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GPs to develop list of unnecessary interventions under scheme to tackle overtreatment

A group of royal colleges including the RCGP is launching a new initiative to tackle overuse of unnecessary drugs and procedures that they say are doing more harm than good.

Led by Dr Aseem Malhotra, from the Academy of Medical Royal Colleges, the ‘Choosing Wisely’ campaign will encourage GPs to discuss potential harms of treatments with patients, as well encouraging patients to ask if tests are really needed.

By autumn, each of the colleges will submit a list of the top five tests or procedures that are of ‘questionable value’ and will advise doctors on stopping using them.

The move comes after a team of GPs, led by RCGP Council member Dr Margaret McCartney, set up a working group on over-medicalisation.

Professor Maureen Baker, chair of the RCGP, said: ‘If there is evidence to show that a particular intervention might be of little benefit to a patient, it is good practice that alternatives are explored.’

She added that GPs were ‘under considerable pressure to prescribe, or take some form of action’ so it will be important to work together with people so they ‘realise that drug or surgical treatment isn’t always the best way forward’.

BMJ 2015; available online 12 May

Readers' comments (23)

  • I though that was NICE's remit.More talking shops for the politicos.Ah well keep slaving at the front line while some where a mile or 2 back the generals plan the next vain glorious over the top plan.Must do that emotional resilience course but I cant be bothered any more.

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  • Unnecessary intervention No 1: Membership of the RCGP

    Rationale:

    Not efficacious and a drain on budget with no obvious effect.

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  • Unfortunately so much of our prescribing is driven by the badly negotiated QOF, there is a fashion to 'name and shame' GPs who miss a cancer diagnosis and also a consumer culture which encourages complaints when people feel they did not get what they wanted. Until you address the culture of fear' that permeates through the NHS and the rising tide of demand from the public, the overuse of unnecessary drugs and procedures will only get worse.

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  • How to you quantify and measure harm?
    You can stop prescribing paracetamol, ibuprofen, topical ibuprofen gel, emollients and vitamin D for a start. That is the start of reducing an FP10 culture.
    But that will never happen so this exercise is pointless.

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  • "Five years to go if I last that long!" is my reflex reaction to all of these stories now. Too many tests, but refer more 2 ww; too many antibiotics but you're not taking sepsis seriously...

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  • Vinci Ho

    'If there is evidence to show that a particular intervention might be of little benefit to a patient, it is good practice that alternatives are explored.’

    Yes. My mother is a woman.

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  • There is a new thing called consent form for not intervening. So if one decides NOT to operate for example based on risk versus benefits, one needs to ideally get a consent for not operating after explaining the pros and cons of the same.
    See the Medical Defence advice.
    So we have to get consent form to confirm no need Abx as likely viral but a small chance could be bacterial and you could worsen and develop pneumonia or Otitis which can rarely cause deafness or tonsillitis which rarely can cause Quinsy etc.
    Most GP`s know those who are a (cervicalgia) of General practice and will NOT accept the uncertainty of medicine and give a deferred prescription. However formalizing it would require consent for NOT giving Abx in a suspected viral infection unless one has access to CRP ASAP (which itself has a grey area!).

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  • Solicitors and litigation organisations are currently running riot with no one in a position to stop this proliferation of actions against an easy target such as an underfunded NHS prepared to do anything. If you do not address the cause then expect investigations as a result of defensive medicine and associated costs to spiral out of control. If however you want to control costs then control lawyers who raise costs of 50 k for work which would ordinarily be worth 1k !!

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  • Not sure what they are trying to achieve here.

    If there is a firm uncontested evidence a treatment/test has little value then each clinician will use their brain and stop the test/procedure. We don't need RCGP or any other college repeating what we already know.

    To commission a research to prove an intervention can cause more harm (or little value) would be welcomed.

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  • The group looking at this is a wide ranging group including a gmail group where lots of us non politicos can read the evidence behind things. I do not have the time or intelligence to offer much to the group but in reading evidence from them which is digested from high quality work this group is trying to challange an issue head on which we've ignored for years. I feel the anxiety of GPs and the pressure to test, prescribe and refer. But we all see patients harmed duue to interventions- how many worried well clutching private scans etc.....

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