Hi

I have started working for a charity that provides home alcohol detoxes with the GP providing the prescription. If we were take over the prescribing who needs to be informed/agree. The GP’s certainly because of budget issues but we’re really not sure who else. And I'm sure there are loads....

I would imagine the GP would be enough wouldn't it?

when you say 'take over the prescribing' I don not quite understand. Who are you taking over from (you say you are prescribing through GPs). In terms of prescribing, the only responsible person is the prescriber so on a very basic level only the prescriber needs to be involved. However in order to run a scheme successfully you will need to offer good robust support to GPs and to be in touch and be accepted by local PCT clinical governace leads.
You will also want to make sure that everyone involved is working within their confidence and competance. Remuneration for GPs may also become an issue.

we have the south birmingham community alcohol team locally who do a similar thing, supporting community detoxes. maybe you could speak to their manager for advice. South Birmingham Community Alcohol teamTel: 0121 414 0888

If they are helping one of my patients, they will ring me or fax me as the GP, and ask for their usual alcohol detox cocktail to be prescribed, which they then pick up with the permission of the patient, and dole out each day to the patient, during the detox, along with breathalysers and support. I presume that is what you are describing? Is there a history of anybody else offering this service in your area? if not, as Jim says, there may be an issue of remunerating GPs for taking on the work, maybe through a LES?

I agree with Jim, you need to speak to the PCTs clinical governance people, and presumably you are already in conversation with whoever comissions alcohol services locally.

The service is certainly very very helpful locally, and one of my patients is at present delighted to be T-total having just completed a detox.

I set up an alcohol home detox team in my previous post and we worked similarly - contacted the client's GP and asked them to prescribe the detox which we supervised. Now I supervise alcohol detox's at the Practice and prescribe chlordiazepoxide and vitamins myself. We are planning an alcohol LES.

We are currently providing approx 20 detoxes per month, apologies for repetition as I have already posted this request on another forum, but we routinely give IM Pabrinex as a harm reduction tool. Does anyone else? And if you do, do you have a PGD available?

No I use oral thiamine and vitamin B strong.

Thanks for the comments, most of them helpful and a couple being followed up.



"when you say 'take over the prescribing' I don not quite understand. Who are you taking over from (you say you are prescribing through GPs). "


Sorry if I wasn’t clear.

I perform the community alcohol detox making daily visits to the patients‘ home, monitoring withdrawal symptoms, taking and recording observations and treating some of the more common ailments such as diarrhoea.

With many of the patients I will have performed the assessment and then presented it at our team meeting. If a home detox is appropriate and agreed I then make plans with the patient and write to their GP. This letter will inform the GP of the recent assessment, the outcome and the details of any proposed treatment package, including details of my clinical role. This will include me supervising/managing the detox with the patient/carer. I will then go on to say that having discussed it with their patient we have agreed to start on …… And could s/he please write a prescription for xxx chlordiazepoxide 10mg capsules using as reference a copy the patients individually tailored reduction regime which I have supplied.

Following the detox I’ll then write a comprehensive summary of the episode and include the post detox plan. The contents of such a plan will depend on which route the patient takes.

Now having been with the patient for the entirety of this episode and planned/co-ordinated most of the treatment it would seem appropriate for me to “take over the prescribing”, particularly as I am an independent prescriber, practicing in my field of expertise, supervised by a consultant psychiatrist from the local NHS drug service and advising the GP on what to prescribe to their patients……

This would also save the GP the valuable time of script writing and me the valuable time wasted hanging around GP surgeries waiting for a prescription. Winners all round?



"No I use oral thiamine and vitamin B strong.


Beverley Harniman "

hasn't oral thiamine been shown to be ineffective?



"we routinely give IM Pabrinex as a harm reduction tool. Does anyone else? "

This is being looked at favourably. However as the risk of anaphylaxis is there - albeit statistically extremely low, we are lacking a clear policy and any necessary protocols. Until then......

aah that's fine.. If you have your own prescribing budget, just write the script within your own professional judgement, and send a letter to the GP so that it can be part of the patient's record.

It would be just the same as for example a community drug team prescribing methadone, then informing the GP.