Restriction of GP telephone advice to residents temporarily abroad

Summary

The requester sought documents regarding restrictions on GP telephone advice for Isle of Man residents temporarily abroad, specifically asking for contract clauses, guidance, and insurance policies. Manx Care responded that no such restrictions exist in the GMS contract, but clinical decisions depend on registration status, while prescribing is limited to a three-month supply for those abroad.

Key Facts

• The General Medical Services contract between Manx Care and GP practices contains no clauses restricting telephone or remote advice to patients outside the Isle of Man.
• GP practices make clinical decisions on whether to provide advice based on whether the patient is still considered registered.
• Patients traveling abroad for more than three months are entitled to a maximum of three months' supply of medication at NHS expense.
• A 2019 DHSC policy on prescribing for patients abroad is now out of date and is being replaced by a new Manx Care policy currently under ratification.
• The response included an attachment titled 'QUANTITY OF MEDICATION SUPPLIED ON MANX CARE PRESCRIPTIONS POLICY'.

Data Disclosed

• 2025-10-21
• 2025-11-06
• 5014413
• three months
• 2019
• 29 June 2019
• 12:52
• page 4 section 2.3.2
• IM4 4R
• (01624) 650 000

Original Request

Under the Freedom of Information Act, I am requesting copies of documents or extracts relating to GP practices' ability to provide telephone advice to registered patients who are temporarily outside the Isle of Man. Specifically, I request: 1. The current General Medical Services contract between Manx Care and GP practices, including any clauses that restrict or prohibit the provision of telephone or remote advice to patients located outside the Isle of Man. 2. Any practice directions, circulars, or guidance issued by Manx Care, DHSC, or any relevant body that instruct GP practices not to provide advice to patients abroad. 3. Copies or extracts from any insurance, indemnity, or self-insurance policy documents held by Manx Care or issued to GP practices that explicitly state restrictions on providing medical advice to patients abroad (particularly advice that does not involve prescribing). 4. Any risk assessments or policy papers prepared by Manx Care or DHSC regarding the provision (or refusal) of advice to patients temporarily outside the Isle of Man. For the avoidance of doubt, I am seeking the actual wording of clauses, policies, or guidance that underpin the refusal of advice, not general references to indemnity. Please treat this as a formal Freedom of Information request. If parts of this request are held by different departments, I would be grateful if you could confirm this and pass them on accordingly.

Data Tables (6)

Full Response Text

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 5014413 5 November 2025

Dear

We write further to your request, received 21 October 2025, which states:

"Under the Freedom of Information Act, I am requesting copies of documents or extracts relating to GP practices' ability to provide telephone advice to registered patients who are temporarily outside the Isle of Man. Specifically, I request:

1. The current General Medical Services contract between Manx Care and GP practices, including any clauses that restrict or prohibit the provision of telephone or remote advice to patients located outside the Isle of Man.

2. Any practice directions, circulars, or guidance issued by Manx Care, DHSC, or any relevant body that instruct GP practices not to provide advice to patients abroad.

3. Copies or extracts from any insurance, indemnity, or self-insurance policy documents held by Manx Care or issued to GP practices that explicitly state restrictions on providing medical advice to patients abroad (particularly advice that does not involve prescribing).

4. Any risk assessments or policy papers prepared by Manx Care or DHSC regarding the provision (or refusal) of advice to patients temporarily outside the Isle of Man.

For the avoidance of doubt, I am seeking the actual wording of clauses, policies, or guidance that underpin the refusal of advice, not general references to indemnity.

Please treat this as a formal Freedom of Information request. If parts of this request are held by different departments, I would be grateful if you could confirm this and pass them on accordingly."

Response

1. The current General Medical Services contract between Manx Care and GP practices, including any clauses that restrict or prohibit the provision of telephone or remote advice to patients located outside the Isle of Man.

There is no mention within the General Medical Services contract of the circumstances described above.

1. Any practice directions, circulars, or guidance issued by Manx Care, DHSC, or any relevant body that instruct GP practices not to provide advice to patients abroad.

If a person is going abroad for more than three months, all they are entitled to at NHS expense is sufficient supply of medication to get to the destination where they should register with a local doctor for continuing supply; this may need to be paid for by the patient.
In addition the patient may need monitoring by a local doctor. In cases such as this the IOM GP would not be aware of any consultations that occur within another country and so it would depend if the practice deemed the patient to still be a registered patient at their practice. If the patient was no longer registered then the practice would not provide advice to patients abroad.
The GP speaking to a patient would make a clinical decision as to the advice and guidance he provided (or did not) based on the circumstances.

