Protocol: Implementation of Erectile Dysfunction Treatment Prescribing Policy

Rationale

This protocol supports NHS Trafford’s Prescribing Policy, Erectile Dysfunction Treatment which states:

  • GPs should not prescribe on the NHS for patients suffering from erectile dysfunction unless the patient qualifies under the list of specified medical conditions specified or
  • Where a GP believes a patient may be suffering from severe distress, he/she should refer to Self Help Services for assessment where appropriate. GPs should not prescribe for severe distress on the NHS without the patient having been initially assessed by Self Help Services.
  • All NHS prescriptions should be endorsed SLS to confirm prescribing is for an allowed condition
  • GPs should only prescribe one treatment per weekfor erectile dysfunction on FP10

Method

  1. Run a computer search to identify patients who are currently receiving NHS prescriptions for the drugs Sildendafil (Viagra®), Tadalafil (Cialis®) , Vardenafil (Levitra®), Alprostadil (Caverject® , Viridal Duo® & MUSE®), by generic and brand name.
  2. Determine if the patient is entitled to receive an NHS prescription ie Patient suffers from one of the specified medical conditions or has been assessed by Self Help Services as suffering from severe psychological distress.
  3. Inform patients who do not qualify for treatmentthat NHS prescriptions can no longer be issued. Offer a private prescription and/or an appointment to review their condition as agreed by the practice. (See example letter A)
  4. Refer patients who you believe may be suffering from severe distress* to a specialist service e.g. Self Help Services. Patients who have been receiving treatment on the NHS should continue to do so until the outcome of this assessment is known. (See example letter B)
  5. For those patients who qualify for NHS treatment, determine the quantity of Erectile Dysfunction Drugs issued each month.
  6. Amend the quantity prescribed to a maximum of ONE treatment perweek (Four doses per month). Inform the patient of any changes by letter and send an updated repeat prescription request slip. (See example letter C)
  7. Ensure all relevant practice staff are aware of the policy.
  8. Monitor results of review e.g. cost savings via PPD data, complaints, problems encountered etc.

*The following criteria should be considered when assessing distress:

  • significant disruption to normal social and occupational activities;
  • a marked effect on mood, behaviour, social and environmental awareness;a marked effect on interpersonal relationships

Exclusions

Patients receiving Erectile Dysfunction Drugs via a private prescription only.

To flag up for special consideration by GP

  • Patients currently prescribed Tadalafil (Cialis®) 5mg or 2.5mg once daily should be reviewed by the GP and offered continued treatment via a private prescription or the option to transfer to an ‘on demand’ treatment in an appropriate dose and quantity at NHS expense.
  • Any patients recorded as qualifying for NHS treatment due to severe distress who have not been reviewed by a specialist service e.g Self Help Services.

Points to discuss with practice

  1. Who is the contact in the practice for project?
  2. Agree how patients not qualifying for treatment are managed ie. Private prescription offered or review by GP prior to offer.
  3. Agree content of patient letters.
  4. Any practice additions, deletions or amendments to the protocol.

Medicines Management Team0161 873 9507/9585February 2011