Letter: Deciding who prescribes

Sir: Your article "GPs get red list of 'too costly' drugs" and editorial (3 May) have misinterpreted what Bromley Health Authority is doing.

Drugs have not been "banned" from GP prescription and GPs do not have to "seek permission" before prescribing. The guidelines drawn up in Bromley after extensive local consultation, which included GPs and other health professionals, simply give advice to doctors about drugs which, because of their complex and/or specialist nature, it would be more appropriate for hospital doctors to prescribe.

The demarcation between hospitals and GPs over responsibility for prescribing has been an issue for some years. It is likely to remain so where there are complex and specialist therapies involved.

The NHS Executive issued guidance in 1991 which reaffirmed the principle that it is for the doctor who has clinical responsibility for a patient to undertake the prescribing. In acknowledging the developing role of health authorities, further guidance was issued last year asking them to develop local policies on a range of prescribing issues. Inter alia, they were asked to consider the circumstances in which GPs may be asked to take on prescribing responsibility for specialist drugs, and those in which responsibility should more appropriately lie with hospital consultants.

There are sound clinical reasons for clarifying these issues on a local basis - GPs should only take on prescribing responsibility for a particular drug if they feel clinically competent to do so. The guidance to be issued by Bromley is aimed at helping doctors and GPs to reach a common understanding on such matters, thereby reducing the need for discussion over individual patient cases and consequent treatment delays.

Nothing in the NHS Executive's guidance nor in the action taken by Bromley Health interferes with the Government's commitment to ensuring that patients receive all the medicines they clinically need.

Yours etc,

GERALD MALONE

Minister for Health

Department of Health

London, SW1

3 May