Keep this open during every session. Nothing here assumes you already know UK/NHS systems — every term is explained where it first appears.
⚠️ Read first · every document
Stop and escalate to Asterix HQ the same day if a document involves any of the following:
A safeguarding concern
A new suspected cancer pathway, or cancer diagnosis
A seriously abnormal result (e.g. very high potassium, AKI, severe anaemia, very abnormal clotting / LFTs)
Imaging suggesting malignancy, fracture, clot, stroke / TIA, aneurysm, cauda equina
An urgent medication change with unclear action needed
A palliative / end-of-life medication issue
An abnormal result or medication risk in pregnancy
A child or young person concern
Anything where a delay could cause harm
If any of the above applies, escalate first — don't work through the rest of this sheet before you've done that.
A. Start of session
Insert your smart card (your NHS chip ID card) into the reader first, always — then pick the correct practice for this session.
Log into GPitC — the remote-access system that lets you connect into practice computers from outside the building.
Open EMIS Web (the clinical record system) — check the organisation ID on screen matches the practice you're working for today.
Open EmisX and AccuRx (a texting tool for messaging patients) on your second screen if you have one.
In EMIS Web, click the round EMIS icon (bottom left) > Workflow > Workflow Manager — this is where documents needing review are held.
Click Awaiting filing — the list of documents nobody has actioned yet. Start here.
B. Work the list
Start with the oldest document (by the date it was created), or anything marked urgent.
If a colleague is also working documents this session, check with them so you don't both work the same ones.
Every document needs a decision before you move to the next one — never leave one half-done.
C. For every document, ask
Is any action needed at all?
If nothing needs doing (already actioned, or no longer relevant), still code / file it correctly and add a short note saying you reviewed it and why no action was needed. "No action" is not the same as "no filing."
Does this document definitely belong to the patient I'm about to act on?
Check the name AND date of birth (or NHS number) match. Don't assume the system has already matched it correctly for you.
Is this document asking me to do something, or just informing me?
A specialist letter saying "GP to prescribe" or "GP to continue" is a request, not an automatic instruction. Before acting, check: is this appropriate for a GP to take on, does it need shared care, is monitoring in place? If there's any unclarity, escalate and check with Asterix rather than proceeding.
What kind of change is this?
Start, stop, dose change, formulation change, duration change, monitoring request, shared-care request, information only, or already actioned? Naming the type of change before you touch EMIS makes it much less likely you'll do the wrong thing to the record.
Have I checked this patient's recorded allergies / sensitivities?
Do this before you code or issue anything, not after. If nothing is recorded, don't assume "no known allergies" — for new prescribing or any higher-risk medicine, check the wider record / summary, and contact the patient or practice if it's still unclear.
Was this started by a hospital, specialist, out-of-hours service, or bought privately?
Reconcile it onto the record even if you are not the one prescribing it going forward. Add current medicines to the active list only if the patient is actually taking them; add stopped, historic, declined or specialist-only medicines with the correct status and a clear note. This is "medicines reconciliation."
Have I avoided leaving the record messy?
No duplicate active medications, no old dose left active alongside a new one, correct acute vs repeat status, and no missing stop date where one was specified.
Does the exact dose match the document?
Same strength, same frequency, same form (tablet / liquid / etc), same units. Don't accept whatever dose EMIS remembers or suggests by default. Check it against this document, every single time.
Have I read the whole instruction, not just the drug's name?
Phrases like "for this flare-up only," "reduce the dose every month," or "review again in 4 weeks" mean something has to happen later, not just now. Set up a task, a note with a review date, or a coded stop date today — don't rely on remembering it.
Have I told the patient about this?
Any new prescription, dose change or stopped medicine should be communicated — send a text via AccuRx explaining what's changed and why, so it isn't a surprise when they next collect their medicine or check their record.
Controlled drugs
You are not expected to prescribe these yourself in a remote session — it's outside what Asterix asks of you. Don't issue it. Code what's being asked for, then pass it back to the practice or escalate to Asterix HQ.
EMIS tip: when you add a drug, check the Warnings tab. A controlled drug shows a line like "Schedule 2 / 3 / 4 / 5 (CD…)" under the name (e.g. dihydrocodeine shows "Schedule 5 (CD Inv)"). Any "Schedule" + "(CD…)" label means treat it as controlled — even if the name isn't one you recognise.
