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GP prescribing crackdown after review finds 600 excess deaths a year

The health secretary has promised to make the NHS the 'safest healthcare system in the world' with a new scheme to trace GP prescribing errors and prevent 600 deaths in primary care a year.

The new national system will link GP prescribing with hospital admissions data for the first time and see if a wrong prescription 'was the likely cause of a patient being admitted to hospital'.

The move comes after a Department of Health and Social Care-commissioned study found nearly three-quarters of the 66m potentially clinical significant medication errors were in primary care.

But the chair of the RCGP said this scheme should not be used to 'admonish' GPs for making genuine mistakes and that the long-term solution was a 'properly funded NHS'.

Announcing the strategy, first floated last year, the DHSC said it would see 'new systems linking prescribing data in primary care to hospital admissions so the NHS can see if a prescription was the likely cause of a patient being admitted to hospital'.

The DHSC said this would 'initially focus on how different medicines may be contributing to people being admitted to hospital with gastro-intestinal bleeding'.

Under the new system, 'doctors will, for example, be able to trace whether a patient prescribed a non-steroidal anti-inflammatory drug on a regular basis ended up in hospital with a gastro-intestinal bleed because they were not given something to protect their digestive system', the DHSC said.

But whilst GPs would seemingly face stricter scrutiny, the DHSC said pharmacists would have 'new defences' for when they make 'accidental medical errors rather than being prosecuted for genuine mistakes as is the case currently', which the DHSC said would 'ensure the NHS learns from mistakes and builds a culture of openness and transparency'.

And health secretary Jeremy Hunt said: 'We are taking a number of steps today, but part of the change needs also to be cultural: moving from a blame culture to a learning culture so doctors and nurses are supported to be open about mistakes rather than cover them up for fear of losing their job.'

The announcement also included a target to 'accelerate' the rollout of electronic prescribing to more NHS hospitals this year, with the ambition to 'reduce errors by up to 50%'. It said currently only a third of trusts have a 'well-functioning' e-prescribing system.

The DHSC said the action comes in response to new research showing the 'shocking toll' of medication errors in the NHS.

The study, commissioned by the DHSC and carried out by researchers from the Universities of Sheffield, Manchester and York, estimated that there were 66 million potentially clinically significant medication errors in England annually, 71% of which were in primary care, where most drugs are prescribed.

They further estimated that primary care medication errors leading to hospital admissions caused 627 deaths and cost the NHS £83.7m a year. In total across the NHS they estimated medication errors caused 712 deaths a year, costing £98.5m.

RCGP chair Professor Helen Stokes-Lampard said: 'What is essential, is that highlighting that prescribing errors do occasionally happen is not used to admonish hardworking NHS staff - including GPs - for making genuine mistakes, but to address the root cause, and in general practice that is intense resource and workforce pressures, meaning that workloads and working hours are often unsafe for GPs and our teams.

'New measures to help reduce prescribing risk are certainly helpful, but the long-lasting solution to this is a properly funded NHS with enough staff to deliver safe patient care.'

Medical Protection Society senior medicolegal adviser Dr Pallavi Bradshaw said: 'The move to bring in new defences for pharmacists who make accidental medication errors, rather than prosecuting them for genuine mistakes, is a step in the right direction.

'But to bring about a real shift towards a culture of openness, learning and improvement from system wide mistakes, these defences would need to be extended to doctors and other healthcare professionals. There has never been a more important time to debate this issue, and we are pleased work is underway.'

BMA GP committee chair Dr Richard Vautrey said the 'vast majority of prescribing is carried out to a high standard', adding that 'linking data to reduce prescribing risks is already happening in some areas'.

'The NHS needs to learn from these instances, and we hope these plans will lead to improved systems in hospitals and community settings that reduce the possibility of errors as much as possible.'

But he said it comes as GP practices 'are facing increasing demand on their services, with patients presenting with increasingly complex health problems, so the Government needs to continue to work with us to establish a workforce strategy', which he said should include 'greater involvement of pharmacists working in, or linked to, practices and surgeries'.

MDU medicolegal adviser Dr Caroline Fryar said: 'The MDU, of course, welcomes any initiative to improve patient safety. Medication errors can have a huge impact. For many years we have shared information with our members about common risks in order to help GPs to continue to practise safely.

'This initiative is unlikely to have any impact on the cost of indemnity.'

Labour's shadow health minister Justin Madders said: 'If we want the NHS to be the safest in the world then there are fundamental issues that need to be addressed.

'Ministers have to be much clearer about what extra funding and capacity they’ll be providing so that NHS staff can to do their jobs to the best of their ability, without mistakes, and to really ensure our NHS is as safe for patients as it can possibly be.'

