Common Medication Questions

We are occasionally asked by patients to prescribe sedating medication for flying.

We regret that we are not able to facilitate these requests on the grounds of patient safety and our need to prioritise the delivery of NHS care on the basis of patients’ clinical needs.

Sedating medication, e.g. benzodiazepines such as diazepam, can render someone either paradoxically aggressive, or less able to follow instructions in an emergency, thus putting crew and other passengers at risk.

Sleeping tablets similarly have no indication for flying, and again could make a passenger difficult to rouse or transfer if there was a genuine in-flight emergency. Often passengers mix these medications with alcohol, with deleterious consequences. We would not wish you to to be barred from a flight or face prosecution, or find yourself incapacitated due to the unpredictable effects of said medication. The drug driving legislation which came into effect in recent years would also potentially prohibit onward driving from an airport.

Flight anxiety should be treated by Cognitive Behavioural Therapy – a form of counselling, which has long lasting benefits and is safe. Airline carriers offer excellent courses for free, so do speak with your flight provider to arrange to go on a course well in advance of when you know you will be flying.

It is not within the remit of the NHS to render someone fit to travel on a voluntary holiday or business trip. We acknowledge there may be occasion when you have previously received a prescription for this purpose. We regret that we will be unable to agree to such requests henceforth. This is a joint decision, unanimously made by all senior clinical staff within the practice.

Patients are reminded that they are able to arrange a consultation at a private travel clinic should they wish to pursue the option of in-flight medication further, but we cannot accommodate their request and so would politely ask that they respect this universal practice policy from 25^th April 2023.

We have been supported in the drafting of this policy by Cambridgeshire Local Medical Committee.

If you have recently been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) you will have received an initial diagnosis and treatment plan from a psychiatrist. Many patients are now choosing to attend private psychiatrists. This page provides essential information on the process of St Mary’s Surgery taking over prescribing your ADHD medication for both patients and private clinicians.

For Patients:

Your psychiatrist will be responsible for creating an initial treatment plan; determining the appropriate type, dosage, and monitoring schedule based on your individual needs. Once you are on a stable dose of medication (normally around 3 months), many patients ask if we can take over prescribing.

In order for St Mary’s Surgery to continue to take over prescribing there will need to be a “Shared Care Agreement” between ourselves which follows our local NHS guidelines (please see: https://www.cpics.org.uk/shared-care-guidance/ under title: “Methylphenidate, Dexamfetamine, Lisdexamfetamine for Adults with Attention Deficiency Hyperactivity Disorder”

Before we consider taking over prescribing responsibility we ask for:

• Information from your psychiatrist including date of diagnosis on a headed letter. This should be either posted or emailed to the practice.
• Name and dose of medication and how long you have been stable on this dose for
• We will need a baseline blood pressure, pulse and weight.
• You will need to be responsible for arranging regular follow-ups with your consultant, this is normally annually. Without regular follow-up with your psychiatrist (as agreed by the shared care agreement) we will no longer be able to continue prescribing. 
• Your medication will be reviewed 6 monthly by your named GP/clinical pharmacist. You will need to ensure you have a BP, pulse and weight check every 6 months, which can be booked by our Patient Services Team (01353 663434).  

In case of side effects or urgent matters related to your medication, please seek immediate medical attention. Notify both your GP and the specialist as soon as possible. If you wish to discontinue your ADHD medication or transfer care to a different healthcare provider, please discuss this with your named GP and psychiatrist to ensure a smooth transition.

For private clinicians:

Before we prescribe medication for ADHD, we require a formal diagnosis of ADHD from a psychiatrist on the GMC specialist register practicing within the UK. The psychiatrist will provide a formal diagnosis of ADHD and establish an initial treatment plan, including medication initiation and titrated. The psychiatrist will conduct regular consultations with the patient to assess treatment efficacy and make adjustments when necessary. The GP should be copied into any correspondence regarding patient consultations on a headed letter.

After a minimum of three months on a stable dose, the GP may consider taking over prescribing if asked by the patient and agreed with the specialist. We will require your clinic to meet the standards of shared care as set out by our local NHS Shared Care Agreement (https://www.cpics.org.uk/shared-care-guidance/ under “Methylphenidate, Dexamfetamine, Lisdexamfetamine for Adults with Attention Deficiency Hyperactivity Disorder”).

Specifically you should send us baseline observations (pulse, BP and weight) alongside a copy of the original ECG; along with clear prescription advice and a means to contact you in the event of an issue. We would expect you to provide ongoing annual input for the patient.

Medication reviews with the GP or clinical pharmacist will take place at the six month interval in between your annual reviews. The patient is responsible for arranging appointments for observation monitoring and follow-up appointments with their psychiatrist. Failure in attending appointments may result in their prescriptions being discontinued.

Previously, gluten-free products used to be available for prescribing for eligible patient groups.

However, with the increased availability, it is much easier to purchase a wide range of gluten-free products from the supermarket. As such, the Prescribing Partnership for Cambridgeshire & Peterborough Integrated Care System have changed the policy for prescribing gluten-free products.

GP surgeries have now been advised to cease prescribing of these products and they will no longer be available on repeat. 

If you would like to discuss this further, I recommend speaking with the Cambridgeshire formulary team:

• Email: cpicb.contact@nhs.net 
• Phone: 0800 279 2535

We understand that the NHS dental care is under immense pressure but GP’s are not qualified or insured to deal with dental matters. We have a strict practice policy that all dental related requests will be declined.

Please contact either your dentist or the emergency dental services on 0300 555 6667, option 1 to access urgent dental care in Cambridge, Huntingdon, Peterborough and Wisbech.

Weekday evenings, Weekends and Bank Holidays: please call NHS 111