Burney Street Practice Policy on Sedative Prescriptions

We are unable to prescribe sedatives, such as diazepam, for any procedure or scan being undertaken outside the practice. This includes MRI scans and dental procedures.

If you feel you need sedation for a procedure or scan, please speak to the team undertaking the procedure or scan, as they are responsible for providing this if needed. All our local NHS hospitals have formal procedures in place for sedation during procedures, so you should not be directed to your GP for this.

Why We Do Not Prescribe Sedatives for External Procedures:

• Lack of Regular Involvement and Training: GPs are not regularly involved, skilled, trained, or appraised in sedation skills. Providing too little sedation won’t help you, and providing too much sedation can make you too sleepy, which could lead to the procedure being cancelled. Excessive sedation can also dangerously affect your breathing. After taking a sedative for a procedure or scan, you will need to be closely monitored to keep you safe.
• Unpredictable Effects of Diazepam: Although diazepam makes most people sleepy, in some rare situations, it can have the opposite effect and make people aggressive or agitated.
• Timing of Sedation: Scans and hospital procedures are often delayed. Therefore, the team performing the procedure or scan should provide the sedation to ensure you become sleepy and relaxed at the right time.
• Need for Regular Monitoring: Sedated patients should be regularly monitored. There has been a case where a GP prescribed sedative was used, the patient wasn’t monitored, and subsequently had a respiratory arrest in an MRI machine.
• Guidelines from the Royal College of Radiologists: The Royal College of Radiologists’ guidelines on sedation for imaging make no mention of GP involvement or prescribing and stress the importance of experienced, well-trained staff being involved and the need for monitoring of sedated patients.

Feel free to show this policy to your hospital team or dentist.

Burney Street Practice Policy for prescribing diazepam for fear of flying

 

Burney Street Medical Practice is unable to prescribe sedatives to patients for fear of flying including benzodiazepines (such as diazepam). Many other GP practices have a similar policy.

 

Diazepam in the UK is a Class C/Schedule IV controlled drug. The following short guide outlines the issues surrounding its use with regards to flying and why the practice no longer prescribes such medications for this purpose.

 

• They are sedating drugs which can cause safety concerns. If you are drowsy, your reaction times may be slower and you may be unable to act quickly in an emergency on-board a flight. If you are drowsy you may move around less and sit for longer, increasing the risk of a DVT (blood clot) in the leg or even lung. This can have serious (even fatal) outcomes.

 

• They can cause respiratory depression (slower breathing rate) which can be dangerous as blood oxygen levels are already reduced at high altitude.

 

• Whilst most people find benzodiazepines like diazepam sedating, a small number of people experience the opposite effect and may become aggressive. Benzodiazepines can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.

 

• They are a controlled (regulated) drug in the UK and we must prescribe medications safely: The use of benzodiazepines to treat phobia (fear) is contraindicated (ie. not allowed) – this is the advice given in the BNF (drug formulary) which is the manual used for information about drugs. They are only indicated for severe or disabling anxiety – we would not advocate flying if a patient was suffering from this.

 

• Benzodiazepines are illegal in some countries meaning you may risk breaking the law if you take these medications with you.

 

• They should not be mixed with alcohol which may be available to buy on or before a flight.

 

 

Given the above we will no longer be providing Diazepam or similar drugs for flight anxiety. Any doctor prescribing diazepam for a fear of flying would be taking a significant legal risk as this goes against national guidelines.

 

 

We appreciate patients may have a genuine fear of flying. Several of the big UK-based airlines provide ‘Fear of Flying’ courses which are recommended.

 

https://www.gatwickairport.com/at-the-airport/passenger-services/Travel-advice/fear-of-flying/

 

Easy Jet www.fearlessflyer.easyjet.com

 

British Airways www.flyingwithconfidence.com

 

Virgin www.flyingwithoutfear.co.uk

 

 

Other useful resources

 

https://orpheusmindtechnologies.com/fear-of-flying-app/

 

www.nhsinform.scot/illnesses-and-conditions/mental-health/phobias

 

Flight anxiety does not come under the remit of General and Personal Medical Services as defined in the GP contract and so we are not obliged to prescribe for this.

Patients who still wish to take benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic.

 

 

Thank you for your understanding in this matter.

 

 

Burney Street Practice Partners

 

 

 

 

Due to increased waiting times for outpatient appointments, GPs have seen a rise in patient requests to “expedite” their appointments.

As a GP surgery, we are not notified of any waiting times for clinics. If your appointment has been delayed, please contact your consultant secretary for any updates. If you are waiting for your first appointment with a consultant and have not heard for a long time, please contact the outpatient department in the first instance and then the consultant’s secretary.

If you have been unable to contact outpatients or the secretary, please contact PALS (Patient Advice and Liaison Service)

What is PALS (Patient Advice and Liaison Service)? – NHS (www.nhs.uk)

 

When patients contact the hospital, they are sometimes told to ask their GP for an ‘expedite letter’. This is frustrating for you and for us, and we cannot guarantee that this will result in your appointment being brought forward.

