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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)

  • IDGAF - reminds me of the enthusiasm I had when I joined as NHS GP from being a medical registrar.
    As much as I understand and appreciate where you are coming from, I have to agree the pressures faced by the run of the mill full time GP.
    Only advice is look after yourself and family and do not burn out as no one else cares and bothers !
    Good luck

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  • doctordog.

    Agree with IDGAF.
    those annoying pop ups on the computer are there for a reason.

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  • i frequently see letters from specialist starting a treatment and then i add it on emis and get a severe interaction warning. i then have to inform the specialist and the patient who never says sorry.

    we have had software checking prescribing for years. they have a soggy out of date bnf.

    it is not rocket science guys, but it is also clearly not a priority for hospital managers. after all there isn’t a target for it.

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  • Repeat prescribing is a dangerous nonsense. we should prescribe drugs enough to last until the next appointment.
    but that would not suit pharmacies would it ?

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  • Not really sure why IDGAF has received so much criticism for pointing out how frequently drug errors occur.

    I think the real issue is a culture that doesn't respect drugs for the potential poisons they can be. We have become FP10 happy for any number of disorders and moving the goal posts for health and disease is just adding to this.

    There also needs to be a dedicated safety/prescribing champion in each practice - GP or pharmacist. Their role would be to ensure adherence to safe repeat prescribing but this doesn't come without cost.

    If Hunt is really serious about prescribing safety, he would provide adequate pharmacist cover for ALL practices st no extra cost to them. Otherwise we are all trying to squeeze this work into an already long day.

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  • Make the hospital do the first prescription for everything they start. Then they have to sign off that first prescription and make sure they know its safe. If its to be long term they should also have the facility to state that a number of repeats are authorised until the patient is reviewed.

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    Whatever we think...being busy etc etc will never be an excuse if there is a serious incident.... The situation is even riskier for locums if you are signing a script for a patient you don't know... Also we all know the very busy day and someone saying can you just sign this.... Someone said... Sign in haste ...Regret at your leisure...
    Checks are needed... Keep it Safe
    E prescribing is potentially risky as you just need one click
    and it is easy for a few drugs to go through...
    Can be heard to pull it back..
    (p.s. Nothing personal IDGAF.. just nice discussion )

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  • This has indeed been a stimulating discussion; such a thread which gets new (or infrequent) contributors to chip in usually tend to be.

    As others have alluded to, errors which lead to significant harm (and the need to involve ones defence union) are not too frequent but an effective defence can never be built around the argument "I was too busy M'Lord". I think this leads to prescribers playing the percentages which allows things to slip by un-noticed but at some point even 'winners' lose.

    I think electronic prescribing is a double-edged sword; on the one hand a swift click of the mouse and the "virtual signature" is made, but perversely using this system with all the patients notes close to hand (and to view) makes the sloppiness of not inspecting them a bigger "offence" as compared to the remoteness of the paper script. In effect, the opportunity to detect lapses in pharmaco-vigilance arise every month (if patients get a months supply) IF those who are signing scripts bother to check. It may become a source of seething resentment if only one doctor bothers to do so.

    For those readers whose ire I have drawn are prepared to do the following for just one full working day I am of the opinion that it may be instructive:

    1. Every electronic script you sign for any drug which in and of itself needs monitoring (eg thyroxine, lithium, valproate, ARBs/ACEIs, MTX etc) or pertains to a condition which requires monitoring (DM, ant-psychotics, statins etc) you take a moment to inspect the notes to establish whether or not its been done;

    2.If stuff needs doing (to ensure the Prosecution case is dismissed!) the patients details are given to the support staff along with instructions to get it done.

    I think this would be a worthwhile endeavour.

    This kind of attention to detail takes time, but patient care improves as does your chances of not being [censured] by GMC or other pontificating legal outfit. Its this degree of diligence that is expected of a medical registrar, who to get to that position would have had his/her prescribing habits scrutinised by consultants for a number of years as an SHO (or todays equivalent) which is in contrast to the GP hospital trainee doing his/her (typically solitary) 6 month "medical" job.

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  • Dear All,
    My mother told me a story that when i was 4 I had an aunt come up and say "how are you duck?". my reply, "i'm not a duck". i've been evidence based every since. All i would respond to IDGAF (apart from stopping hiding behind anonymity) is where is the evidence for all this didactic checking you do? Where is the evidence that TFTs need checking every 6/12? Weren't we once exhorted to do U&Es pre ACE inhibitor? Lipids must be checked every year or is it not now 5? How many patients have you ever seen have their Roaccutane stopped because of a raised cholesterol? If you drill down to where these recommendations come from you will usually find they are based on the views of collections of experts and very rarely any real evidence. As a graduate physiologist i'd argue that a more likely thyroid check interval would be with the seasons. I've looked at our evidence base pre and post QUOF. Pre QUOF we were way off the targets, we are now 90%+ but have we had any fewer under or over treated thyroid patients? how many of our patients have had ACE or ARB induced renal failiure - none, pre or post QUOF. The list goes on. The point as made in less empathic ways by others is don't mistake safety for being spoonfed. Channel your enthusiasm not into slavishly following this or next years gold standard but into questioning the world around you. Lead, don't follow.
    Paul C

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  • IDGAF sounds like a great GP. (No irony or envy there, btw). And the bigger point is that sadly, the dynamics of our current system dictate that he/she has got a short distance to go 'til burn out / divorce / MH issues etc.
    I'd love to be proved wrong...

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