Hospital Medication Requests Policy

 

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Purpose

This policy sets out the practice’s position on handling medication requests from hospital departments.

It ensures safe prescribing practices and appropriate responsibility-sharing between primary and secondary care.

Policy Statement

When a hospital requests the initiation or titration of medication for a patient, the following principles apply:

1. Initiation of Medication

  • The first prescription must be issued by the hospital department that is recommending the treatment.
  • The hospital remains responsible for any initial monitoring, assessment of suitability, and patient counselling regarding the medication.

2. Titration and Dose Adjustments

  • If the hospital increases or adjusts a medication dose, they must arrange and review necessary blood tests or other required monitoring.
  • The hospital must issue prescriptions for the medication during the titration period.
  • The hospital remains responsible for making any required medication alterations based on the results of monitoring.

3. Transfer to GP Prescribing

  • Once the patient is clinically stable, the GP practice will consider taking over routine prescribing.
  • The hospital must provide clear guidance on ongoing monitoring requirements and confirm that it is safe for the GP to continue prescribing.
  • The practice will not issue prescriptions for medications that require ongoing specialist monitoring unless a formal shared care agreement is in place.

Example Scenario

For medications such as methotrexate, if the hospital increases the dose, they must:

  • Arrange and review blood tests.
  • Make any necessary medication alterations.
  • Issue prescriptions during the titration period.

Once the patient is stable, the GP practice may take over prescribing as part of routine care.

Staff Guidance

  • Any medication requests from hospitals should be reviewed against this policy.
  • If a prescription request does not meet the outlined criteria, the request should be referred back to the hospital for action.
  • If there is any uncertainty, consult with one of the GP Partners before actioning the request.

This policy ensures patient safety and appropriate prescribing responsibility between primary and secondary care.

Example Letter

The sample letter to be sent to the hospital is attached below:

  • [Department Name]
  • [Hospital Name]
  • [Hospital Address]
  • [City, Postcode]
  • [Date]

Re: Medication Request for [Patient Name & DOB]

Dear [Specialist’s Name],

We have received your request to initiate/prescribe [Medication Name] for the above-named patient. As per our practice policy and standard prescribing guidance, the responsibility for initiating, titrating, and stabilising certain medications lies with the specialist team before transferring prescribing responsibility to primary care.

In line with this, we kindly request that:

  • The first prescription is issued by the hospital.
  • Any dose titration and monitoring are managed within your department, including arranging and reviewing any necessary blood tests.
  • The patient is only transferred to GP prescribing once clinically stable, with clear guidance on ongoing monitoring requirements.

This also applies to all medications regardless of their Lancashire and South Cumbria Medicines Management RAG status (except for RED and BLACK drugs) or whether they are classed as shared care medications. 

This policy is necessary in order to ensure safe prescribing practices and appropriate responsibility-sharing between primary and secondary care. The initiating clinician therefore remains responsible for any initial monitoring, assessment of suitability, and patient counselling regarding the medication being issued. Any requests for the practice to take over prescribing of unlicensed medications or unlicensed dosages (or not licensed for the specific indication for which they are being prescribed) will be rejected outright. The practice will also not entertain any requests that it deems outside of their clinician’s expertise or experience. 

For example, if this request relates to methotrexate or another specialist medication (for which this practice has a formal funded shared care agreement in place), the hospital should handle dose adjustments and necessary monitoring before transferring responsibility. Once the patient is stable and all relevant monitoring arrangements are in place, we will be happy to continue prescribing in primary care.

Please confirm how you wish to proceed with this request. If a shared care agreement is in place, please provide full details of the monitoring arrangements and patient safety protocols.

Should you wish to discuss this matter further, please do not hesitate to contact us.

Yours sincerely,
[Practice Name]

Providing NHS Services

Contact

Holland House Surgery
Lytham Primary Care Centre
Victoria Street, Lytham
FY8 5DZ

Freckleton Health Centre
Douglas Drive, Freckleton
Lancashire, PR4 1RY

Telephone: 01253 229470

The Practice

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