Patient partnership and complex prescribing decisions

Consent, capacity, communication, adherence, remote prescribing, self/family prescribing and complex judgement.

Pre-prescribing foundation: this module develops knowledge and judgement for formal prescribing education; it does not authorise prescribing.

• Integrate consent, capacity, preferences and health literacy into prescribing.
• Explain shared decision-making without abandoning professional responsibility.
• Recognise adherence barriers and medicine beliefs.
• Apply additional safeguards to remote/online prescribing.
• Recognise conflicts in self-prescribing or prescribing for close contacts.

Shared decision-making requires understandable information about options, benefits, harms, uncertainties and the option not to treat.

Adherence problems may reflect burden, beliefs, side effects, cost/access, cognition, health literacy or disagreement with the plan.

Remote prescribing increases the importance of identity, adequate assessment, records, access to monitoring and safety-netting.

Prescribing for self/family creates conflicts and continuity/safety risks and should be approached within professional standards and exceptional circumstances.

1. Define the clinical problem and whether prescribing is indicated.
2. Gather the patient-specific assessment and diagnostic information needed.
3. Check competence, professional authority and employer/service scope.
4. Compare reasonable options using current authoritative sources.
5. Agree the plan with the patient, including uncertainty and alternatives.
6. Prescribe accurately only when the decision is justified.
7. Document, monitor, review and safety-net.

Module emphasis: Explore what matters to the patient, capacity and communication needs, explain reasonable options and uncertainty, and ensure the chosen plan remains clinically safe.

Scenario 1. A patient wants a medicine despite understanding that expected benefit is small and harms are material.

Reasoning prompt: Explore what matters to the patient, capacity and communication needs, explain reasonable options and uncertainty, and ensure the chosen plan remains clinically safe.

Scenario 2. A video consultation lacks access to recent blood results needed for safe prescribing.

Reasoning prompt: Explore what matters to the patient, capacity and communication needs, explain reasonable options and uncertainty, and ensure the chosen plan remains clinically safe.

Scenario 3. A prescriber is asked to prescribe for a close family member while no independent clinician is immediately available.

Reasoning prompt: Explore what matters to the patient, capacity and communication needs, explain reasonable options and uncertainty, and ensure the chosen plan remains clinically safe.

• Shared decision-making means doing what the patient asks.
• Remote prescribing is the same consultation through a screen.
• Non-adherence is usually deliberate refusal.

• What clinical problem am I trying to solve, and is prescribing indicated?
• What information is missing before a safe decision can be made?
• Is this within my current competence, professional authority and employer/service scope?
• Which current authoritative medicine or guideline source should I check?
• What patient-specific factors change benefit, harm, dose, route or monitoring?
• What will I document, monitor, review and safety-net?
• When should I seek supervision, pharmacy advice, specialist input or urgent escalation?

Optional reflection: Without entering identifiable patient or employer information, identify one capability you would need to strengthen before prescribing independently in this area.

• Shared decision-making requires understandable information about options, benefits, harms, uncertainties and the option not to treat.
• Adherence problems may reflect burden, beliefs, side effects, cost/access, cognition, health literacy or disagreement with the plan.
• Remote prescribing increases the importance of identity, adequate assessment, records, access to monitoring and safety-netting.
• Prescribing for self/family creates conflicts and continuity/safety risks and should be approached within professional standards and exceptional circumstances.

Check current versions for time-sensitive decisions.

• RPS-01 - Royal Pharmaceutical Society: A Competency Framework for All Prescribers (2021)Open official source
• NMC-01 - Nursing and Midwifery Council: Standards for prescribersOpen official source
• GPHC-01 - General Pharmaceutical Council: Standards for education and training of pharmacist independent prescribersOpen official source