Dr David Smith, Chair, Sefton LMC

Prescribing Optimisation Form

This month’s edition of the Chair’s Bulletin is dedicated to the new outpatient Prescribing Optimisation Feedback Form.

Colleagues may recall that earlier this year, Sefton LMC wrote to all local NHS providers to advise that from 2nd August 2023, we would be asking Sefton GP practices to reject all unsatisfactory prescribing requests using a dedicated form, sent to a dedicated email address at each provider.

This created quite a furore, particularly our stipulation that a 14-day supply of any new medication should be prescribed by the outpatient service itself.

Following a discussion at the North Mersey Primary-Secondary Care Interface Group, Sefton LMC agreed to pause the initiative to allow time for outpatient providers to introduce the necessary governance, for further debate about the duration of outpatient prescriptions, & to work with the ICB/ our neighbouring LMCs to adopt one pushback process across the North Mersey footprint.

Sefton LMC is delighted that this has resulted in an ICB-approved outpatient Prescribing Optimisation Feedback Form – this should have been uploaded to your EMIS systems & be ready for use (if not, we have attached it to this email) – of note, we have agreed to pause the 14-day supply stipulation for the time being to focus on the safety & quality of outpatient prescribing.

The central communications about this form have been limited so we would like to take this opportunity to share a simple guide to using the form, & to ask that all Sefton GP Practices start doing so as a matter of routine from Monday 4th December 2023 – thank you in anticipation of your support.


Step 1 – When to use the form

As you will see when you open the form, there are 12 reasons why you might wish to send the form – you can select 1 or more reasons for each medication.  We would like to draw you attention to the following:

No. (7) This item is a short-term prescription (28 days or less) so it should be prescribed by the service recommending it.

This means the majority of acute prescription requests can be rejected.

No. (8) This item requires monitoring or titration within the first 14 days & the service recommending it has not arranged these.

e.g. The initiation or up titration of an ACE inhibitor/ ARB medication.

No. (9) We require clarification that the recommendation to prescribe this item has been discussed with the responsible clinician.

Please select this for requests by advanced practitioners or junior doctors where it is not clear that the consultant has supervised the request.

No. (10) We have not received a timely outpatient letter detailing what the   patient has been told about the following:

  • Indications/intended benefits
  • Common & serious potential side effects
  • Monitoring & follow up required.

So we should not be accepting anything less than “I have advised this patient to commence amlodipine to improve their blood pressure; I have advised them of the common & serious potential side effects, in particular… and I have advised them to contact their GP practice to arrange a repeat blood pressure check in 1 month; please add this to their repeat prescription list.”

No. (11) We have been asked to select an item from a list of options but we feel the service recommending this is better placed to do so.

A common example is when a neurologist asks us to initiate one of a selection of medications for migraine prophylaxis.

The form is only to be used for outpatient prescription requests – it has been approved by all local NHS trusts but you are at liberty to use it for requests made by others, e.g. non-NHS provider outpatient departments if you wish.