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GP practices with low prescribing quality rating more likely to prescribe homeopathy

GP practices that perform poorly across prescribing quality indicators are two times more likely to prescribe homeopathy, compared with those that perform well, new research has suggested.

Researchers from the University of Oxford found that over 2,700 homeopathy prescriptions were issued by GP practices over a six month period, costing a total of £36,532.

Over 600 practices issued at least one homeopathy prescription between December 2016 and May 2017, which researchers have suggested is ‘strongly associated with poor performance’ across a range of prescribing quality indicators.

The study, published in the Journal of the Royal Society of Medicine, analysed monthly prescribing data published by NHS Digital to determine which practices prescribed homeopathic treatments.

They then assessed practices using six prescribing quality measurements, which looked at issues of cost, safety, efficacy and patient recommendations.

The research team found that practices which had the worst prescribing quality scores were two times more likely to prescribe homeopathy than those with the best prescribing quality scores.

They also said that the worse a practice’s performance was on the standard prescribing measures, the more likely they were to have ever prescribed homeopathy.

Commenting on these findings, the authors wrote: ‘Even infrequent homeopathy prescribing is strongly associated with poor performance on a range of prescribing quality measures.

‘The association is unlikely to be a direct causal relationship, but may reflect underlying practice features, such as the extent of respect for evidence-based practice, or poorer stewardship of the prescribing budget.’

Lead researcher and senior clinical research fellow at the University of Oxford Dr Ben Goldacre said: ‘Although NHS expenditure on homeopathy is low, we believe the strong association between homeopathy use and poorer prescribing in general is more important than cost. It should raise concerns and may be of interest to those seeking to understand variation in clinical styles and the use of alternative medicine by clinicians.’

BMA GP committee clinical and prescribing policy lead Dr Andrew Green highlighted that 'almost half of practices' that did prescribe homeopathy, did so only once within the six month period, suggesting that it was 'in response to an exceptional circumstance'.

But he added that the 'tiny minority' of practices which prescribe homeopathy more than once per week 'undoubtedly deserve further study'.

Dr Green also stated: 'BMA policy is clear, homeopathic substances have no place in the NHS, nor, I would propose, in community pharmacies.'

These findings come after NHS England announced its intention to ban GPs from prescribing homeopathic treatments, as part of cost saving measures.

NHS England said in November that it would be ‘pressing ahead’ with the removal of 18 ‘ineffective, unsafe and low clinical value treatments,’ including some dietary supplements, herbal treatments and homeopathy, in a bid to save the NHS £141m per year.

Readers' comments (11)

  • Strange that, poor prescribing from advocates of dilute water.......

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  • What is measured in 'standard prescribing measures'? Is it patient outcome by any chance? The commentators above ignore there are 449 peer-reviewed published papers showing benefit for homeoapthy- perhaps they would wish to present transparent evidence of each one being incorrect? "believe the association is unlikely to be a causal." yet the insinuation of this article is just that and a malicious slur on a form of medicine used world wide by hundreds of thousands of doctors and many millions of patients with patient outcome benefit stretching over 200 years.
    A recent Australian report on Homeopathy has been accepted for review by the Ombudsman as the data was analysed showing benefit for Homeopathy 3 years prior to the more recent publication. It took that long to come up with the spurious cut off of 'n150' to eliminate 152 of the previously assessed 157 papers.
    Professor Greenhalgh's recent book'How to Implement Evidence-based Healthcare' is an excellent read and brings into question much of the evidence base. It would appear the commentators in the piece above have not studied this part of the relevant literature. They would do well to do so.
    The GMC is quite clear on the following:
    GMC Guidance Working collaboratively with colleagues

    35 You must work collaboratively with colleagues, respecting their skills and contributions.

    36 You must treat colleagues fairly and with respect.

    37 You must be aware of how your behaviour may influence others within and outside the team.

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  • Not sure if I understand the study. If precribing homeopathic medicines are that to be bad practice, then surely the prectice will already have a low quality precribing rating??

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  • David Banner

    So some GPs are prescribing homeopathic treatment on the NHS.
    Why hasn’t this been banned? If people want to pay privately for placebos then that’s their business, but why on Earth is the NHS picking up the tab???
    Simple, blacklist them, problem solved.

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  • Dear All,
    OMG what a surprise. Evidence based prescribers don't prescribe water. Those that prescribe water as a medical treatment are less likely to follow evidence based prescribing.
    Ban it.
    Paul C

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  • Agree with Do Good above. Using EBM as a blunt instrument against homeopathy exclusively is ridiculous. And so is this study. Maybe we should compare the efficacity of prescriptions made by doctors who believe in God compared to those who don't. Meantime EBM itself got a hiding in this article which quotes sources of the highest repute. Starting with evidence for angioplasty. Or lack thereof.

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  • How exactly do you prescribe homeopathy? I wouldn’t know where to start.

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  • @Northwestdoc
    1. Read the seminal piece of literature in homeopathy, The Organon by Samuel Hahnemann.
    2. Acquire an encyclopaedic knowledge of the effects of minerals and herbs on healthy volunteers and the forensic knowledge gained in accidental poisonings. Warning: This is onerous. Most homeopaths think of it in terms of decades of study.
    3. Be able to take a detailed medical history as well as a rudimentary assessment of psychological health and be particularly interested in your patients' subjective experience of their symptoms as well as being careful to take a good orthodox medical history and examination when needed.
    4. Give your patients enough of the most precious commodities you can offer - your time and caring.

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  • doctordog.

    Why do we always return to this highly polarised debate on the effectiveness of homeopathy?
    We all know it works if you want it to work.

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  • Dear All,
    Oh dear....from homeopathy advocate "4. Give your patients enough of the most precious commodities you can offer - your time and caring." and if that doesn't fit the bill, .......water.
    Homeopathy, medicine for doctors who don't know how to say no (even in the most empathic terms). Honestly homeopathy is a joke.

    Paul C

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