Only the hospital can compare your needs with those of other patients on their waiting list and they will action your request accordingly.

If you want to inform a hospital of a change in your symptoms, you may use the templates below when contacting the hospital – please use copy and paste. One is for patients waiting for a first appointment with a specialist, the second is for patients waiting for a follow-up appointment, treatment, or operation. You should post or email your letter to either Outpatient Appointments (for first appointments) or your consultant’s secretary (for follow-up care)

 

Letter for a first appointment with a specialist:

 

Dear Consultant,

I am awaiting care from you for <Write your original problem here>. I have been referred by my GP at the Burney Street Practice.

I await an appointment and / or treatment but report the following change in my condition since my referral was sent to you:

<Explain briefly what has changed since your referral>

I request that you take the following action

 

• Review my hospital notes alongside this letter to determine whether my care might be expedited
• Contact me directly to inform me of the outcome of that decision, and my likely wait for further care
• File this letter and document your decision in my medical record.

 

Yours faithfully

 

<enter your name>

 

Letter for a for a follow-up appointment:

 

Dear Consultant,

I am receiving care from you for <Write your original problem here>.

I await a follow-up appointment and / or treatment but report the following change in my condition since your last contact with me:

<Explain briefly what has changed since your last contact with the specialist>

I request that you take the following action:

• Review my hospital notes alongside this letter to determine whether my care might be expedited
• Contact me directly to inform me of the outcome of that decision, and me likely wait for further care
• File this letter and document your decision in my medical record.

 

Yours faithfully

<enter your name

Information for Patients Seeking NHS Shared Care

 

We understand that you have a legal right to choose the NHS hospital or service you prefer.

A shared care agreement is a formal agreement that enables GPs to accept responsibility for the safe prescribing and monitoring of specialist medicines.

Please be aware that we only enter into NHS shared care agreements with NHS services approved by the NHS South East London Integrated Care Board (ICB) or nationally commissioned services where a local service is not commissioned.

There are a number of reasons for this:

• We rely on our Integrated Care Board (ICB) to commission specialist services.
• Where there may be shortfalls in specialist service provision, we will not put our patients at risk by trying to fill any deficiencies.
• We are unable to review every NHS clinic or individual and be assured that they provide a high quality service.
• We are unable to determine that appropriate follow up and ongoing specialist care is in place at other clinics, should any complications arise during treatment.

If you choose an NHS specialist service that is not approved, the responsibility for NHS prescription drugs will remain with the specialist. You may wish to discuss this with your clinician at the time of your referral.

All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds. The responsibility for your care and ongoing prescribing of drugs then remains the responsibility of the NHS provider.

 

Investigations

We will not undertake monitoring or investigations on behalf of an NHS provider or nationally commissioned services where no ICB Shared Care Agreement is in place.

Prescribing of medication

Guidance is in place for the prescribing of medication on the basis of patient safety. A traffic light system is used to determine responsibility for prescribing of drugs initiated in primary care and secondary care.

South East London Joint Medicines Formulary Formulary (selondonjointmedicinesformulary.nhs.uk)

SEL IMOC – RAGG list definitions – NHS South East London (selondonics.org)

The category that your medication falls into will determine if it will be prescribed by the practice. It will also depend if the practice agrees with the treatment plan being suggested by an external clinician.

Green drugs – We can prescribe green drugs if the medication is licensed for the indication given. All prescribing is at the discretion of the prescriber and there may be circumstances where the prescriber is not in agreement with the treatment plan. If this is the case, we reserve the right to decline prescribing medications and an explanation will be provided.

Amber drugs – These are specialist drugs that must be initiated by secondary care specialist prescribers. We will not enter into any shared care agreements, other than those approved by the NHS South East London ICB. Patients will need to return to their provider for ongoing prescribing of amber drugs where an approved shared care agreement is not in place.

Red drugs – These drugs are for hospital use or for use by a specialist within a specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the hospital clinician or specialist. We will not prescribe any medications from the red drug list.

Grey Drugs – Medicines not normally recommended for routine prescribing. Weak evidence of cost effectiveness, benefit and/or safety. Drugs which the SEL IMOC consider do not represent good value to the NHS. Drugs where the formulary application is not presented to IMOC within the specified timeframes

 

Transferring your care to a locally commissioned service where there is a shared care agreement in place or a nationally commissioned service where a local service is not commissioned

If you are relocating to this area, we can refer patients to approved NHS secondary care specialties when appropriate. Waiting times vary considerably depending on the NHS specialty.

While you are waiting for your approved NHS secondary care appointment, you will need to obtain medication and continue receiving care from your current provider.

Any other new physical or psychological medical issues that arise can be managed under standard NHS care.

Information for Patients Seeking Private Treatment

 

We accept and understand that some patients will choose to have some or all of their care needs provided by a private consultant or clinic.

