What is patient-led prescribing, and how do I navigate It?

13 July 2021 By Lorraine Gray

​A patient-led NHS or patient-led care are terms we are hearing more often in the medical sector. This is where our patients steer the conversation and influence the care they receive, with experienced and appropriately qualified input from medical professionals, of course. Within this, we’re beginning to hear of patient-led prescribing. It’s a phrase that both medical and non-medical prescribing colleagues might find jarring. So what is patient-led prescribing, and how do you approach it?

Navigating patient-led prescribing

Sometimes you may feel pressured by your patients to prescribe medication where your own clinical assessment doesn’t suggest a need for any. There can be myriad reasons for this. Some clinicians have felt increased pressure during Covid from patients for the prescription of anti-biotics due to their anxiety, however, in order to navigate the challenging situation of patient-led prescribing, we have created a guide to help you ensure the best possible patient care.

Why patient-led prescribing can happen:

  • The patient is frightened and does not believe your diagnosis

  • Leading on from this, the patient has researched their symptoms and self-diagnosed, including the treatment and medication they think they need

  • The patient is actively seeking pain medication – this could be a genuine request because they are in pain, or it could be because the patient is an addict or a substance abuser

  • The patient is vulnerable and attempting to gain medication under false pretences for a third party

  • The patient is frustrated, particularly post-Covid, with long waiting times and feeling like their treatment is on hold. The emotional side of this could mean feeling like they need to see some movement or action, translating as they want a prescription

  • Finally, and perhaps controversially, the patient could be feeling external pressure, maybe from social media or society in general, that a prescription or diagnosis makes them more worthy somehow. That they are more interesting or have a story to tell by having a prescription

Considerations when prescribing medication:

Whenever you are prescribing medication, it must always be in line with legislation and within the code of conduct, standards and guidance of your governing body. That might be the World Health Organisation (WHO), the General Medical Council (GMC) and the body that you are a member of. For example, for non-medical prescribing colleagues, that could be the Royal College of Midwifery or the Royal Pharmaceutical Society.

The 5 Rs when it comes to medicine administration are vital to keep in mind when it comes to prescribing.

The “5 rights of medication administration” in the UK

  1. The right patient

  2. The right drug

  3. The right dose

  4. The right route

  5. The right time.

Whilst these points are self-explanatory and almost beautiful in their simplicity; they are often overlooked.

When these points align, then you are fully justified in prescribing medicines to your patient. However, just one “R” being out of sync should be a warning flag to pause before issuing the prescription. For example, your patient has presented with a set of symptoms – you are confident of the right drug, the timing, the dosage and the route of administration, but you know the patient is vulnerable. It may be that you aren’t confident they can understand the instructions on how to take the medicine or that a support carer is not available to take instructions.

That is sufficient reason to withhold the prescription until you can be confident every ‘R’ has a green light beside it.

How to properly support your prescribing choices:

When it comes to prescribing, your experience and qualifications should tell you that you need the following:

  • An appropriate history of the patient

  • A complete understanding of the condition/s to be treated

  • A thorough clinical assessment of the patient

  • An awareness of the risk or potential risks to the patient

  • Knowledge of how to support the patient if appropriate

  • The ability to identify vulnerable patients

The onus is on the prescriber to take individual responsibility for the prescribing decisions. Be confident of yours, document your choices and your decision-making process. Although we can all feel pressure, particularly from patients and clinical targets and other influences, you are the expert.

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