In 2019 (pre Manx Care) the DHSC issued a policy titled ‘Prescribing For Patients Travelling/Living Abroad or Otherwise Absent From The Isle Of Man’
This policy is now out of date and a new Manx Care policy regarding prescribing for patients travelling / living abroad or otherwise absent from the IOM is currently under ratification and is referred to on page 4 section 2.3.2 of the QUANTITY OF MEDICATION SUPPLIED ON MANX CARE PRESCRIPTIONS POLICY that I have attached to this FOI response.

In addition Manx Radio Saturday, 29 June 2019 12:52 issued the following statement
Manx travellers will have to find local supplier while abroad
Manx residents travelling abroad, will no longer be able to get prescriptions for longer than three months.
The Department of Health and Social Care already recommends a maximum supply of three months for prescription medications for those travelling or moving to another country, but is now making this a formal policy.
Those who will be off Island for longer will need to make arrangements in their new country of residence.
The policy applies to all DHSC prescribers, including GPs, hospitals and outpatient clinics.
Exemptions will be made in certain cases, such as for oil rig workers or those employed on cruise ships.
The new policy comes into force immediately.

1. Copies or extracts from any insurance, indemnity, or self-insurance policy documents held by Manx Care or issued to GP practices that explicitly state restrictions on providing medical advice to patients abroad (particularly advice that does not involve prescribing).

The indemnity cover for General Practices states that one of the Membership Conditions is:
“(c) indemnity in respect of clinical negligence claims against the corporate member arising out of the provision of medical or dental treatment or care by, or on behalf of, the corporate member in England, Northern Ireland, Scotland, Wales, Channel Islands and the Isle of Man”

It is clear in the Member Guide:
“We do not offer benefits outside of these jurisdictions (England, Scotland, Wales, Northern Ireland, Channel Islands and the Isle of Man) other than in respect of Good Samaritan acts.”

“MDDUS specialises in the separate jurisdictions that exist within England, Northern Ireland, Scotland, Wales, the Channel Islands and Isle of Man, and does not offer indemnity in respect of medical or dental treatment or care outside of these countries. Notwithstanding this exclusion, MDDUS may in its absolute discretion provide indemnity in respect of a corporate member’s legal liability in respect of clinical negligence arising from Good Samaritan acts”

“General Practitioner (GP) membership is appropriate for qualified general practitioners working in the NHS in the Isle of Man. You must notify us if you undertake any GP work outside this area.”

1. Any risk assessments or policy papers prepared by Manx Care or DHSC regarding the provision (or refusal) of advice to patients temporarily outside the Isle of Man.

Primary Care Services is not aware of any from a Manx Care perspective.
DHSC would need to be approached for their answer.

Please quote the reference number 5014413 in any future communications.

Your right to request a review

If you are unhappy with this response to your freedom of information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post.

An electronic version of our complaint form can be found by going to our website at https://services.gov.im/freedom-of-information/Review . If you would like a paper version of our complaint form to be sent to you by post, please contact me and I will be happy to arrange for this. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act 2015; or 2. Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision. More detailed information on your right to a review can be found on the Information Commissioner’s website at www.inforights.im. Should you have any queries concerning this letter, please do not hesitate to contact me. Further information about freedom of information requests can be found at www.gov.im/foi.

I will now close your request as of this date.

Yours sincerely

QUANTITY OF MEDICATION SUPPLIED ON MANX CARE PRESCRIPTIONS POLICY – V1 Page 1 of 10 QUANTITY OF MEDICATION SUPPLIED ON MANX CARE PRESCRIPTIONS POLICY

Author(s) Medicines Optimisation Team Version Number 1 Document effective from August 2025 Next review due August 2027

Intended audience All prescribers within Manx Care Superseded documents None Stakeholders consulted prior to ratification • Medical Director • Executive Director of Nursing & Allied Health Professionals
• Chief Executive
• Executive Director of Health Services
• Clinical Directors • Matrons • Senior Nurse Leadership Team • Care Group/General Managers • Allied Health Professionals Leads • GPs • Primary and Community settings (non-acute) • PCN • Ambulance Service • Prison • Community Nursing • Antimicrobials • Community Pharmacy/MOT • Nobles Pharmacy • Medicines Safety Ratified by Integrated Medicines Optimisation Group (IMOG) Date: 08/09/2025 Previous reviews N/A Changes made during latest review N/A

