279

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Re: Rammya Mathew: Prescribing isn’t a single act—getting it right requires time and effort

Dear Editor

I was very surprised to read that Rammya Mathew writes “In recent years I’ve seen a growing trend for patients who are seen in hospital outpatient clinics not to have medicines prescribed at all but for a recommendation to be made back to their GP to initiate this instead...... It concerns me that it’s becoming common practice to devolve this responsibility”.

I recently retired from the NHS after 35 years, most of which I was a hospital consultant. I was taught very early on as a trainee, that GPs regarded it as a crime for a hospital doctor to prescribe for their patients following an outpatient appointment and that I would get a kicking if I transgressed. It was made clear that the patient belongs to the GP and we were there to give advice when required. I can remember a number of GPs being upset when one of my trainees had the audacity to prescribe for their patient. I respected this aspiration throughout my career and completely understood its intention. We could only give a recommendation within our relatively narrow area of expertise and the GP was the expert on the whole picture and was in the best position to weigh up our advice in the context of all they knew about their patient. I can count on one hand the number of outpatient prescriptions I wrote and I have never had a prescription pad.

How things have turned around so fundamentally that Dr Mathew's position can seemingly prevail is beyond me. I can only suggest that, since GPs gave up on continuity of care and have become clinical delegators, they no longer feel that they own their patients. If this is indeed the case, we are all in deep trouble.

Competing interests: No competing interests

10 February 2024
Richard Caplan
Consultant Psychiatrist
10 Harley St, London W1