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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)

  • Jones the Tie

    Pharmaco-vigilance is something that we should all practice. Unfortunately this is one of those things that takes time and knowledge for which NO ACCOUNT is taken during our working day. If one looks at the main culprit drugs it is the usual suspects, nsaids, chemo agents etc. More complex drug to drug interactions take time and knowledge to prevent. I have lost count of the number of times I have had to point out to consultants in secondary and tertiary care that their prescription is potentially harmful. The responses I get are rude to say the least. We ALL need to improve our prescribing but I think MR H will find that just 'monitoring admissions' will not help. Often drug interactions and ADRs are complex and it takes time to stop patients suffering potentially avoidable type A ADRs. I don't think any of the 'sneering secondary care ' professionals will have ever tried to police hundreds of complex scripts week after week and organise complex recall and monitoring systems that need to take in to account the ability to provide the service. I suspect they think just writing in a letter stating what should happen with monitoring miraculously makes it occur. It doesn't . It takes time and expertise and a pragmatic and rational approach. No matter how good we make systems drugs will still cause harm. Full stop. What Mr Hunt needs to do is realize that the service he has got is what he pays for. Staff and expertise are expensive but he should realize that what the NHS is suffering from is chronic low morale, underfunding compared to other similar nations, under-staffing and a lack of coherent planning. I have NO allocated time to check repeat prescribing in my day and cover for colleagues when they are on leave. If I had dedicated time it would need resourcing properly. That would be your job Mr Hunt.. help us health professionals and prescribers have enough time to be able to safely carry out the tasks we all know about..and no professor Lord Tertiary neurologist Badcrumble I won't issue a script for propranolol for 'benign tremor' to a brittle asthmatic at your say so...it's a bloody good job I know my patients and check these things which you don't and now I've got to tell the patient why I won't prescribe it as ' that professor said you'd do me a prescription' ..well Mr Shaky in the grand words of Doc Martin ' I have an aversion to killing my patients' rant over

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  • here here.

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  • Cobblers

    Oh FFS, Jezza 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.

    Yet another "The NHS is the XXXXest in the world!" Political soundbite crap.

    Errare humanum est.

    And not even God prevents deaths. It might delay things a bit but mortality for all is 100%.

    Take the pressure off JH and you might oddly see less mistakes.

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  • Could we also have a Conservative Party austerity crackdown on the basis of all the excess deaths their WILFUL negligence has caused over the last 8 years?
    Ought to be a few hundred manslaughter charges to bring in there.

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  • I agree that in an ideal world what IDGAF says makes sense but I really find it difficult to stop the insulin of a patient with DM because they are not up to date with their blood tests.
    Likewise, not having a current eGFR is hardly a reason to STOP a patient's anti-hypertensive meds!

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  • Macaque

    Agree with you IDGAF.

    For all those criticised IDGAF, how can a doctor say 'my workload is so high, so I am not gonna bother much about my prescribing accuracy. If a patient dies, TOUGH!' ??

    It is discriminatory to say 'Oh he must be newly qualified', 'He must be doing 2 sessions a week with plenty of time to twiddle the thumbs'.

    Forget about JH, we all have to get our act together with our prescriptions. Don't see 50 patients a day!

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  • Thank-you Macaque ' 7.06.

    The user name IDGAF applies to not GAF what the other contributors here think, including regarding the slur that I've fabricated my CV. I will continue to say it as I see it. What I do GAF about is using my skills and training to do the job thoroughly and systematically. I just wish others aspired to do the same.

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  • Retired & Foolishly Came Back @6.58.

    No-one said stop the insulin or anti-hypertensive; I would arrange to get the patient in for the necessary tests.Do not use my posts as a Rorschach test.

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  • 627 extra deaths for primary care prescribing errors. this has to be a number derived by a theoretical statistician and not a real person. as we know, anything can be done with statistics.
    for once i find myself agreeing with Jeremy Hunt; Lets get over a blame culture and look at the reasons. certainly it needs to be taken out of a political arena and into the everyday world of general practice and real life. a sense of reality is very much needed not point scoring or purist ideology. sometimes shit does happen. patients do have more than one disease. Daily GPs see twice the number of patients they should do. Hospitals continually shift prescribing into primary care.
    627 deaths may be too many but how does this compare to the 1800 who die ach year on uk roads. Do we think twice about getting in the car to collect our prescription.
    Lets really keep this erudite number in perspective.

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  • 1) How many of those 'errors' were comitted by GP prescribing, and how many by GPs obeying the instruction that they MUST provide a script for what the consultant says GP must, but is not brave enough to put their own signature to?
    2) how many of the 1 serious error per patient per year are actually significant interactions like ACE plus frusemide - both drugs lower blood pressure - use only 1 at a time, but still get BP down below 130/85 or get struck off for poor care?
    3) does anyone really belive they won;t use it to reduce GP pay as well as increasing workload???

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