While the majority of requests from Secondary Care to Primary Care to take over prescribing responsibility are appropriate, occasionally they are not. Any requests from Secondary Care (or other provider) to prescribe a drug or device which is not endorsed for use in Primary Care should be reported on the form below. This allows the CCG to monitor and report back on all such requests. In addition, it will be necessary for individual Prescribers to communicate directly with the requester to explain that they will not be able to take on the prescribing as suggested.
The CCG collates information on such requests so they can be raised directly with the providers to minimise future (inappropriate) requests or to prompt review of prescribing guidance where appropriate.

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* 1. Practice name

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* 2. Practice Code (e.g. MXXXXX)

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* 3. Date of Breach

Date

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* 7. Consultant (or other healthcare professional advising), including job title

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* 8. Was a Treatment Advice Note (TAN) received

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* 9. Please indicate which area the Provider Contract is believed to have been breached, by selecting the relevant option(s) below. NB. Medicines include prescribable (FP10) appliances e.g. dressings, devices

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* 10. Name of Drug or Device being requested (if applicable)

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* 11. Please provide details of the breach: (Please do not include Patient Identifiable Data, this includes NHS numbers)

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* 12. Action taken by GP practice

 
Thank you for taking the time to report this breach.

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