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A faulty production line

Practices ‘should scrutinise individual GPs’ prescribing safety’

Primary care academics have called for practices to monitor their individual GPs’ prescribing, so as not to miss repeated high-risk prescribing that may not show up by looking at a practice’s overall prescribing safety record.

Their research suggested that the majority of high-risk prescribing by GPs is masked by better prescribing practice of their colleagues.

The team, led by Professor Bruce Guthrie, professor of primary care at the University of Dundee, studied prescribing data from 38 GP practices in Scotland, and found rates of high-risk prescribing of NSAIDs varied much more between GPs than between the practices.

Overall, such high-risk prescribing was low, occurring in 1% of all potential encounters with patients who would be particularly vulnerable to NSAID adverse drug effects.

But rates were as high as 20% for individual GPs, compared with just under 4% for practices.

Statistical models showed that three times more variation in high-risk prescribing was down to the variation between GPs than the variation between practices.

The researchers concluded that ‘high-risk prescribing is more of a “bad apple” than a “spoiled barrel” problem’ and that ‘only targeting practices with higher than average rates will miss most high-risk NSAID prescribing’.

They said that prescribing safety improvement should target all practices, but should also ‘encourage practices to consider and act on variation between prescribers in the practice’.

Readers' comments (8)

  • Definitely room in Practice for more monitoring, if we got rid of ALL clinical work it would free up more time and we could simply complete all the 100s of documents / Quango requirements and genius ideas from 1 session-per-year academics and maybe there would be an hour a week to introduce ourselves to our families - then again GPs shouldn't be so selfish…. that time could be put to better use being flogged in public for not providing 24/7 personal care to every person in the world visiting the UK (obviously we'll pay personally for all their care).

    GP - great choice. FY2s what is stopping you?

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  • Some academics need to see the wood from the trees.

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  • why don't we just refer all GPs to the GMC in one go as this seems to be the direction of travel.

    does this country actually want doctors ?

    our job involves risk - it is not a case of 'if' we will get a complaint or make a bad judgement it is 'when' and 'ho often'. Each time a risk assessment fails it can cost us our job.

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  • Vinci Ho

    Very politically correct .
    Persecutions should come along with this , I suppose?
    Thank you the people living up the tower ......

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  • All GP's self refer themselves to the GMC, CQC and the health ombudsman just in case there might be the slightest risk of any patient coming to unintentional harm from prescribing any medications, ordering or not ordering any test, referring or not referring any presentation. Our jobs are black and white, everything presents classically and we should know with our crystal balls how our patients will respond/change/deteriorate/get better before they stop through the door. Why does anyone want to a doctor in the UK?

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  • As a "portfolio" GP I see prescribing in a number of practices. Mostly it is simply disorganised rather than dangerous. I would love to cross off most of it, but that's not my role as a locum.
    It nearly killed me in my last practice to get the prescribing safer, and I'm not going back into a regular job unless GPing is a supportive, happy place to be. We need support to get this better, not more targets.

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  • This research is annoying - very annoying - but true - very true.

    I agree with 8.39 above - Every doctor that reads this article knows of a GP who just cannot stop dishing out the Bennies / the 'Z's / Tramdol by the bucketful and who regards any attempt at carrying out even a perfunctory repeat medication review as being a sign of terminal OCD.

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  • Any practice not having clinical meetings is unusual. Any Doctor who feels unable to have a quiet word with a colleague's odd practice is already outside GMC GMP. A GP's best interests for a resilient business is also at stake. Most CCGs have medication monitoring that prompts closer looks.

    Sometimes it's how the sensible suggestion is phrased that makes it sound as if the speaker isn't aware of the structures in place already.

    Also beware in the current climate, of sounding more negative than necessary. It adds substance to the feeling that over and above heavy regulation, costs of which imposed on Doctors themselves to fund, more might be ladled on, without a care to opportunity or other costs.

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