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NHS calls on GPs to review prescriptions of patients with learning disabilities

NHS England is urging GPs to review prescriptions of patients with learning disabilities and to stop drugs being used as a ‘chemical restraint’ in latest guidance aimed at tackling the over-prescribing of psychotropic drugs.

The six-page guidance tells GPs to lead a review of prescriptions of all patients with a learning disability, with a view of implementing a supervised dose reduction strategy.

It says that psychotropic drugs should only be continued in patients where a significant benefit has been seen or where the behaviours experienced prior to prescribing are so severe that it would be inappropriate to stop their medication.

The guidance – endorsed by the RCGP and the Royal College of Psychiatrists among others – states: ‘The goal [of the guidance] is to improve the quality of life of people with a learning disability by reducing the potential harm of inappropriate psychotropic drugs that may be used wholly inappropriately, as a “chemical restraint” to control challenging behaviour, in place of other more appropriate treatment options.’

It follows a report from PHE last year that stated that drugs for patients with learning disabilities were being prescribed ‘in the absence of the conditions for which they are known to be effective.’

Included in the guidance is an algorithm to help GPs kick-start the medication review. It suggests that reductions should be stepwise and realistic, withdrawing one drug at a time and reducing the medication that has the least evidence of benefit first.

If after the review, GPs do not feel that any of the psychotropic drugs can be reduced or stopped, they must document this, outlining the evidence of why they have come to this decision.

Current NICE guidance states that once prescribing is transferred to primary care, GPs should be given guidance by a specialist on which behaviours to manage, how long the medication can be taken for and plans for stopping the medication.

Dr Matt Hoghton, medical director for the RCGP clinical innovation and research centre, says: ‘Whilst GPs rarely initiate these medications, they have a key role to play in reviewing and ensuring our patients with learning disabilities are only taking drugs if they need to, and that their records indicate why they are taking them, so this guidance is welcome.’


Readers' comments (4)

  • And in other news... GPs call on NHS England to fund services for patients with learning difficulties.

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  • GPs best placed again BLAH BLAH BLAH,wheres the funding mate?

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  • I declare an interest as I have four cousins with severe learning difficulties from birth. In 2001 I was asked by the then East Surrey PCG/PCT to help devise a health check for patients with learning disabilities. Along with Jill Rasmussen and Chris Botten we set about determining what was the best way to treat anyone with LD. I was personally fed up with being asked to 'try' a new antipsychotic to see what it would do. The GP's cradle to grave responsibility is to all patients irrespective of their status and to refer to specialists when needed. The carers of my patients knew them best and could tell me what the issues were without needing a chemical cosh! It was usually dental or constipation and relatively easy to sort as I was known to the patient unlike the random specialist who saw a different behaviour and had a drug to calm it. I watched one who flew over the Cuckoo's nest and vowed I would not treat people that way! We set up a LES which is still going and was rolled out across Surrey. There was training if need be or patients could transfer to those practices with an interest. There are ways of caring without chemicals and so long as it is adequately resourced everyone can be happy!

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  • Except carers usually know nothing about their patients. And there are no services for these patients. And you get 10 calls a week to assess them because of their behaviour. And social services won't intervene unless they have a medical assessment every time they call, 'just in case'.

    Shouldn't be prescribed as a 'cosh' but to reduce it to these terms is massively oversimplifying the situation.

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