NHS guidance states:

• It should always be clear whether an individual procedure or treatment is privately funded, or NHS funded.
• Private and NHS care should be kept as separate as possible.
• The patient should bear the full costs of any private services. NHS resources should never be used to subsidise the use of private care.
• The arrangements put in place to deliver additional private care should be designed to ensure as clear a separation as possible of funding, legal status, liability and accountability between NHS care and any private care that a patient receives.

 

Your right to NHS care does not change if you access private services however, in the majority of circumstances we are not able to undertake the work requested by private clinicians. There are a number of reasons for this:

 

• We rely on our Integrated Care Board (ICB) to commission specialist services.
• Where there may be shortfalls in specialist service provision, we will not put our patients at risk by trying to fill any deficiencies.
• We are unable to review every private clinic or individual and be assured that they provide a high quality service.
• We are unable to determine that appropriate follow up and ongoing specialist care is in place at private clinics, should any complications arise during treatment.
• We do not have the capacity to meet additional demand from the private sector or fill deficiencies that may exist in locally or nationally commissioned specialist services.

 

Patient Referrals for Private Services

If you choose to seek private treatment, you can self-refer. However, some private consultants will only see patients that have a referral from a GP.

If a private provider or insurer requests a GP referral, the private company can be charged because this would be classed as non-NHS work.

Fees For Non-NHS Services Explained – Burney Street Practice

If a private provider requires medical information about you, you can provide copies of hospital letters received or share your records via the NHS App or online medical records system (for information entered after 11^th October 2023). You can also make a Subject Access Request to obtain a printed summary of your medical record free of charge.

Subject Access Request (SAR) – Burney Street Practice

If a private provider requests more information, this can be provided following patient consent. The cost of preparing the report can be charged to the private provider.

Pre and post-operative Private Care

In most cases patients will have purchased a “package of care” from a private provider which includes pre and post-operative investigations, treatment and care. In these cases, we will not provide pre or post-operative investigations, care or treatment and you will need to return to your private provider.

If you become unwell following private care or whilst receiving private treatment, you will need to return to your provider for assistance. If you are unable to access care from your private provider and there is a serious unforeseen risk to your health, the practice will provide immediate treatment to ensure your safety.

Investigations

If we receive requests from a private provider or patient to arrange tests or investigations for private treatment, complying with these requests is outside the scope of NHS primary medical services.

If you have self-referred to a private provider or if a private provider has insisted on a primary care referral, the practice will not carry out any work-up investigations. These will need to be undertaken by the private provider.

Once you are under the care of a private provider, any monitoring or investigations needed as part of your care must to be carried out by the private provider as part of that package of care. We will not undertake monitoring or investigations on behalf of private providers.

Once a package of private care has been completed, the practice may offer ongoing investigations that would be considered necessary under the NHS.

 

Prescribing of medication

South East London Joint Medicines Formulary Formulary (selondonjointmedicinesformulary.nhs.uk)

SEL IMOC – RAGG list definitions – NHS South East London (selondonics.org)

NHS guidance is in place for the prescribing of medication on the basis of patient safety. A traffic light system is used to determine responsibility for prescribing of drugs initiated in primary care and secondary care.

The category that your medication falls into will determine if it will be prescribed by the practice. It will also depend if the practice agrees with the treatment plan being suggested by a provider or external clinician.

Green drugs – Whether private or NHS recommended, we can prescribe green drugs if the medication is licensed for the indication given. All prescribing is at the discretion of the prescriber and there may be circumstances where the prescriber is not in agreement with the treatment plan. If this is the case, we reserve the right to decline prescribing medications and an explanation will be provided.

Amber drugs – These are specialist drugs that must be initiated by secondary care specialist prescribers. We will not prescribe any amber drugs at the request of a private provider.

Red drugs – These drugs are for hospital use or for use by a specialist within a specialist centre only. Initiation, ongoing prescribing and monitoring of treatment should remain under the total responsibility of the hospital clinician or specialist. We will not prescribe any medications from the red drug list, whether requested by an NHS provider or private specialist

Grey Drugs – Medicines not normally recommended for routine prescribing. Weak evidence of cost effectiveness, benefit and/or safety. Drugs which the SEL IMOC consider do not represent good value to the NHS. Drugs where the formulary application is not presented to IMOC within the specified timeframes

Transferring your care from Private to NHS Provider

We can refer patients to NHS secondary care specialties when appropriate. Waiting times vary considerably depending on the NHS specialty.

While you are waiting for your NHS secondary care appointment, you will need to obtain medication and continue receiving care from your private provider.

Any other new physical or psychological medical issues that arise can be managed under standard NHS care.

Private providers can make referrals to NHS services without referral back to the GP, provided the patient would be eligible for NHS referral.

Burney Street Practice is committed to supporting our patients. However, when applying for benefits, housing, passes, adjustments or any other matter where medical conditions may be relevant, we will only supply this information when approached formally by a third party for a factual report.

We will not supply letters of support directly to patients.

Please note all requests from the third party will require the patients’ formal consent.

We will only complete factual responses. We are not able to give an opinion. If in doubt we will refuse to complete the request and may issue a copy of medical records instead with your consent.

Be aware we charge for any requests.