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CAMHS won't see you now

Every GP practice's medication errors could be published 'within weeks'

Exclusive GP practices will see figures of their 'higher risk' prescribing linked to gastrointestinal bleeds published this spring, in a move that is causing real concern among safety experts.

Health secretary Jeremy Hunt announced a drive last month to reduce the 'shocking toll' of medication errors in the NHS, and Pulse has learned that this will involve the publication of practice-level data linking prescribing with hospital admissions.

The first data release will focus on admissions from GI bleeds, highlighting how often - for example - a practice has not prescribed gastroprotection with an NSAID prescription and this has resulted in a hospital admission.

But the move to allow the publication of this on a practice level has been branded a 'retrograde step' by GP leaders and even the Government's own advisers on the scheme have expressed concern that the figures will mislead the public on the safety of their GP practice.

The Government crackdown on medication errors followed research it commissioned which estimated that primary care errors had caused over 600 deaths and cost the NHS £83.7m a year. 

Department of Health and Social Care told Pulse that 'aggregated' data linking 'higher risk' GP prescriptions to hospital admissions will be published 'at a GP practice level'. Patients will not be identifiable and individual GPs will only be named if they are a single-hander, the DHSC clarified, with the first set of indicators - focusing on gastrointestinal bleeds - set to be published 'in spring'.

But the University of Nottingham's Professor Anthony Avery, a prescribing safety expert whose research was used to develop the indicators and who has been advising the DHSC on the scheme, told Pulse: 'There are some concerns about making practice-level data publicly available on potentially hazardous prescribing.

'If this happens I think that practices and CCGs need to be prepared to explain that while efforts are being made to improve the safety of prescribing, variations between practices may be for a whole variety of reasons (such as population demographics) and do not necessarily mean that one practice is safer than another.’

The first set of indicators, developed in collaboration with NHS England, NHS Business Services Authority, NHS Improvement and academics from the University of Nottingham, will be published by NHS Digital shortly, Pulse was told.

But Dr David Wrigley, former BMA deputy chair and a GP in Carnforth, Lancashire, said Mr Hunt was 'once more playing the blame game'.

'What happened to his culture of learning and the "no blame culture" he so often espouses? There are so many nuances involved in patient care and closer analysis over patient care is always required.

'This move is a retrograde step and the DHSC need to seriously reconsider this move as it will further demoralise the profession and lead to yet more GPs walking away as this is just another stick to beat us with.'

Nottinghamshire GP Dr Steve Kell commented: ‘It is obviously important to reduce prescribing errors at all stages of patient care. Clearly, prescribing can be linked to upper GI bleeds but so can lifestyle factors such as smoking and alcohol. Cause and effect isn't straightforward.

‘The safest way to reduce prescribing errors in the NHS is to ensure there is a sustainable workforce, time to care for patients and rapid access to alternatives to prescribing such as physiotherapy and surgical opinions where needed.’

Berkshire, Buckinghamshire and Oxfordshire LMC chief executive Dr Paul Roblin added: 'The devil is in the details. It will depend on how they analyse the data and how they reach their conclusions.'

Last September the DHSC established the Short Life Working Group to provide advice on the scope of the programme to improve medication safety, in reaction to the World Health Organization’s launch of the third global patient safety challenge.

This aimed to cut avoidable medication-related harm by 50% globally, within the next five years.

Readers' comments (30)

  • How do ‘they’ have this info when I don’t even know myself re my patients! Presumably it won’t be identifiable so we will have no way to check the actual clinical scenario rather than algorithmic headline figure?

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  • National Hopeless Service

    Perhaps they should also look at NICE advice on NSAI and PPI cover first.

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  • Hunt playing the saviour again and saying -look at these lazy GPs or whosoever are left of them. Rationing medication and looking for medication errors-just a second how do you do that and how to prove you are right. Pathetic as it goes and all target as good as getting 5000 GPs-lies.

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  • Perhaps they could do the same for secondary care esp around DOACs

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  • The end-game plan of this government is not clear.

    What we need to beware is the risk that patients may use this information against GP practices in this compensation-ridden society.

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  • what about patients with contradictory contra-indications?! And those who won't take what they're prescribed? And will the hospital stats be able to distinguish between OTC NSAIDs and GP-prescribed?

    Many prescriptions are a balancing of risks by patients and their doctors (neither of whom will have full knowledge and understanding of every possible risk, and either of whom may make their own perspective/judgements, not necessarily the same).

    Perhaps the plan is to inhibit prescribing all round

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  • David Banner

    As expected, an opportunity to improve on prescribing errors has been turned into a GP witch hunt, exactly as most GPs feared. It’s always depressing to have your cynicism proved right.

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  • What is Professor Avery going to do if his concerns about the use of his indicators aren't heeded?

    Well Professor?

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  • So let them do it. Then they can figure out that the marker is too crude, that it is riddled with confounders and makes little correlation with safe prescribing. How much do these guys get paid?

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  • Bring it on. All that will happen is that everyone will be shown to make errors - surprise surprise. We won't know who thay are. They will be on scripts written by locums / trainee / someone else in the practice / ourselves. It will demonstrate that GP is unsafe and under-resourced and patients shouldn't use it. It may mean days when I don't have to see the punters because I have to trawl through hundrends of errors and work out policies and procedured to prevent recurrence or some other pointless bollocks as usual. Hey ho. Whole thing is a pantomime. Just smile and see the funny side.

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