A 2012 GMC analysis of prescription items found roughly one in eight patients was affected by a prescribing or monitoring error and, although only one in 550 errors was found to be severe, prompted changes to GP training.

A more recent audit of 500 practices’ prescribing, published in the BMJ in 2015, found around one in 20 patients received a prescription that should have been avoided as it could worsen their condition or interact with another medication.

GP leaders said at the time that pharmacist-led medication reviews could help boost safety and take pressure off GPs.


Readers' comments (61)

  • Jezza, you forgot to mention that prescribing advisers come and change patient's medications causing unnecessary reactions, confusion, consultations, manufacturing problems without and against a lot of GP's agreement or knowledge. Yes you get 1 GP partner to sign it to get yourself off the hook but most GPs do not know and do not want the change.

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  • Truth finder @8.19

    Brief CV for you-qualified 1994; passed MRCP(UK) in 1999 and worked at medical registrar level before doing GP training which was completed in 2003 and worked as a GP since.
    I sign as many scripts as my colleagues and correct any errors I come across, and I always read the notes -as one would expect with the level of training I have.

    This is where the superficial nature of GP training and a lack of a comprehensive and systematic approach to clinical medicine is made abundantly clear.

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  • Would help enormously if there was a central electronic drug database for each patient so when patients are discharged, or updates are made, all parties can see what has happened and who made the changes and why. As things stand we laboriously transcribe written documents into gp database and manually alter scripts. Never enough time with relentless patient interruptions, telephone interruptions, screen messaging etc etc. Not really rocket science that as human beings we make mistakes.
    IDGAF, your ideals are laudable, but i bet my career that you make mistakes too.
    GPs do the lions share of the work on a shoestring. We take massive risk every day on behalf of our patients. There are not enough of us and no other bugger willing to shoulder the burden.
    So yes Jeremy, use to usual dogma of learning from mistakes dada dada. I like Cundy's analysis that we are actually safer.
    End of rant.

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  • Maximum 20 Patient contacts a day by GP
    Practice pharmacist to sign all GP repeat
    GP to stop all specialised prescriping hence ending so called share care

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  • I suspect IDGAF has a small cohort of loyal patients who attend for their weekly blood pressure checks, 3 monthly medication reviews etc. He/she gives these 500 patients personalised bespoke care whilst his colleagues cope with the unsustainable overflowing demand that £340m yearly appointments in general practice represents.
    Perhaps IDGAF is correct. I would prefer to practice this way. But for us all to do this is requires we all halve our pay or we leave the NHS en mass. FWIW I would prefer the later.

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  • Two things:

    Firstly, I think Paul is correct in thinking that the rate of drug errors is three times higher in hospitals than it is in general practice, based on the figures we have been given. This is despite (or perhaps because of) the medications being regularly reviewed by teams of doctors, nurses and pharmacists.

    Secondly, we can perform useful comparisons on risk using these numbers. For instance, General Practice sees around 360 million contacts per year (depending on whose figures you use). 627 deaths gives a figure of 1 death per 575 000 appointments. Alternatively, allowing for a population of 60 million, a rate of 1 death per 96 000 people.

    For comparison, annual death rates on the roads (using 2016 figures) are 1 per 33 500 people.

    I'm not arguing that we should not strive to maximise patient safety, but this is a politically-driven, soundbite approach to risk management, and we need to have a sense of perspective on the level of risk involved, and also a sense of context in that we work in a massively under-resourced and high-stress system, even compared with our hospital colleagues.

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    Just checking IDGAF
    Do you or Dont you
    Give a fcuk

    Good job the buck will never stop with Jeremy
    Plenty of people to place between him and the fan

    Jeremy plays it both way ...
    cuts funding and resources or does not provide them
    Vilifies Doctors whilst
    expressing concern at their executions

    All whilst actually not doing anything

    Shame on You Theresa May for allowing this guy to continue

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  • This comment has been removed by the moderator

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    Vote of no confidence in GMC / jeremy Hunt
    No one to place the vote with
    as no confidence with BMA OR RCGP
    Will just have to vote with our feet

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    IGDAF .. Sometimes patients are very elderly and it is difficult to get them in for blood tests or it is logistically difficult to get someone to go and get the blood tests done
    Yes the current culture is calling for extremely defensive practice .... but some peoples health may be put at risk by not issuing medication pending defensive checks
    a healthy common sense is required
    ok lets be by the book
    no egfr .. no script
    at least we are medicolegally safe
    damned if you do damned if you dont ???

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