Muscle Relaxant Prescribing for Hospital Procedures

Policy Statement

Talybont Surgery does not prescribe medications like diazepam or other muscle relaxants specifically for hospital procedures such as MRI’s, endoscopies or minor surgeries.

Rationale

GPs are generally advised not to prescribe these medications because:

1. Clinical responsibility lies with the team doing the procedure
   • The doctor or service organising the procedure is responsible for:
     • Assessing the risks and benefits
     • Choosing the right drug, dose and timing
     • Providing monitoring and aftercare
   • BMA and NHS Wales guidance is clear that if a hospital (or private provider) initiates or requires a medicine for a procedure, they should prescribe and supply it themselves , not shift that work to general practice without agreement.
   • This applies, for example, to diazepam for MRI scans – it is the responsibility of the MRI/hospital team to prescribe if they feel it is needed.
2. Safety and monitoring issues
   • Muscle relaxants and sedative-type drugs can:
     • Depress breathing
     • Interact with other medicines, alcohol or recreational drugs
     • Affect driving and capacity to consent
   • The safest place to prescribe and administer them is within the service that:
     • Knows exactly what procedure is being done
     • Has protocols, monitoring, and resuscitation facilities
   • A GP is often not present at the time of the procedure and cannot control how/when the drug is taken.
3. Legal and professional liability
   • The prescriber is legally responsible for the prescription and any consequences.
   • If a GP prescribes a sedative/muscle relaxant for a hospital procedure and there is a complication, the GP carries the liability, even though they are not in control of the procedure environment.
   • GMC and BMA guidance emphasise that doctors should only prescribe when:
     • They have adequate knowledge of the patient
     • They are satisfied the medicine is appropriate
     • They can ensure appropriate follow-up/monitoring
   • For procedure-related drugs, this is usually best met by the hospital team.
4. Workload and contractual boundaries
   • General practice is under significant workload pressure.
   • NHS guidance on responsibility for prescribing between primary and secondary care (2018) states that:
     • Drugs needed as a result of an outpatient attendance should be supplied by the hospital, at least until the GP has clear information and has agreed to take over.
   • Writing “one-off” prescriptions for hospital procedures is not core GMS work and is considered an inappropriate transfer of workload from secondary care to GPs.
5. Consistency and governance
   • Hospital services usually have:
     • Standardised protocols for pre-medication
     • Clear inclusion/exclusion criteria
     • Governance and audit processes
   • If GPs prescribe variably, it can undermine those protocols and create inconsistent, potentially unsafe practice.

Because of all this, the standard position is:

• If a procedure requires a muscle relaxant/sedative, the hospital or provider organising the procedure should prescribe and supply it.
• GPs are encouraged by the BMA to decline such requests and direct the request back to the hospital team, often using a template letter explaining that this is outside GP contractual responsibility and raises safety and liability concerns.

Alternative Options

If you’re asking as a patient and have been told to “get something from your GP” for a scan or procedure, the appropriate route is usually to go back to the hospital/clinic and ask them to prescribe and supply what they feel is needed, in line with their own protocols.