Annual Prescription Reviews & Patient Rights

Disclaimer: This article is for information and advocacy purposes only and does not constitute legal or medical advice. It discusses sensitive topics including trauma, mental health, and self-harm. Readers’ discretion is advised, and they are encouraged to seek independent advice where appropriate.

Annual Prescription Reviews: Patient Rights, Consent, and Clinical Boundaries Across the UK

What Is an Annual Prescription Review?

An annual prescription review is intended to assess whether a patient’s medication is:

Still clinically appropriate
Effective
Safe
Causing side effects
Aligned with the patient’s current circumstances

Reviews are promoted by NICE and the General Medical Council, but guidance is not law. This distinction is critical.

Is an Annual Prescription Review Mandatory?

Across England, Wales, Scotland, and Northern Ireland, prescription reviews are recommended by healthcare professionals but are NOT mandatory in law.

However:

GPs are professionally required to prescribe safely
Patients are legally entitled to refuse investigations or methods of review

This creates a tension between clinical guidance and patient autonomy, not an automatic obligation to comply.

Do Prescription Reviews Differ Across the UK?

Broadly, the NHS operates similarly across all four nations, but:

Wales & Scotland place a stronger emphasis on prudent healthcare and co-production
England increasingly uses cluster pharmacists
Northern Ireland operates under separate HSC structures but similar NICE principles

In no UK nation is there legislation that forces a patient to undergo blood tests or attend reviews in a specific format.

Are Blood Pressure Checks and Blood Tests Mandatory?

No, consent is always required.

Blood tests and BP monitoring are:

Clinically recommended for some medications
Not universally required for all prescriptions

Mental Health Medications & OCD

For:

OCD
Clinical depression
Anxiety

Routine blood tests are not automatically required, unless the medication itself carries known physiological risks (e.g. lithium).

Overactive Bladder Medication

Most antimuscarinic or beta-3 agonist medications:

Do not routinely require blood tests
May justify blood pressure monitoring, depending on the drug (but this can be done at home, using your own device)

There is no blanket rule requiring blood tests simply because someone is prescribed mental health or bladder medication.

What Does NICE Actually Say?

NICE guidance distinguishes between:

(1) People with OCD & Clinical Depression

Emphasises psychological well-being
Warns against re-traumatisation
Supports the least intrusive monitoring
Encourages reasonable adjustments

(2) Patients with Cardiac or Metabolic Risk

Blood pressure and blood tests may be justified
Monitoring must still be proportionate and consensual

Can a GP Withdraw Medication If You Refuse Tests?

This is a grey area and is frequently misrepresented.

A GP:

Cannot punish or coerce
Cannot force compliance
Must not threaten

However, a GP may argue that they cannot safely prescribe without certain monitoring.

⚠️ The moment this becomes a threat rather than a discussion, legal issues arise.

Self-Isolation and Home Monitoring

If you:

Self-isolate
Do not leave your home
Do not accept visitors

You cannot be forced to attend tests.

You can:

Monitor blood pressure at home
Keep symptom logs
Submit reports

There is no legal basis for refusing home data without justification, especially where reasonable adjustments are required.

Why Is “No Change to My Health” by Email Often Rejected?

Because systems prioritise professional protection over patient experience, not because email is inherently unsafe.

But:

Written confirmation can form part of shared decision-making
Dismissing it outright may breach equality and autonomy principles

Trigger Wording, Trauma, and Questioning About Self-Harm

Failing to warn patients about trigger wording can:

Exacerbate OCD
Intensify intrusive thoughts
Re-traumatise survivors

Good practice supports:

Advance warning
Neutral language
Scaling questions (e.g. 1–10)
Time-based framing (now / last month / 6 months ago)

Forcing repeated reliving of trauma to suit a clinician’s narrative is not therapeutic care.

What If the Practice Makes Your Mental Health Worse?

You may have grounds for breach of:

Especially where:

Reasonable adjustments were ignored
Consent was undermined
Coercion or threats were used

What If a Complaint to the Practice Manager Fails?

Next steps include:

What If a Call Recording Is Refused?

A refusal may breach:

UK GDPR
Data Protection Act 2018

You are entitled to personal data, including call recordings, unless a lawful exemption applies.

Forcing Someone Against Their Will: What Laws Are Engaged?

Potentially:

Coercion is not consent.

Are GP Practices “Small Businesses”?

Yes, GP practices are independent contractors to the NHS.

They:

Receive funding per patient
Generate income through prescribing and services
Would struggle financially if patient lists collapsed

This does not override patient rights, but it explains systemic pressure.

Conclusion

Most recently, I have found myself in conflict with my GP practice following an annual prescription review that was conducted without warning. A cluster pharmacist contacted me unexpectedly, without a scheduled appointment, and abruptly asked whether I had thoughts of, or had attempted, self-harm. This line of questioning felt entirely disproportionate and unconnected to my medical history, as I have never indicated any intention to harm myself. The sudden use of such sensitive questioning triggered a surge of intrusive thoughts, significantly undermining the progress I have made in recovering from longstanding trauma.

As a law student and a health and well-being writer, I felt compelled to advocate for myself by submitting a formal complaint. Since doing so, I have been informed that I must now undergo an annual blood test despite there being no clear clinical justification, and that written email reports confirming no change in my health will not be accepted. I have also been told that failure to attend a face-to-face appointment may result in my medication being reviewed or withdrawn.

I perceive this approach as coercive rather than collaborative, and it has had a profound negative impact on my mental health. Instead of feeling supported, I have been left anxious, distressed, and questioning the intent behind these actions. The resulting stress has disrupted my sleep, affected my concentration, and exacerbated my exhaustion, despite my efforts to manage my well-being responsibly. I live for my daughter and am driven by a desire to make the world a safer, more compassionate place for her and others. It is for this reason that I am working towards launching the charity www.disabilityuk.org, to advocate for dignity, transparency, and trauma-informed care, and to ensure that patients are treated with a duty of care in their healthcare, not as problems to be managed.