Prescriptions

Each year 25% of the population visit their GP for a respiratory tract infection (eg sinus, throat or chest infection). These are usually caused by viruses.

For patients who are otherwise healthy, antibiotics are not necessary for viral infections.

These infections will normally clear up by looking after yourself at home with rest, plenty of fluids and paracetamol.

• Ear infections typically last 4 days: 89% of cases clear up on their own
• A sore throat typically lasts 7 days: 40% of cases clear up after 3 days and 90% after 7 days without antibiotics
• Sinusitis typically lasts 17 days: 80% clear up in 14 days without antibioticsCough/bronchitis typically lasts 21 days. Antibiotics reduce symptoms by only 1 day
• Antibiotics only work for infections caused by bacteria.

Taking unnecessary antibiotics for viral infections should be avoided because they may not be effective next time you have a bacterial infection.

In accordance with NHS recommendations most prescriptions will have the generic name rather than the brand name. The effectiveness and safety of the generic preparation is identical to that of the brand name. If you are at all uncertain please check with us.

A generic drug or other product is one that does not have a trademark and that is known by a general name, rather than the manufacturer’s name.

Prescribing for patients travelling or living abroad :

If you are concerned about taking medication abroad you can visit your local community pharmacy who are well placed to provide the information that is needed, and can also advise on a wide range of travel-related health issues.

The NHS accepts responsibility for supplying ongoing medication for the treatment of existing long term conditions for up to three months when a patient travels abroad.

• If a person is going to be abroad for more than three months then only a sufficient supply of his/her regular medication should be provided to enable them to get to the destination and find an alternative supply.
• NHS prescriptions must not be obtained by relatives or friends on behalf of patients who are currently abroad.
• Patients are responsible for ensuring that any drugs they take into a country conform to local laws

If a patient is travelling abroad for longer than three months, they are expected to arrange for alternative access to care and supply of medication at their destination. By law, the NHS ceases to have responsibility for the medical care of patients when they leave the UK.

• For patients who will be out of the country for less than three months, it is reasonable to provide sufficient medicines for existing conditions.
• Patients out of the country for more than three months should be advised to register with a doctor in the country they are visiting/residing for their on-going medical needs.

Background

Benzodiazepines (including Diazepam, Lorazepam, Temazepam, Clonazepam) are medicines which have been in use since the 1960s for a wide range of conditions, such as alcohol withdrawal, epilepsy, and muscle spasms.

These medications can have negative effects on memory, co-ordination, concentration and reaction times, as well as being sedating. They are addictive and withdrawal can lead to seizures, hallucinations, agitation, and confusion.

Unfortunately, benzodiazepines have widely become drugs of abuse.

Policy Decision

Patients often approach their GP to prescribe Diazepam for fear of flying or to assist with medical procedures or scans. It is not recommended that we prescribe Diazepam in these situations and therefore the Practice has  made the decision that we will no longer be prescribing for these reasons.

Reasons

Flying

1. The national prescribing guidance followed by GPs (The British National Formulary – BNF) states that all benzodiazepines are contraindicated (not allowed) in the treatment of phobias.
   Benzodiazepines are only licensed for short term use in generalised anxiety crisis. If this is the case for you, we advise that you seek support for your mental health and it would not be advisable to go on a flight.
   Your GP would be taking a significant medico-legal risk by prescribing against these national guidelines.
2. Diazepam is a sedative and it can delay reaction times. If an emergency were to occur during your flight, this could impair your ability to follow instructions and reach safety.
3. Diazepam has the potential to make your more sleepy and can induce non-REM sleep and therefore cause you to move less. This can be associated with an increased risk of DVT (blood clot) whether in an aeroplane or not.
4. Going on a plane normally involves your blood oxygen levels decreasing from around 98% to as low as 90% due to the high altitudes. Diazepam works to depress your breathing and therefore can put you at increased risk of hypoxia (very low oxygen levels), which, in combination with a pre-existing lung issue, can be dangerous.
5. In some people, Diazepam can have the opposite effect and make them more agitated or even aggressive, more so in combination with alcohol. This is called a paradoxical effect and can be very inconsistent, even if Diazepam has been used in the past.

What you can do

We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines. These courses are aviation-industry approved and are run by several airlines. The positive effects of the courses continue after the courses have been completed. We have listed a number of these below :

Easy Jet – Tel 0203 8131644
Fearless Flyer EasyJet

British Airways – Tel 01252 793250
Flying with confidence

Ultimately, if you still feel unable to fly, then it may be appropriate to consider alternative routes of transport.

If you still wish to consider Diazepam for fear of flying, we suggest consulting with a private GP or a private travel clinic, who may be able to help you further. These services are private and not offered by the NHS. The private clinics may then liaise with the airlines directly to arrange a medically-trained escort for a passenger who is taking sedative medications, which can be expensive.

