What happens when a prescribing concern is raised with your Council or Board?

When a prescribing concern is raised with your Council or Board in New Zealand, the authority looks at what you prescribed, for whom, on what assessment, with what record and within what law. It measures that against the statements and standards your authority has set for prescribers in your scope of practice. The concern can stay with the authority, go to a competence review, or go to a Professional Conduct Committee,; the Ministry of Health has separate powers. Do three things now. Get advice from your indemnity insurer, your professional association or union, or a lawyer before you write to anyone. Get copies of the prescriptions and the clinical record, and leave every record exactly as it is. Then prepare a response that sets out your reasoning at the time and the evidence of what you have done since.

What a prescribing concern is

A prescribing concern is any question about whether a prescription met the law and the standard for your profession. It can come from a patient, a pharmacist, a colleague, an employer, the Health and Disability Commissioner or the Ministry of Health. The concerns that reach a Council or Board fall into these groups.

• Prescribing for yourself, family or colleagues. Prescriptions written outside a normal clinical relationship, where the authority asks whether there was an independent assessment and a record.
• Controlled drugs. Prescriptions for medicines covered by the Misuse of Drugs Act, where the law sets extra requirements and the authority asks whether they were met.
• A dose or an interaction. A prescription that a pharmacist, a colleague or an adverse event showed to be wrong for the patient.
• Antibiotics. Questions about whether a prescription was supported by the assessment recorded.
• Repeats without review. Repeat prescriptions issued over a period without a recorded review of whether the medicine was still right for the patient.
• Telehealth. Prescriptions issued after a remote consultation, where the authority asks whether the assessment was adequate for the decision made.

A prescribing concern can also be one part of a wider notification about care. Where a patient complained first to the Health and Disability Commissioner, the guide to how an HDC complaint reaches your Council or Board explains how it travels.

The law and the standards

Two Acts set the legal frame. The Medicines Act 1981 governs who may prescribe which medicines and the requirements for a valid prescription. The Misuse of Drugs Act 1975 adds further requirements for controlled drugs. Both give the Ministry of Health its own powers to act where a practitioner's prescribing of controlled drugs or other medicines raises concern, separate from anything your Council or Board does. A concern can therefore run on two tracks at once, and your adviser needs to know about both.

The professional standard comes from your authority. The Medical Council's statement on good prescribing practice sets out what it expects of doctors, and its related statements cover areas such as telehealth and care for yourself and those close to you. The other authorities whose practitioners prescribe, including the Nursing Council for nurse prescribers and nurse practitioners, the Pharmacy Council for pharmacist prescribers, and the Midwifery Council, the Dental Council and the Optometrists and Dispensing Opticians Board, set their own expectations for the scopes they register.

In general terms the expectations share a shape. The authorities expect a prescriber to prescribe within their scope of practice and competence, on an assessment adequate for the decision, with the patient's informed consent, with a record that shows the reason, with the follow-up the medicine needs, within the law on controlled drugs, and with professional distance when the patient is the prescriber or someone close to them. Your authority's own statement is the one that applies to you, and your response should name it.

How a competence review or a Professional Conduct Committee assesses it

A competence review under section 36 of the Health Practitioners Competence Assurance Act 2003 (the HPCA Act) looks at a sample of your prescribing and the records behind it. The reviewers ask whether each decision was within your scope, whether the assessment recorded supported it, and whether the follow-up was arranged. They can interview you about cases and ask you to explain your reasoning. A review asks whether a gap is a single decision or a pattern.

A Professional Conduct Committee is appointed where the concern goes to conduct: controlled drugs prescribed for yourself or someone close to you, prescribing outside scope, prescriptions the records do not support, or an account of events that does not match the pharmacy's record. Where a prescription was false, the matter becomes a question of honesty, explained in the guide to an honesty or probity concern. Where prescribing for yourself is linked to a health condition, the authority can deal with it through the health process under the HPCA Act, which is separate from a conduct matter and handled in confidence.

What happens step by step

1. The concern is raised. The authority writes to you with the prescriptions or the period in question, the route it has chosen and a date for your response.
2. The records are gathered. The authority can ask you, your employer, the practice and the dispensing pharmacy for the prescriptions and the clinical records behind them.
3. You respond. With your adviser, you set out your reasoning at the time, what the records show, what fell short and what you have done since.
4. The authority decides the route. It can close the matter, counsel you, order a competence review or refer the matter to a Professional Conduct Committee.
5. The review or investigation runs. Reviewers or the Committee read the prescribing record, can interview you, and can ask for a wider sample.
6. The outcome is decided. From no further action to conditions on your scope, or a charge before the Health Practitioners Disciplinary Tribunal.

