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Section 2 – Special Prescribing Circumstances

Practice Guidance 18: Family, friends and close colleagues

18.1 You must not prescribe medications to treat yourself. You should be registered with your own medical and/or health practitioner who will be objective in providing you with good care.

18.2 You should wherever possible avoid prescribing for those close to you. People close to you may include your immediate family (parents, grandparents, children, grandchildren, siblings, aunts, uncles and first cousins), someone with whom you have an intimate personal relationship, your friends, and may also include colleagues with whom you regularly work. People you prescribe for should be formally on your caseload as your patient. You should check your employer’s policy on whether you are permitted to treat family, friends and colleagues.

18.3 You should avoid prescribing for family, friends and colleagues unless:

  • no other prescriber is available to assess their clinical condition and to delay prescribing would put their life or health at risk, or cause intolerable pain 
  • the treatment is immediately necessary to save life, avoid serious deterioration in their health and well-being or alleviate otherwise uncontrollable pain.

18.4 Changes to legislation must be made before therapeutic radiographer independent prescribers may prescribe from a limited list of controlled drugs. If such legislative changes are made you must not prescribe a controlled drug for someone close to you unless no other prescriber is available to assess the patient’s clinical condition, and to delay prescribing would put the patient’s life or health at risk, or cause intolerable pain. 

18.5 You should be able to justify your decisions to prescribe for those close to you. You must record the nature of your relationship and the special circumstances that necessitated your action of prescribing for family and friends.

Practice Guidance 19: Children

19.1 Medicines are potent treatments and prescribing them can present significant risk to patients. This is especially so for children whose responses may differ from adults. You must have relevant education, training and competence in treating children in order to prescribe for them. You should recognise the unique implications of prescribing for children and young people. Caution should also be taken when prescribing for pregnant and lactating women.

19.2 You should make reference to the following documents that address medicine management issues in paediatrics:

• The BNF for children www.bnfc.org

Department of Health National Service Framework for Children, Young People and Maternity Services. Medicines for Children and Young People  (2004)  https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...

• Medicines Standard: National Service Framework for Children, Young People and Maternity Services (Wales) (2005)   http://www.wales.nhs.uk/sites3/documents/441/englishnsf_amended_final.pdf

• Royal College of Paediatrics and Child Health www.rcpch.ac.uk/publications

• Scottish Executive – The Administration of Medicines in Schools (2001) http://www.gov.scot/Resource/Doc/158301/0042868.pdf and The Right Medicine: A Strategy for Pharmaceutical Care in Scotland (2002) http://www.gov.scot/resource/doc/158742/0043086.pdf

• Scottish Intercollegiate Guidelines Network (SIGN) Guidance www.sign.ac.uk

• Department of Health, Social Safety and Public Services in Northern Ireland (DHSSPS) (2015) Medicines Optimisation Quality Framework (2015)   https://www.dhsspsni.gov.uk/consultations/medicines-optimisation-quality-framework

• Department of Health Every Child Matters (2003) https://www.education.gov.uk/consultations/downloadableDocs/EveryChildMatters.pdf

Practice Guidance 20: Unlicensed medicines

20.1 Medicines are classified as unlicensed if they do not hold a UK Marketing Authorisation issued by the MHRA. If you are a radiographer supplementary prescriber you may prescribe unlicensed medicines that are defined within a written CMP. Therapeutic radiographer independent prescribers may NOT prescribe unlicensed medicines.

Practice Guidance 21: Mixing of medicines

21.1 Medicines are also rendered unlicensed if they are mixed together prior to administration. The law defines ‘mixing’ as the combination of two or more licensed medicines together for the purposes of administering them to an individual patient. If you are a therapeutic radiographer independent prescriber you may mix medicines prior to administration.

21.2 Radiographers may mix medicines, and must follow the guidance contained in the following document when prescribing and/or administering medicines: 

  • National Prescribing Centre    Mixing of medicines prior to administration in clinical practice: medical and non-medical prescribing (2010)

https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...

  • National Prescribing Centre   Mixing of medicines prior to administration in clinical practice — responding to legislative changes. Supporting Guidance for Healthcare Providers, Practitioners and Commissioners (2010)

http://www.webarchive.org.uk/wayback/archive/20140627111725/http://www.n...

21.3 Mixing of medicines must be done so according to best practice guidelines and be done on the basis of patient need only; never for practitioner convenience. Radiographers undertaking mixing of medicines must do so within their organisation’s governance framework. 

21.4 If you are a radiographer Supplementary Prescriber you may mix medicines that are defined within a written CMP.

Practice Guidance 22: Off-label use of medicines

22.1 An off-label medicine does hold a UK Marketing Authorisation issued by the MHRA, but is used in a way that is not described within the medicine’s Summary of Product Characteristics (SPC).

22.2 If you are an independent and/or supplementary prescriber, you may prescribe medicines for off-label use, but if you decide to do so you should: 

  • be satisfied that a licensed alternative is not available which includes your proposed usage within its SPC 
  • be satisfied that there is a sufficient evidence base for using the medicine in an off-label way to demonstrate safety and efficacy. Where the manufacturer’s information is of limited help, the necessary information should be sought from another reliable and reputable source 
  • record the medicine prescribed and the reasons for using an off-label product in the patient’s notes
  • explain to a patient in broad terms why you are using the medicine in an off-label way 
  • make a clear, accurate and legible record of your reasons for using a medicine in an off-label manner.

22.3 It is often necessary in paediatric practice to use licensed medicines in off-label ways. You must consult the BNF for Children or other appropriate guidelines before prescribing for children.

