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GPs go forth

NHS England considering patient safety alert over learning disability patients on psychotropics

NHS England is considering issuing a patient safety alert after finding up to 35,000 patients with learning disabilities are likely to be on unnecessary psychotropic medication.

It has called an urgent action summit for later this week (17 July) at which professional and patient group representatives can establish a plan to reduce prescribing.

Although NHS England acknowledged that the drugs were ‘rarely’ initiated in general practice, it urged GPs to work more closely with hospital specialists to ensure prescribing to patients with learning disabilities is reviewed.

NHS England’s call comes as it received reports from three separate investigations into the matter from Public Health England, the CQC and NHS Improving Quality respectively.

This included PHE finding tens of thousands of patients are unnecessarily on antipsychotic or antidepressant drugs, with its report stating: ‘[W]e estimate that between 30,000 and 35,000 adults with a learning disability in England are taking one or both of these types of drug in the absence of the conditions for which they are indicated.’

Based on the three reports, NHS England has concluded that:

  • There is a much higher rate of prescribing of medicines associated with mental illness amongst people with learning disabilities than the general population, often more than one medicine in the same class, and in the majority of cases with no clear justification.
  • Medicines are often used for long periods without adequate review.
  • There is poor communication with parents and carers, and between different healthcare providers.

In a letter to frontline staff, NHS England said: ‘We recognise that these medicines are typically initiated by specialist doctors and only very rarely by general practitioners.

‘Whilst the responsibility for prescribing lies with the practitioner who signs the prescription, it is critical that GPs and specialists work together, through shared care arrangements, to monitor and regularly review patients taking these powerful medicines.’

Responding to the call, RCGP chair Dr Maureen Baker said that prescribing drugs appropriately is something that GPs take ‘incredibly seriously’.

However, she added: ‘Whilst psychotropic drugs can have benefits for some patients with learning disabilities, it is important that every patient is taken on a case by case basis and not simply prescribed drugs as a matter of course.

‘It is also important that the principle of prescribing the lowest possible dose for the shortest possible time, which doctors generally follow in their everyday practice, is applied to all patients – including those with learning disabilities – when dealing with drugs associated with mental health – and that these prescriptions are regularly reviewed.’

Readers' comments (6)

  • 'NHS England said it is ‘critical’ that GPs work with specialists ‘through shared care arrangements’'

    'There is poor communication with parents and carers, and between different healthcare providers. '

    No one with MBBS MRCPsych regularly sees our patients, so there is no one to have poor communication with.

    Not GP provider role to commission this however.

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  • In my area all antipsychotic medications have to be initiated by secondary care, stabilised then shred with primary care.
    We view these drugs to be the same as methotrexate and other DMARDS.
    This gives parity of esteem although we have not yet got the antipsychotics onto the 'near patient testing' DES.
    I understand Denusomab has been added to the DES otherwise it would have been secondary care only.
    My advice is 'specialist drug = specialist care' no specialist available = no drug prescribed

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  • and of course if they are unwell because of no prescribing then send them to hospital, that usually frees up resources

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  • oops, i meant to say 'shared' not 'shred'

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  • Looks like lots of reviews by our psychiatric colleagues then- let's hope they can cope with the demand.

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  • Getting access for these patients to a psychiatrist with interest in LD's is like getting access to rocking horse manure in my experience.

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