For sedation in medical procedures (including dentistry) and scans

We do not provide sedative medications such as diazepam for use in other situations, such as for dental/hospital procedures or scans.

The Royal College of Radiologists sets out clear guidance for sedation in hospital radiology departments which states “Sedation and analgesia should be administered by a competent and well-trained sedation and oversight provided by a sedation committee within the institution”.

The Intercollegiate Advisory Committee for Sedation in Dentistry has a similar guideline which states “The monitoring and discharge requirements for oral sedation are the same as for intravenous sedation. Oral sedation must only be administered in the place where the dental treatment is provided and must only be carried out by practitioners who are already competent in intravenous sedation.”

As a result, responsibility for this type of treatment lies with your dentist or hospital staff, and not your GP. If you feel this is required, we suggest consulting with your dentist or the hospital teams in good time before any scans or treatments occur.

When you are discharged from Hospital you should normally receive seven days supply of medication.

On receipt of your discharge medication, which will be issued to you by the Hospital, please contact the Surgery to provide them with this information before your supply of medication has run out.

Hospital requests for change of medication will be checked by a prescribing clinician first, and if necessary a prescribing clinician will provide you with a prescription on request. 

Specialists will often suggest particular medication at a hospital appointment and ask us to prescribe for you. To ensure your safety we do need to receive written information from the specialist before prescribing. Sometimes a medicine is suggested that is not in our local formulary. There is nearly always a close alternative, and specialists are told that we sometimes make suitable substitutions when you are referred. We will always let you know if this is the case.

The NHS Medicines, Care and Review Service is a voluntary service for people with long-term conditions. It’s available at all community pharmacies across Scotland.

You can only use this service if you’ve registered with a community pharmacy.

You may have heard people referring to Polypharmacy. It means lots of medicines. A medicine review is particularly useful for people who take a lot of medicines; for these people their medicines review may be called a Polypharmacy Review.

A GP in the surgery can only provide a private prescription if the medication is not available on the NHS.

A private prescription is not written on an official NHS prescription and so is not paid for by the NHS. A prescription is a legal document for which the doctor, who has issued and signed it, is responsible. A doctor you see privately is unable to issue an NHS prescription.

The cost of a private prescription is met wholly by the patient and is dictated by the cost of the medicine plus the pharmacists charge for supplying it.

Non-repeat prescriptions, known as ‘acute’ prescriptions are medicines that have been issued by the Doctor but not added to your repeat prescription records. This is normally a new medication issued for a trial period, and may require a review visit with your Doctor prior to the medication being added onto your repeat prescription records.

Some medications are recorded as acute as they require to be closely monitored by the Doctor. Examples include many anti-depressants, drugs of potential abuse or where the prescribing is subject to legal or clinical restrictions or special criteria. If this is the case with your medicine, you may not always be issued with a repeat prescription until you have consulted with your Doctor again.

Regarding pre-operative and post-operative care from patients who are considering surgery abroad. The Scottish Government & NHS Scotland have issued the below guidance to all GP Practices in Scotland:

While the NHS in Scotland will always provide emergency care where necessary, all routine pre and post-operative care should be part of the package of care purchased by the individual patient.

• There will be no obligation on NHS Boards to provide such routine pre and post-operative care.
• In the event of a patient advising a healthcare professional of plans to travel overseas for privately arranged and purchased surgery, they should be advised firstly that this is not recommended, and secondly that there will be no obligation on their local NHS Board to provide routine pre and post-operative care. All care required should be provided within the package of care sold by the overseas provider.

You may have noticed that the label on your painkiller medicine says: “May cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.”

Your doctor or nurse may also have discussed side effects of your painkillers with you.

Strong painkillers (or opioids) affect each person in a different way. They can make some people drowsy and reactions can be slower than usual. This may be worse if you take other medicines that cause drowsiness or if you drink alcohol. If you are someone who drives you may be wondering if it is safe for you to drive. The following information will help you to decide.

• You must not drive if you feel sleepy
• You must not drive after drinking alcohol or taking strong drugs which have not been prescribed or recommended by your doctor for example, cannabis.
• You must not drive if you start taking other drugs that cause sleepiness, either prescribed by your doctor or bought from the chemist for example, hay fever medicine.
• You must not drive on days where you have had to take extra (breakthrough or rescue) doses of a strong painkiller.

If you are staying outside the practice area for holidays, work etc. we are unable to send prescriptions by post/email/fax. You should register with a practice as a temporary resident and request the medication. The Practice will contact us to confirm what medication you are currently being prescribed. Alternatively depending on your location some pharmacies may be able to provide the medication for you.