What you can do now

• Get advice the same day. For doctors the Medical Protection Society, for nurses NZNO, for midwives NZCOM, and for other professions your indemnity insurer or professional association. Tell them if the Ministry of Health has also been in touch.
• Collect the records. The prescriptions, the clinical notes for each, any messages or telehealth records, and the policy or protocol you were working under. Request them in writing.
• Find your authority's statement. Read the statement or standard on prescribing that applies to your scope, and identify the paragraphs the concern touches.
• Write out your reasoning. For each prescription, what you knew at the time, what you decided and why, and what the record shows. Keep memory and record apart.
• Ask about interim steps. Ask your adviser whether to offer the authority a voluntary undertaking or a period of supervision while the matter is open. An offer made early can be weighed when the authority considers whether an interim order is needed.
• Complete remediation before the response goes. Dated certificates attached to the response are evidence that you have engaged with the standard.

The guide to writing a response to a notification sets out the structure of the response, and the guide to what happens after a notification sets out every route.

The outcomes

• No further action. Where the prescribing met the standard, or a single gap has been addressed and evidenced.
• Counselling or advice. The authority sets out its expectations in writing and closes the matter.
• Conditions on your scope of practice. After a review, the authority can limit what you may prescribe, require supervision or a regular audit of your prescribing, and set a competence programme.
• Interim suspension or conditions. While a Professional Conduct Committee investigates, section 69 of the HPCA Act lets the authority suspend you or set conditions if it considers that necessary to protect the public. The guide to interim suspension and conditions explains how these are made and lifted.
• A charge before the Tribunal. A Committee can lay a charge where the conduct is serious. The guide to a Tribunal hearing explains the penalties, which include censure, a fine, conditions, suspension for up to three years and cancellation of registration.

Where remediation fits

An authority reads a prescribing response to decide whether the public is safe now. Evidence that you have gone back to the standard, and that you understand why it exists, is the part of the response you control. Prescribing Guidance and Standards covers the legal and professional frame for prescribing in New Zealand. Ensuring Clinical Competence and Patient Safety covers how a practitioner shows an authority that their practice is safe. Reflection for Fitness to Practise covers how to write the reflection that goes with the response; the guide to showing insight and building a remediation plan explains where it sits.

Each course is NZ$200, takes 2 CPD hours, is self-paced with immediate access, and ends with a dated certificate issued by Healthcare Ethics Courses that you can submit to your Council or Board or put in your remediation plan. The remediation courses for every Council and Board are on the hub page, and the Council and Board investigation process explained shows each stage. Profession guides describe what happens after a notification to the Medical Council about a doctor, a notification to the Nursing Council about a nurse and a complaint to the Pharmacy Council about a pharmacist.

Sources and further reading

• New Zealand Legislation: the Medicines Act 1981, the Misuse of Drugs Act 1975 and the Health Practitioners Competence Assurance Act 2003.
• Medical Council of New Zealand: the statement on good prescribing practice and the related statements.
• Health and Disability Commissioner: the Code of Health and Disability Services Consumers' Rights and how complaints about medicines are handled.

Frequently asked questions

Can the Ministry of Health act on my prescribing as well as my Council or Board?

Yes. The Medicines Act 1981 and the Misuse of Drugs Act 1975 give the Ministry of Health its own powers to act where a practitioner's prescribing raises concern, and those powers are separate from your authority's. The two can run at the same time and can share information. Tell your adviser about every letter you receive, from either body, so that what you say to one is consistent with what you say to the other.

Is prescribing for myself or my family a conduct matter?

It can be. The Medical Council's statements set out its expectations on care for yourself and those close to you, and other authorities set their own. Where controlled drugs or a pattern of prescriptions are involved, the authority can refer the matter to a Professional Conduct Committee. Where the prescribing is linked to a health condition, the authority can deal with it through the health process instead, which is handled in confidence and is not a finding of misconduct.

Will the authority look at prescriptions beyond the one in the concern?

It can. A competence review reads a sample of your prescribing and the records behind it, and the reviewers can widen the sample to see whether a gap is a single decision or a pattern. A Professional Conduct Committee can ask pharmacies and your employer for records across a period. Prepare your response on the basis that the authority may see your wider prescribing record, and do not alter any record.

Should I stop prescribing while the concern is open?

Do not decide this alone. Ask your adviser whether to offer the authority a voluntary undertaking, such as supervision or a limit on the area of prescribing in question, while the matter is open. An offer made early, with your adviser's help, can be weighed when the authority considers whether an interim order is needed. A decision made without advice can have consequences for your employment and your response.

What does an authority want to see in my response to a prescribing concern?

Your reasoning at the time, taken from the record. The statement or standard that applied to your scope, named. A plain account of what fell short, without excuses. Evidence of what you have done since, such as supervision, an audit of your prescribing by a named supervisor, and dated certificates for courses completed. A short reflection on what you understand now. Your adviser should read the draft before it goes.