11/13/24, 7\:44 PM Guide | Prescribing in primary care

Prescribing in primary care

Table of contents

Introduction

All UK doctors begin work in a hospital environment and become familiar with writing prescriptions on an inpatient
prescription and administration record or “Kardex”
. Many hospitals are now moving to electronic prescribing for inpatients.
However, most prescriptions are issued to patients in a primary care setting and there are some important di
consider.
This article will cover the principles of prescribing in primary care, including how to write an FP10 prescription.

Prescription forms

Prescriptions written for NHS patients in primary care are done on set prescription forms - either as part of a handwritten
prescription pad or prescription forms that can be printed using GP practice computer software.
The legal prescription requirements are the same across these forms, but it is important to understand the di
correct one is used. The below tables provide an overview of key form colours in each major UK region.

England

Table 1. Prescribing forms in England
All prescription forms originating in England begin with the code FP10.
Code
Form
colour
Issued by Notes
FP10
FP10NC
GREEN
FP10SS
FP10HNC
FP10MDA BLUE
FP10SP
LILAC
FP10PN
GPs
Nurse prescribers
AHP prescribers
Pharmacist prescribers
Hospital doctors (outpatient)
Prescribers managing substance misuse
patients
Community/independent nurse
prescribers and AHP prescribers
FP10D YELLOW Dentists
The su
prescriber (e.g. HNC for hospital)
Instalment dispensing prescriptions for the
purpose of treating addiction.

Wales

Table 2. Prescribing forms in Wales
Form
Code
colour
Issued by Notes
https\://app.geekymedics.com/osce-guides/prescribing/prescribing-in-primary-care/ 1/611/13/24, 7\:44 PM Guide | Prescribing in primary care
WP10
WP10SS
WP10SP
GREEN
GPs, hospitals and supplementary
prescribers
The su
prescriber (e.g. HP for hospital)
WP10HP
WP10HSP
WP10MDA
GREEN
WP10HP(A
Prescribers managing substance
misuse patients
Instalment dispensing prescriptions for the purpose of
treating addiction.
D)
WP10CN
GREEN
WP10PN
Community/independent nurse
prescribers
WP10D GREEN Dentists

Scotland

Table 3. Prescribing forms in Scotland
Form
Code
Issued by Notes
colour
GP10
PEACH GPs
GP10(SS
)
HBP(A) PINK
Prescribers managing substance
misuse patients
Instalment dispensing prescriptions for the purpose of
treating addiction.
GP10(N) LILAC Nurse prescribers
HBP BLUE Hospital-based prescribers
GP14 YELLOW Dentists

Northern Ireland

Table 4. Prescribing forms in Northern Ireland
Code Form colour Issued by
HS21
SHADED
GPs
GREEN AND PINK
HS21CS
HS21X
SHADED
Non-medical
GREEN AND PINK
HS21XCS
prescribers
HS21N
SHADED
Community nurses
GREEN AND PINK
HS21NCS
HS21D YELLOW Dentists

Sources of information

Before you put pen to one of these forms it is important you have all the right information to hand so that your prescription is
safe and correct.
https\://app.geekymedics.com/osce-guides/prescribing/prescribing-in-primary-care/ 2/611/13/24, 7\:44 PM Guide | Prescribing in primary care

Local formulary

A good place to start is the local formulary for your organisation (e.g. NHS trust). These give information on which drugs to
prescribe per class/indication, usually based on clinical guidelines (such as NICE/SIGN) and cost.
For example, if you have an adult patient with asthma and wish to prescribe an inhaled corticosteroid, your local formulary will
indicate which to consider the
the most cost-e
Figure 1. Sample Asthma Guideline adapted from SIGN/BTS

British National Formulary (BNF)

The BNF is the go-to resource for drug information in the UK. It is available as a printed book, mobile app or website. The BNF
is organised into 16 main chapters which are subdivided by condition, the drugs are then organised under the conditions by
class.
Be sure to check both the condition summary, class monograph and drugs monograph as important information for your drug
may be included in the class monograph and not repeated for each individual drug.

Summary of product characteristics

Each licensed medicine in the UK has a "Summary of Product Characteristics" available on medicines.org.uk. These contain
more detailed information beyond what is contained in the BNF and are a useful source of further information if your query is
not answered by the BNF.

