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GPs face new spotchecks on their controlled drugs

More practices will be subject to random checks on how they manage controlled drugs under guidelines aimed at tightening inspection of GPs.

The guidance from the National Prescribing Centre also calls for more 'routine and co-ordinated' visits to GPs to check storage, prescribing, recording and disposal of controlled drugs. It comes in

advance of recommendations from the Shipman Inquiry, which is expected to call for tougher inspection and monitoring systems in a report due this summer.

Professor Richard Baker, the GP academic who revealed the scale of Harold Shipman's crimes, also called for an overhaul of the regulations earlier this year because GPs were becoming reluctant to hold supplies of controlled drugs.

His research found GPs were 'anxious and confused' because systems to ensure they followed controlled drugs regulations had fallen into 'neglect and decay'.

Clive Jackson, chief executive of the National Prescribing Centre, said the guidance for practices, PCOs and inspection bodies would help tighten up monitoring systems and practices' procedures. Both were 'variable', he added.

'Inspections need to be more co-ordinated, and there needs to be a little more routine about it. On occasion a random inspection might be a good thing.

'It's quite rare for people to be acting outside the law for anything other than accidental reasons, but it's beholden on every professional to work within the law and ensure whatever process they have is as good as possible.'

Dr Richard Fitton, a GP in Glossop who countersigned a cremation form for Shipman, said he was frightened to carry diamorphine around in case he was accused of misusing it.

He welcomed the clearer guidance, but said random checks should not create a 'negative culture'.

He added: 'If something is wrong you should not be struck off but given time to put it right.

'This is to our benefit and that of patients. We are still living under the shadow of Shipman and I even think some people are not getting controlled drugs when they should.'

Professor Baker, head of health sciences at the University of Leicester, said GPs would welcome inspection, but would be more in favour of visits

announced in advance.

He added: 'Having someone there who can come along and give advice is a good thing.'

Best practice for managing

controlled drugs

Stock control

lGPs' stocks of controlled drugs should be kept to a minimum and reassessed every year.

lInvoices for stock should be kept for seven years.

Registers

lPractice registers must be bound volumes specific to a practice, contain sections for each drug, have entries written in ink and witnessed by colleagues.

lCorrections must be signed and dated; registers must be kept for two years after the last entry.

lRegisters should contain dates, quantity, form and strength of drugs received or supplied to patients or colleagues, as well as patients' names and those of doctors receiving or removing drugs.

lSeparate registers should be held for doctors' bags. Restocking of the bag and entries on the register should be witnessed.

lA further register of drugs returned by patients should be kept.

Storage

lDrugs should be stored in lockable rooms not accessible to patients in locked metal cabinets fixed to solid walls or floors using rag bolts only accessible from the inside.

lDoctors' bags should be locked at all times.

lIf multiple locums are used stock should checked against registers every week.

lDiscrepancies between stock and registers should be investigated immediately and results recorded.

If source of discrepancy cannot be found, NHS organisations should be informed and the police brought in if it still cannot be traced.

Prescribing

lScripts should be handwritten – only GPs providing services regularly to drug addicts can print scripts.

lDoses and frequencies should be written in full, with GMC registration numbers and full personal details.

Disposal

lDestruction of expired or returned drugs must be approved by authorised people, including police, PCO chief executives, PCO medical directors, PEC member – but not if the drugs were supplied to that person or by them.

By Ian Cameron

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