Contents 1. AT A GLANCE..................................................................................................................... 2 The purpose of this document is to: ................................................................................ 2 Scope: ............................................................................................................................... 2 Summary of Guidance: ..................................................................................................... 3 2. ADDITIONAL INFORMATION ............................................................................................. 3 2.1 Definitions ........................................................................................................................ 3 2.1.1 Prescription Interval ......................................................................................................... 3 2.1.2 Controlled Drug (CD) ........................................................................................................ 3 2.1.3 Monitored Dosage System (MDS) .................................................................................... 3 2.2 Roles and Responsibilities ................................................................................................ 4 2.2.1 Prescribers 4 2.2.2 Pharmacists 4

QUANTITY OF MEDICATION SUPPLIED ON MANX CARE PRESCRIPTIONS POLICY – V1 Page 2 of 10 2.3 Related Policy/Strategy/Legislation/Guidance ................................................................ 4 3. POLICY ............................................................................................................................... 4 3.1 Manx Care Recommended Prescribing Intervals ............................................................. 4 3.1.1 Prescriptions for Newly Initiated Medications ................................................................ 4 3.1.2 Regular repeat medication for long term / pre-existing conditions ................................ 4 3.1.4 Prescribing Controlled Drugs (CD) .................................................................................... 6 3.7 Specialist Drugs and High Cost Medications .................................................................... 6 4. REFERENCES AND/OR RESOURCES ................................................................................... 6 5. APPENDICES ...................................................................................................................... 7

1. AT A GLANCE

The purpose of this document is to:

Clarify the responsibilities of clinicians, regarding the quantity of medication supplied to a patient on a Manx Care prescription at any given time. This document also advises on the prescribing intervals supported by Manx Care and circumstances in which longer prescribing intervals are acceptable. The policy generally supports shorter prescribing intervals where possible to promote safe, effective, and responsible prescribing of medicines. The aim is to get a good balance between patient convenience, good medical practice and minimal drug wastage.

The benefits of 28 day prescribing intervals include: • Reducing the amount of medicine that is currently wasted and thus financial losses when medicines are stopped or changed • Easier identification of compliance and concordance issues if the basic medication regime is well managed and reviewed regularly • Less duplication of medicines packs, which reduces the chance of confusion in the elderly

Scope:

This guidance applies to all services contracted by or delivered by Manx Care across the Isle of Man including: GP Practices, any other primary care providers, Nobles Hospital, Manx Care community providers, out-patient clinics, and independent providers providing Manx Care commissioned care.

This policy does NOT cover prescribing for patients under homecare service arrangements or outpatient prescriptions for instalment dispensing by Nobles pharmacy department. For further information on prescribing in these circumstances see Manx Care Policy for Medicines Homecare; Medicines Policy – Chapter 2: Prescribing; and Standard Operating Procedure for the Prescribing of Nice TA Drug Therapies for Long term conditions (excluding Oncology).

QUANTITY OF MEDICATION SUPPLIED ON MANX CARE PRESCRIPTIONS POLICY – V1 Page 3 of 10

Summary of Guidance:

• 56 day prescribing intervals is supported by Manx Care in the following situations: o For patients who are stable and on non-complex regimens o Where cost to the patient from prescription charges is a concern and the patient is stable on treatment • Longer prescribing intervals are acceptable if: o Treatment packs specifically covering different durations, e.g., Hormone Replacement Therapy (HRT) o Special packs which cannot be split e.g.- so they do not need to be split or where this is not feasible o Where 28 days is not equivalent to the number of doses in a special pack e.g., a 200 doses inhaler as "1 OP” (original pack) • ‘When required’ or ‘PRN’ medications should be estimated (and clear directions given) to provide a supply that is sufficient for 28 days or other duration up to a maximum of three months if appropriate. • A one-off synchronisation prescription is recommended where regular, stable items run out at varying times during the month. The time invested to synchronise medication will reduce wasted medication and staff time in dealing with the same patient several times a month. • Prescriptions for controlled drugs (CDs) schedule 2, 3 and 4 should never exceed 1 month’s supply (max 30 days) except in exceptional circumstances, which should be clearly documented in the patient notes. • Patients who receive a Multi

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