Practice Guidance 23: Remote prescribing

23.1 Most prescribing should occur on the basis of a face-to-face consultation with your patient. Remote prescribing occurs if you issue a prescription based on a telephone, e-mail, fax, video-link, web-based or other non-face-to-face contact with a patient and would be an exceptional circumstance. You should only remote-prescribe for your own patients or patients on your own case-load. You must ensure that you have an appropriate dialogue with your patient to: 

  • establish the patient’s current medication history 
  • carry out an adequate assessment of the patient’s condition 
  • ensure there is sufficient justification to prescribe the medicines remotely, including discussing the feasibility of seeing another prescriber who can carry out a face-to-face consultation. This is particularly important when a remote-consultation does not permit an adequate assessment of the patient’s condition to be undertaken 
  • ensure there are no contraindications to the proposed medicine 
  • ensure arrangements are in place to provide follow-up and continuity of care 
  • ensure a clear record is made of the prescribing decision and in particular the method of remote prescribing used eg instruction over the phone, e-mail etc.
  • ensure that the primary care record holder is informed 
  • ensure that the patient has “sufficient information” to make an informed choice to accept your recommendation.

23.2 Where you cannot satisfy all of the conditions above, you should not use remote means to prescribe for your patient.

Practice Guidance 24: Prescribing on the recommendation and/or at the request of others

24.1 You should only prescribe for patients on your own caseload and under your overall care. You must not prescribe for any patients upon whom you have not undertaken an appropriate assessment. 

24.2 If you prescribe on the recommendation of another health professional who does not have prescribing rights, you must satisfy yourself that you have performed an appropriate assessment of the patient yourself in order to reach a diagnosis so that you can determine that the prescription request is appropriate for the patient concerned and that the professional is competent to have recommended the medication.

Practice Guidance 25: Controlled drugs

25.1 If you are a supplementary prescriber working within a written Clinical Management Plan (CMP), you may prescribe any controlled drug listed within the CMP.

25.2 If you are a therapeutic radiographer independent prescriber, subject to changes to the Misuse of Drugs Regulations, you may prescribe from a limited list of controlled drugs deemed necessary to ensure patients are able to access optimal and timely treatment. The list of controlled drugs will support patients with conditions most commonly seen by radiographers in practice. This list will also follow national best practice evidence and guidance.

25.3 You must not prescribe a controlled drug for yourself.

25.4 You must not prescribe controlled drugs for someone close to you unless; 

  • no other prescriber is available to assess the patient’s clinical condition and to delay prescribing would put the patient’s life or health at risk, or cause intolerable pain.
  • you can justify your decisions to prescribe controlled drugs for those close to you. You must record the nature of your relationship and the special circumstances that necessitated your action of prescribing controlled drugs to those close to you.

25.5 You must know who your local Controlled Drug Accountable Officer for Designated Body (AO) is and comply with any local monitoring and/or inspection requests that the AO may make.

25.6 You must follow the Standard Operating Procedures (SOPs) that are in place within your organisation for the usage and secure storage of CDs according to Regulations. SOPs must include procedures for prescribing CDs, administering CDs, and recording any adverse reactions. 

25.7 If you are a supplementary and/or independent prescriber you may instruct another person to administer CDs in accordance with your valid prescription and in accordance with national guidance.

25.8 You must ensure that any prescription for a CD is completed on the correct prescription form and contains all the information required commensurate with the Schedule of the controlled drug being prescribed, which will in all cases include the patient’s NHS number or other unique identifier.

25.9 You must ensure that: 

  • in-patient prescribing of CDs is recorded on the Medicines Administration Record (MAR) or in-patient sheet in accordance with local policies 
  • CDs for patients being discharged are written on locally approved To-Take-Out (TTO) sheets or equivalent 
  • out-patient prescribing must be on an FP10PCD form or equivalent.
  • out-patient prescribing by supplementary prescribers is on the relevant FP10SS form or equivalent.

25.10 You must only prescribe CDs at the time of clinical need and you must not prescribe more than is needed for the immediate clinical need, and in any event for no more than a 30 day supply. You must remember that the validity of prescriptions for Schedule 2, 3 and 4 CDs is 28 days.

25.11 You may use computer-generated prescriptions for CDs, providing the necessary software is in place and that there is an audit trail of your prescribing practice. Your signature must be hand-written. Where patient sticky-labels are used they must be tamper-evident labels and you must sign or initial over the sticky label to indicate that the sticky label relates to the patient for whom your prescription is intended.

25.12 If any part of your prescription for a CD is hand-written, you must write it yourself and not ask any other person to write all or part of the prescription for you.

25.13 All private CD prescribers require a separate 6 digit prescriber code for private CD prescriptions (this is different to your unique NHS prescriber code). This ensures that there is a clear separation between NHS and private CD prescribing and if you prescribe in both NHS and private settings you must keep your two prescriber codes separate.

Practice Guidance 26: Simultaneous prescribing and administration

26.1 Prescribing and/or supply followed by simultaneous administration of a medicine to the patient creates the opportunity for errors to occur. If you prescribe for a patient, where possible a pharmacist should supply the medicine to the patient prior to administration.

26.2 Simultaneous prescribing and administration should be undertaken only in exceptional and rare circumstances and only if it is in the patient’s best interests. You should ensure wherever possible that a second person checks that your prescription is what is administered to the patient. The second ‘’checker‟ need not be a prescriber or registered health-professional themselves but should be able to verify that the correct medicine is being supplied to the patient.

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