Monitored medicines
E.g. warfarin or another anticoagulant, insulin, lithium, methotrexate or another DMARD.
These need regular blood tests or level checks to stay safe. Confirm the required monitoring is up to date before you issue anything. If it isn't, that becomes your action for this document — don't issue and hope someone else notices.
Commonly encountered controlled drugs
Strong painkillers (opioids): buprenorphine, diamorphine, morphine, tramadol, dihydrocodeine
Benzodiazepines: diazepam, lorazepam, clonazepam, midazolam
Sleeping tablets: zolpidem, zopiclone
Stimulants: lisdexamfetamine (often a psychiatry shared-care drug)
Other: cannabis (medical) — treat as specialist / private-initiated
Not exhaustive — tramadol, zopiclone, zolpidem and dihydrocodeine are especially easy to miss, since they don't read as "strong" drugs. When in doubt, check the EMIS warning, or the gov.uk controlled drugs list, or your local SOP / formulary / shared-care guidance.
Specialist follow-ups & easy misses
If a specialist asks for a repeat test, scan or review at a future date, set up a task or recall with the actual date given — a letter you've read and filed can look identical to one that's been properly actioned, but isn't.
If it isn't clear whether the hospital or the practice is arranging it, confirm that rather than assuming.
Watch for: an incidental finding mentioned in passing in a letter mainly about something else; a "did not attend" letter from a specialist clinic (needs a decision — rebook, discharge or safety-net, not just filing); and two documents about the same episode (act on the most recent, correct one).
D. Communicate & document
Add a clinical note recording what you did — include the date of the document, who it's from, and what action you took.
Does the patient need to know something (beyond medication changes)? Send a text via AccuRx.
Does the practice need to know something? Send a task in EMIS (an internal message to someone at the practice). A vague task is its own safety risk. Include: what needs doing, why, the timeframe, who should do it, and what to do if it can't be completed. E.g. "Please book repeat TFTs w/c 12 Aug as requested in endocrine letter dated 1 Jul. GP to review result and re-refer endocrine if TSH remains suppressed" — not "please arrange bloods."
Do you need to escalate to the Asterix HQ team? Always escalate a safeguarding concern; a result or finding needing same-day / urgent action; a controlled drug request or renewal; a medication discrepancy you can't confidently resolve; or anything outside your scope or you're not confident about.
E. Before you mark it complete
Read the whole document, not just skimmed it?
Confirmed the patient's identity?
Reconciled any medication changes correctly (not just "coded")?
Added the right codes (F12)?
Sent a task or recall, if one was needed?
Informed the patient, if that was needed?
Escalated anything that required escalation?
Added a clear note — date, who it's from, what you did?
Only mark the document complete once you can say yes to all of the above that apply. "I read it" is not the same as "I actioned it."
Common mistakes
Issuing the wrong strength because EMIS defaulted to an old dose.
Adding a new dose but leaving the old repeat active alongside it.
Filing a hospital letter that actually requested a repeat blood test or scan.
Acting on a private specialist's recommendation without checking local / NHS policy.
Continuing a high-risk drug without checking its monitoring is up to date.
Missing a "stop after 7 days" or "reduce the dose after 2 weeks" instruction.
Coding the diagnosis but forgetting the medication change that came with it.
Acting on an older document when a newer one supersedes it.
Sending a task with no timeframe or clear owner.
Filing a "did not attend" letter without deciding whether the patient needs rebooking or safety-netting.
Need help deciding?
Unsure about process — how to use EMIS, what a step means, who does what → check Atlas or ask Asterix HQ.
Unsure about a clinical decision — is this dose right, should this be prescribed at all → check bnf.nice.org.uk, cks.nice.org.uk, or your local formulary, then escalate to the Asterix clinical lead or a practice GP if still unsure.
Over-the-counter items — some items (e.g. vitamin D, supplements) shouldn't routinely be prescribed on the NHS — see NHS England's guidance and your local formulary.
Most straightforward documents take 5–10 minutes. Complex ones — discharge summaries, high-risk medication changes, anticoagulation, safeguarding, polypharmacy, or unclear ownership — can genuinely take longer, and that's expected. If you're stuck after 10 minutes or unsure of the safe action, pause and ask for support rather than rushing.
Reference terms
EMIS Web — clinical record system
GPitC — remote access to practice PCs
Workflow Manager — where review documents sit
AccuRx — patient texting tool