Prescribing drugs of dependence in general practice, Part A


3.7 Practice policies

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Good clinical governance is supported by comprehensive practice clinical policies aimed at a unified approach to drugs of dependence, which support individual GPs to prescribe these drugs safely and appropriately. Practices may choose to flag some of these policies to patients via a sign in the waiting room.

General practices should consider having, at minimum, agreed clinical policies regarding:

  • conditions for registrars prescribing drugs of dependence
  • handover standards from specialists and secondary care units
  • first presentations of new patients requesting drugs of dependence continuation from another provider
  • ‘repeat’ scripts for drugs of dependence
  • appropriate triaging and management of patients who are assessed as high risk (eg referral to specialised services)
  • practice standard approach/management to patients displaying drug-seeking behaviour
  • providing standard information on harms and risks to patients who are prescribed drugs of dependence
  • setting ceiling limits for opioid prescribing in the practice (above which triggers review)
  • standards for the 12-month review of patient opioid use
  • prescription pad security
  • staff safety – adopting a zero tolerance to violence towards staff.

In the clinical context of chronic pain, mental illness and addiction medicine, it can be difficult to balance benefits and harms. Some practitioners may be more vulnerable to excessive patient expectations – this can be prevented by agreed practice policies (eg setting opioid reiling limits).

Refer to Appendix D of the pDF version for examples of practice policies.

 

3.7.1 Staff safety

All practices must implement strategies to ensure the occupational health and safety of GPs and other members of the practice team. Concerns about violence in general practice continue to be raised by the profession, particularly following the deaths of GPs, and assaults and threats to general practice staff. To deal with these uncommon but distressing situations, the practice should have a risk management strategy that details the necessary steps to protect doctors and practice staff.

A doctor duress system is recommended in each consulting room and doctors should feel confident to use it in any situation where they feel under threat.

Practices can refer to General Practice – A safe place for tips and tools on minimising risks of violence.

Advice on managing aggressive, violent or threatening patients.