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A faulty production line

Plans for GPs to annually review patients prescribed opioids under discussion

Exclusive The BMA and the RCGP are driving plans to review the use of opioids, which could see GPs conducting annual reviews on patients on strong painkillers.

Pulse has learnt that the BMA has written to health ministers calling for an inquiry into drug dependency.

At the same time, the RCGP’s lead for pain has been in discussions with MPs around his proposals for GPs to conduct annual reviews.

Recent data has shown that prescriptions of opioids has massively increased over the past decade, from around 13 million items in 2005 to 27 million items in 2015.

Critics argue there is limited evidence that opioids are effective in chronic pain and the risk of dependency and adverse effects is well documented, and NICE’s latest guideline on back pain advises GPs not to offer opioids such as tramadol routinely for acute low back pain.

RCGP clinical lead on chronic pain Dr Martin Johnson said he is in ‘high-level’ talks with the All Party Parliamentary Group (APPG) on drug dependency around GPs doing annual reviews for all chronic pain patients on opioid drugs - proposal he outlined in a 2015 report from the Chronic Pain Policy Coalition, which he chairs.

He told Pulse: ‘There have been several recent reports on dependency, which raise some good questions, but the issue needs to be addressed at the next level up, with government. So, we’re preparing a high-level inquiry.’

Harry Shapiro, director of online advice site and spokesperson for the APPG, told Pulse the group would ‘absolutely’ support ongoing monitoring of patients’ opioid use.

Meanwhile, a BMA spokesperson told Pulse: ‘We have asked the [Commons’ health] select committee to hold an inquiry into prescribed drug dependence. We had written to former minister for health Nicola Blackwood to discuss this.’

Dr Steve Brinksman, a GPSI in pain in Birmingham and clinical lead for the Substance Misuse Management in Group Practice network, said: ‘The problem is opioids work for less than 20% of people with chronic pain but 80% of prescriptions that get started don’t get stopped.’

However, the BMA GP Committee’s prescribing lead, Dr Andrew Green, said: ‘Individual patient circumstances vary so greatly it is unusual for a specific review interval to be appropriate to everyone.’

He added GPs need more resources if there is to be a change in prescribing patterns.

Readers' comments (9)

  • Cheers BMA and RCGP for delivering another gift wrapped stick to MPs
    to beat us with. And it's great news for academics who see 1 patient an hour about their pain, getting them to agree to stop their meds until 3 months later when they are begging the GP to restart them.
    I foresee the only way to protect ourselves will be a yearly pain clinic referral for these patients.

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  • National Hopeless Service

    "There have been SEVERAL recent reports on dependency" Several to me does not warrant the review of millions of people yearly.

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  • As long as they are absolutely clear what we are supposed to stop doing in order to take up this work. And as for not giving strong pain relief to those patients in severe pain who stagger into our consulting rooms with an acute back -we all know this situation - well flinging a copy of NICE guidelines at them isn't going to enhance my sense of worth tbh.

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  • How many drugs are started by pain clinics??

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  • can anyone point to any of these crazy schemes that actually make a difference over and above just doing a annual review on pts on meds. its all tick box - fill in a form - what are the exclusion criteria lets beat GPs up because their pts are difficult. Stop doing process. locally our pain consultant has been doing a lot of talks on why not to use opiods on chronic pain patients and heart sinks - the rate of prescribing is down no silly boxes no mandatory call recall systems.

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  • David Banner

    to be fair we are already obliged to do annual medication reviews, so this is not really "new work".
    But there are some serious questions here.....
    - If they include CDs like tramadol, what about codeine? Or do they only mean controlled drugs?.
    - In the last century the really strong stuff was only used in palliative care. If these drugs are so dangerous, surely it's time to remove licenses for chronic pain?
    - Pain Clinics often initiate these potent drugs then dump back to GP. Surely they should shoulder more responsibility to ensure safe prescribing?
    - Local Drug Addiction services routinely refuse to see these patients, this must change if there is to be any meaningful reduction.
    - Isn't it time to welcome back co-proxamol? We need more alternatives if they want fewer strong opioids prescribing.
    - Why don't the authorities grow a pair and ban GPs from prescribing these drugs if they are so dangerous? As usual we are left piggy in the middle with an option to prescribe to a demanding patient but with guidelines suggesting we don't.

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  • Dear BMA

    You are a union
    You've singularly failed to represent your members interests at at time when their services are more in demand than ever

    I don't see the RMT worrying about passenger health campaigns? Possibly that's why their pay has gone up and ours has gone down?

    You are a union, an ineffective gentlemanly union. You've let a shortage of staff which should lead to increased rates translate to pay cuts and worse conditions.

    So sad, there are so many people, myself included , who could do the job so much better than you

    You've failed your members as the NHS falls apart.
    Cancel your opioids committee and get real eh?

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  • As one of the people named in this article, I wanted to thank Dr Banner for his sensible comments. Yes GP's are obliged to do annual reviews anyway so this shouldn't be new work - especially if we concentrate on the potentially dangerous strong opioids. I am not an academic but have 30 years experience as a GP Principal plus work in pain clinics. I see & hear about the patients that are not reviewed (sometimes not all), who escalate opioids at will, who have opioids put on repeat before a review is done etc. Yes pain clinics need to play a part as well.

    This is not designed to hit GP's that are doing their job correctly it is simply to emphasise requirements to those that aren't doing it. Plus many GP's ask me what structure a opioid/pain review should take and thus we want to work on the content.

    Alongside all of this, of course we will look at GP workload which I am extremely conscious of - I did specifically say to the Pulse journalist not to put that it was only GP's that are being considered to do reviews - pharmacists, or online reviews may also be possible. There is much much more to be considered than was given in the article above plus I am hoping there can be some central control of opioid doses which will help GP's in their practice.

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  • 'I see & hear about the patients that are not reviewed (sometimes not all), who escalate opioids at will, who have opioids put on repeat before a review is done etc. '

    This cohort of patients overlaps with the 'no one does anything for me' patients who are surprised when I point out their yearly attendance rate of 20 or more appointments.

    Don't believe everything patients say!

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