The Royal Pharmaceutical Society has published updated professional guidance for the prescribers of specials, which is endorsed by the Royal College of GPs, the Academy of Medical Royal Colleges and the Royal College of Nursing.

The guidance remains based around five principles and uses case studies to illustrate particular challenges that must be met to ensure patients receive optimal treatment. The principles are:

1. Establish the optimal treatment for the patient
2. Understand the patient's experience and make a shared decision
3. Identify medicines and preparations
4. Monitor and review
5. Ensure effective prescribing governance.

The guidance encourages pharmacists and prescribers to work together to ensure that prescribing is appropriate, and that patients are supported to adhere to their treatment. As with licensed medicines, accountability for prescribing rests with the prescriber. However, additional considerations for specials are highlighted:

• When prescribing a special, prescribers must be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy
• Because specials can be obtained from a range of sources and not all are manufactured in the same way, their quality, bioavailability and consistency can vary even when the same product is prescribed
• It can be difficult to identify a special at the point of prescribing
• When prescribing responsibility transfers from one individual to another, ensuring safe and timely supply can present additional challenges for the prescriber and supplying pharmacist.

Guidance on the procurement and supply of specials, based around the same five principles, was issued by the Society in December 2015.