SCA practice case · Telephone consultation
“I’ve just moved here and my methadone runs out today — I need a script now”
Telephone consultation
Adult patient
Hard
Mental health & addictionHealth disadvantage & vulnerabilitiesUrgent & unscheduled care
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Danny Boyd · 35 years · male
Setting
Telephone — new patient requesting urgent methadone continuation.
Past history
- Opioid dependence on OST (patient-reported)
- New patient: previous records awaited
Medication
- Methadone 60 ml daily (patient-reported; unverified)
Allergies
Not recorded
Recent notes
⚠ Registered last week after moving area. No prescriber, pharmacy or last-dispensing date on file. Not yet known to the local drug service.
Reason for contact
Urgent phone call. “I need a methadone script today.”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
A new patient asking for urgent methadone continuation is a safe-bridging dilemma. Prescribing methadone BLIND on an unverified phone request is dangerous — methadone has a narrow safety margin and long half-life, and an unverified/excessive dose, or one given to someone who has lost tolerance after a gap, can be fatal — so a GP should NOT issue a methadone script on an unverified request. But the opposite failure, refusing and abandoning him to withdrawal and relapse, is also unsafe and unkind. The safe path is verified, urgent continuity: contact his previous drug service/prescriber and pharmacy to confirm dose/regimen/last pick-up, and route him rapidly to the local specialist drug service for same-day assessment and safe continuation (using transfer fast-tracks), with harm-reduction safety-netting (relapse/overdose risk, don’t top up illicitly, naloxone). The examinable hidden agenda is genuine fear of withdrawal and, more, of relapse and losing hard-won stability, plus shame and expectation of being judged; treat him with respect not suspicion, take the relapse risk seriously, hold the no-blind-script boundary without rupturing trust, and reassure he won’t be abandoned — safe continuity, fast.
The guidance behind it
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