Hello - I write to you as the Medical Director of Dyfed Powys LMC – an organisation that represents GPs in the Hywel Dda and Powys area. 

GPs locally are reporting an increase in the number of patients requesting that GPs prescribe sedation for their imaging procedures at your Healthboard/Trust.

We have the following concerns, and trust that we can count on your support to ensure that if a patient fails to tolerate a scan, it is suggested that the radiologist or prescribing practitioner overseeing the scan arrange sedation themselves if they wish to reattempt; patients should not be advised to contact their GP for sedation. 

This position is not intended to be obstructive, but to simply adhere to our duty to provide safe, consistent, and appropriate care for our patients.  

We would be grateful if you could discuss this with your radiology colleagues to see if a pre-procedure guideline could be formulated which provides you with the necessary arrangements to ensure imaging goes ahead in these most challenging patients. 

We will outline our concerns, which will hopefully explain our refusal to provide such a prescription:

1. Small doses of benzodiazepines such at 2mg diazepam are probably sub-therapeutic for most adults for any effective sedation. Conversely anxiolytics can have an idiosyncratic response in patients, and even very small doses can cause increased agitation in some subsets of patients.
2. A patient may take a sedative ‘an hour’ before their assumed procedure, to then attend the hospital to find their procedure has been delayed, therefore the timing of the anxioyltic being sub-optimal.
3. GPs are not regularly involved or trained in acute sedation for procedures
4. All hospital consultants, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs. If a patient needs a certain medication to enable an investigation to go ahead, they are just as well positioned to provide a prescription, either through the hospital pharmacy or a hospital FP10.
5. Sedated patients should be regularly monitored.
6. The Royal College of Radiologists‘ own guidelines on sedation for imaging makes no mention of GP involvement or provision of low dose anxiolytics and stresses the importance of experienced well trained staff involved and the monitoring of sedated patients: https://www.rcr.ac.uk/sites/default/files/publication/Safe_Sedation.pdf  bfcr18_safe_sedation.pdf (rcr.ac.uk)

We welcome a conversation with you if you feel that this position cannot be supported, but it will be the advice going forward from DPLMC based on the RCR guidance that the GP does not provide the requested sedation for imaging procedures.

Many Thanks

Dr Sophie Bennett

Medical Director

Dyfed Powys LMC