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The General Medical Council’s (GMC) updated guidance, Good practice in proposing, prescribing, providing and managing medicines and devices, represents a significant evolution in the standards expected of UK doctors when managing medicines and medical treatments. Effective from 13 December 2024, this revised document builds upon the principles established in the 2022 version, introducing clarity, and expanded responsibilities. New expectations for safe and appropriate prescribing across all clinical settings come into force.

Fundamentally – ‘prescribing’ ought not to be simply taken as ‘writing the prescription’. Why? The GMC explains this. How? It is the duties of care that need to happen before ‘prescription’. Shocking and a cause for cognitive dissonance will be that a doctor can be a prescriber without writing a ‘prescription‘. Study the guidance to learn how.

This update is particularly important at a time when remote consultations have become more routine, patient expectations are evolving, and regulatory oversight is increasingly focused on transparency and accountability. The guidance reinforces the centrality of patient safety, informed decision-making, and professional responsibility. It also reflects contemporary developments such as the formal regulation of physician associates and anaesthesia associates, restrictions on remote prescribing of cosmetic injectables, and updated protocols for unlicenced medicines and overseas prescribing.

For UK doctors, understanding and applying this guidance is essential to ensure compliance with GMC standards and to uphold high-quality care, reduce prescribing-related harm, and navigate complex clinical scenarios with confidence and competence. This article explores the key changes between the 2022 and 2024 versions, highlighting what has evolved and why it matters for medical professionals today.

Evolution of GMC Prescribing Guidance: Key Structural Changes

The GMC’s prescribing guidance has evolved between 2022 and 2024. These changes reflect updates in clinical practice, regulation and professional roles.

One major structural change is the new title in 2024: Good practice in proposing, prescribing, providing and managing medicines and devices. The 2022 version was titled Good practice in prescribing and managing medicines and devices.

The word “proposing” was added to cover roles like physician associates and anaesthesia associates. These professionals can now be formally regulated by the GMC. They cannot prescribe but may suggest medicines for authorised prescribers to review and sign (2024 para 4).

This shift shows a broader view of medicine use beyond just writing a prescription. It includes decision-making, supply and ongoing care.

Another key update is the integration of new legal and regulatory frameworks, especially around remote prescribing. In 2024, it became clear that non-surgical cosmetic injectables such as Botox must never be prescribed remotely (2024 para 25). This was not specified in the 2022 guidance.

The 2024 document also updated reporting systems. For example, the National Reporting and Learning System (NRLS) was replaced by the Learn from Patient Safety Events (LFPSE) service in England and Wales (2024 para 90a). These changes ensure alignment with current UK-wide safety reporting structures.

The structure of paragraphs remained broadly similar. However, some sections were expanded or reworded for clarity. Notably, guidance on unlicenced medicines was clarified. This included better integration of Northern Ireland MHRA Authorised Route (NIMAR) products (2024 paras 102–108).

Overall, the revised guidance reflects a more structured approach to medicine management. It places greater emphasis on patient safety, shared responsibility and the evolving healthcare landscape.

These structural and wording changes aim to support doctors in meeting high standards of care across different settings.

Significant Additions and Clarifications in the 2024 Guidance

The 2024 GMC guidance introduces several meaningful updates and clarifications compared to the 2022 version. These changes reflect evolving clinical practices, regulatory developments and lessons learned from prescribing-related incidents.

Remote Prescribing of Cosmetic Injectables (2024 para 25)

One of the clearest new restrictions is that non-surgical cosmetic injectables such as Botox must never be prescribed remotely under any circumstances. This was not specified in the 2022 guidance.

This change reinforces the need for a physical assessment before administering these types of medicines, especially given their potential risks and the importance of patient safety and informed consent.

Reporting Systems: LFPSE Replaces NRLS (2024 para 90a)

The 2024 guidance updates reporting mechanisms for patient safety incidents. The National Reporting and Learning System (NRLS) has been replaced by the Learn from Patient Safety Events (LFPSE) service in England and Wales.

This aligns with current UK-wide systems and ensures consistency across NHS reporting structures.

Repeat Prescribing Safeguards (Paras 97–101)

There is now more detailed emphasis on secure processes for repeat prescribing, including:

• Ensuring the correct patient receives the correct prescription
• Monitoring medicine usage and effects
• Confirming staff competence in preparing repeat prescriptions
• Reviewing changes to medicines promptly

These points were present in 2022 but are more clearly outlined in 2024, reinforcing the importance of repeat prescribing safety.

Informed Consent and Patient Communication (Paras 33–48)

The 2024 version places greater focus on two-way dialogue and checking patient understanding. It also recommends using written information, translations and communication aids when needed, particularly for patients with accessibility needs.

This reflects a stronger emphasis on inclusivity and ensuring patients can make informed decisions about their care.

