- RAG rating
- n/a
- Document type
- n/a
- Place
- Hertfordshire and West Essex ICB
- Output type
- Pharmacy / Prescribing
- Document
- Download
Specialist or non-approved drug response letter from GP to Trust
Specialist / Non-approved / Non-Formulary Medicines – GP response letter to Trusts
Patient’s Name: |
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NHS No: |
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Hospital specialist |
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Hospital/Trust |
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Name of Drug |
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Indication |
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You have written to me asking me to prescribe the above treatment for this patient. I am unable to prescribe this medicine for the reason(s) stated below:
Reason(s) that apply are ticked |
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It is a specialist medicine recommended for prescribing by hospital specialists only. |
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It is a specialist medicine, dose, duration or use for which I do not have the necessary prescribing information, experience or knowledge to accept responsibility for prescribing. |
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The medicine requires specialist monitoring and I have not been provided with adequate information about the monitoring required to accept responsibility for prescribing. |
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The majority of care and monitoring for the condition indicated is provided by the hospital and so they also need to provide ongoing prescriptions for this medicine. |
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The patient is in a drug trial for this medicine and it is the responsibility of the hospital to provide ongoing prescriptions for this medicine. |
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The patient’s condition is not stable and it is therefore the responsibility of the hospital to provide ongoing prescriptions for this medicine. |
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This medicine should be started by a specialist, and the patient should be stabilised on this medication before I am able to continue to prescribe. |
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The request is for an unlicenced use of this medicine and therefore should be prescribed by a specialist able to take appropriate clinical responsibility. |
AND/OR
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This is a new medication and the first prescription should be provided by the hospital. |
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This medicine has not been approved for use in Hertfordshire and West Essex by the local Hertfordshire and West Essex Area Prescribing Committee. |
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This medicine appears not to be prescribed in line with recommendations of the Hertfordshire and West Essex Area Prescribing Committee. |
The specialist is required to take one of the following actions:
Action required is ticked |
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Provide the patient with the first prescription for the new medicine. |
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Recommend to me a suitable alternative medicine approved for use in Hertfordshire and West Essex. |
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Provide me with information about the new medicine and the monitoring required. |
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Make the necessary arrangements for the patient to receive ongoing prescriptions and supplies for the new medicine from the hospital. |
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No action required, in accordance with local / national guidelines I am providing the patient with a prescription for the following alternative medicine: |
Please contact me to confirm the action taken and/or if you wish to discuss further.
GP Name: ..…………………… Practice Details: ……………………
GP Signature: …………………