Pharmacists and medicines information services

Pharmacists are experts in the use of medicines and are an excellent source of advice if you are unsure about something. Many
GP practices employ pharmacists in-house; otherwise, those working in community pharmacies may also be able to help.
For more specialist advice, there are Medicines Information Services around the UK whose contact details are located within
the BNF.

Patient-speci

Before you prescribe your drug of choice, it is important to consider the speci
can be used as a checklist to ensure you have considered them when deciding if your prescription is appropriate.
Table 5. Prescribing in speci
https\://app.geekymedics.com/osce-guides/prescribing/prescribing-in-primary-care/ 3/611/13/24, 7\:44 PM Guide | Prescribing in primary care
Factor Prescribing considerations
Age
Weight Renal impairment
Hepatic impairment Pregnancy and
breastfeeding
Children and elderly patients are at higher risk of prescribing complications, so take
special care.
Do you have the patient’s current weight for dose calculation?
Will the excretion of this drug be a
Can this drug worsen renal impairment?
Will the metabolism of this drug be a
Is this drug known to be safe?
What are the bene
Are there interactions?
Other drugs/conditions
Will this drug worsen another condition (check contraindications and cautions in BNF)?

Prescription requirements

All prescriptions, whether written on a hospital chart, primary care prescription form, or private prescription, have the same
basic requirements.
All prescriptions must\:
State the name and address of the patient
Be written or printed legibly in ink
Be signed in indelible ink
Have an appropriate date (usually the date of signing)
State the address of the prescriber
State the age of a child under 12
It is good practice to\:
Include the age and date of birth of the patient
State the weight of the patient where it has been used for a dose calculation
Details of the medicine to include\:
Name of medicine (generic name unless a speci
Form (e.g. tablets, oral suspension)
Strength (e.g. 5mg for tablets or 125mg/5ml for an oral suspension)\: units and acceptable abbreviations are shown in Table 6.
Directions\: should include quantity and frequency and for liquid preparations, it is best practice to write directions using the
mass of active ingredient rather than volume so the pharmacist is clear on the dosage (especially for oral suspensions i.e.
125mg rather than 5ml).
Quantity to be supplied (e.g. 56 tablets)
Table 6. Common drug units and associated abbreviations
Unit Abbreviation
Grams g
Milligrams mg
Micrograms Nanograms Litres L
Millilitres mL
Must be written in full (micrograms)
Must be written in full (nanograms)
https\://app.geekymedics.com/osce-guides/prescribing/prescribing-in-primary-care/ 4/611/13/24, 7\:44 PM Guide | Prescribing in primary care
International units Units (not iu or u)

Example FP10 prescription

Exemplar FP10 Prescription

Legal classi

Medicines licensed for use in the UK can be broken down into four basic categories.

General sales list (GSL)

Medicines that can be purchased from any shop, such as a petrol station, such as paracetamol.

Pharmacy only (P)

Medicines which may only be sold in a pharmacy by a pharmacist or their supervised sta

Prescription only medicines (POM)

Medicines which are only available with a valid prescription.

Controlled drug

Prescription-only medicines, which are subject to extra prescription requirements.

Prescribing restrictions

Most drugs that are GSL, P or POM may be prescribed as described above (however, some health boards/trusts are restricting
the prescribing of GSL and P medicines to encourage patients to buy these themselves).
Controlled drugs are subject to extra prescription requirements which are covered in the controlled drug prescribing article.
You can

References

1. Datapharm Communications Ltd. About the eMC. Published in 2019. Available at\: [LINK]
2. Joint Formulary Committee. British National Formulary. Published in 2020. Available at\: [LINK]
https\://app.geekymedics.com/osce-guides/prescribing/prescribing-in-primary-care/ 5/611/13/24, 7\:44 PM Guide | Prescribing in primary care
3. Pharmaceutical Services Negotiating Committee Is this prescription form valid? Published in 2018. Available at\: [LINK]
4. Royal Pharmaceutical Society of Great Britain. Medicines, Ethics and Practice\: The professional guide for pharmacists. Published
in 2014. Available at\: [LINK]

Reviewer

Dr Lyndsey McConnell
Consultant General Practitioner
Source\: geekymedics.com
https\://app.geekymedics.com/osce-guides/prescribing/prescribing-in-primary-care/ 6/6