Shared Care Responsibilities (Paras 73–81)

Shared care arrangements must now be based clearly on the patient’s best interests, not convenience or cost. Specialists recommending new or rarely used medicines must provide clear protocols, explain departures from guidelines, and ensure both GP and patient understand how to manage the treatment safely.

This strengthens the expectation for transparency and collaboration between healthcare professionals.

Overseas Prescribing (Paras 70–72)

New expectations include confirming monitoring arrangements, understanding local laws and regulations, and considering import/export requirements when prescribing for overseas patients.

These clarifications help prescribers meet legal and ethical obligations when working across jurisdictions.

Ethical Standards and Controlled Drugs (Para 64)

The 2024 guidance reiterates that prescribing sedatives for dementia patients should only occur if clinically justified — not for caregiver convenience. This point was present in 2022 but is more explicitly stated in 2024.

Use of Electronic Systems (Para 8)

Electronic prescribing tools are encouraged not only for alerts (e.g., allergies and interactions) but also for ensuring consistency and compatibility checks across prescriptions. This builds on previous advice and expands the expected benefits of digital systems.

Adverse Incident Reporting (Paras 85–91)

Updated references to reporting systems and clearer responsibilities highlight the importance of timely and accurate incident reporting. There is a stronger link between individual accountability and organisational learning.

Summary

While most of the 2024 guidance builds upon existing standards, it adds clarity, structure and updated expectations in key areas such as:

• Remote prescribing limits
• Repeat prescribing safeguards
• Overseas prescribing considerations
• Enhanced communication and shared care protocols
• Reporting systems and adverse event monitoring

These updates aim to support safer, more transparent prescribing practices across all settings.

The Role of Physician Associates and Anaesthesia Associates: A Focused Update

The 2024 GMC prescribing guidance introduces a clear update regarding the roles of physician associates (PAs) and anaesthesia associates (AAs), reflecting their formal regulation under the GMC from 13 December 2024.

Clarification of Scope of Practice (2024 para 4)

The updated guidance explicitly states that:

“Physician associates and anaesthesia associates cannot prescribe prescription-only medicines, but they are involved in proposing medications or devices for an authorised prescriber to review and sign.”

This marks a formal recognition of PAs and AAs within the GMC’s regulatory framework and clarifies their non-prescribing role.

Importantly, it adds that:

“Once PAs and AAs are regulated roles, individuals employed in these capacities cannot lawfully prescribe using prescribing rights from another regulated role.”

This means that if someone qualified as a nurse or doctor and gained prescribing rights in that role, they must not use those rights when working as a PA or AA.

Key Implications

• No Prescribing Authority: PAs and AAs do not have independent prescribing rights.
• Proposing Role Only: They may propose medicines or treatments, but only an authorised prescriber (e.g., a doctor) can review and sign prescriptions.
• Restrictions on Transferring Rights: Prescribing rights are specific to the profession in which they were granted and are not transferable to PA or AA roles.

This clarification aligns with broader efforts to ensure clarity, safety and accountability in medicine management across multi-disciplinary teams.

Context and Background

This change follows the UK government’s decision to bring PAs and AAs into statutory regulation under the GMC. It aims to improve patient safety by ensuring transparency around professional roles and responsibilities.

Previously, some PAs and AAs may have been working under local arrangements allowing them to prescribe based on prior qualifications. These are now clarified as no longer lawful once the individual is formally employed in a PA or AA role post-13 December 2024.

Summary

While most of the 2024 prescribing guidance applies broadly to all medical professionals, paragraph 4 directly addresses changes affecting physician associates and anaesthesia associates. It confirms their important but non-prescribing role in the care pathway and sets clear boundaries regarding the use of prescribing rights obtained in other professions.

Conclusion

The 2024 GMC prescribing guidance builds on the principles of patient safety, professional accountability and informed decision-making established in 2022. It reflects a healthcare landscape increasingly shaped by remote consultations, evolving roles and regulatory clarity.

A key theme is the need for safe and appropriate prescribing, particularly in remote settings. The prohibition on remotely prescribing cosmetic injectables underscores the importance of physical assessment when risks are high. Similarly, stronger safeguards for controlled drugs and repeat prescriptions reinforce the duty to prioritise patient welfare over convenience.

Another central theme is clarity around roles, especially for physician associates and anaesthesia associates. While most changes apply broadly to all prescribers, paragraph 4 clearly defines these roles as non-prescribing, with an emphasis on proposing medicines for authorised prescribers.

The guidance also strengthens expectations around communication, consent and record-keeping. These elements are not new but are more explicitly tied to accessibility, shared care and repeat prescribing processes.

Finally, the updated framework highlights professional responsibility. Doctors must stay within their competence, use electronic systems effectively and engage in ongoing learning. They must also report incidents transparently and review medicines regularly, especially for vulnerable patients or those on complex treatments.

In essence, the 2024 guidance reinforces long-standing standards while adapting to modern practice demands. It serves as a reminder that safe prescribing is not just about writing a prescription — it is about making sound clinical decisions, working collaboratively and always putting the patient first.