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GPs told to review care home patient records after residents given wrong antiviral dose

Exclusive GPs have been urged to review the records of any care home patients recently prescribed antiviral medicines after a ‘significant untoward incident’ at one care home involving residents being given the wrong doses of oseltamivir, Pulse has learned.

CCGs across Derbyshire and Nottinghamshire have written to practices telling them that some patients had been given ‘an inappropriate dose of oseltamivir’, leading to an SUI, and said there was ‘concern that this could happen again’.

To prevent a recurrence, practices were told to review all their care home patients to see whether there was a ‘concern that patients had been given an incorrect dose’.

But GP leaders have said that this incident raises further questions about the pressure GPs are being put under to prescribe Tamiflu, after Public Health England ‘bullied’ GPs into prescribing it to all care home residents for use as a prophylaxis without undertaking necessary checks.

An email from NHS Newark and Sherwood CCG and NHS Mansfield and Ashfield CCG - seen by Pulse - said they were unable to provide details about the SUI, and who issued the prescription, but stated: ‘It has come to light that some patients received an inappropriate dose of oseltamivir and there is concern that this may happen again so to support prescribing, Public Health England have issued some updated guidance, which is attached to this email.

‘Can I also ask that if any care home patients have been given oseltamivir or zanamivir recently that you review their records and if you are concerned that an incorrect dose has been given please take the following actions: do not give further doses; check the patient’s creatinine clearance levels and ensure appropriate clinical action is taken if necessary; contact the CCG… and we will coordinate any actions that are necessary.’

According to a statement from NHS England, no patient came to any harm but the matter is ‘under investigation’, and confirmed that ‘an alert was sent to all CCGs across Nottinghamshire and Derbyshire for sharing with GPs’.

The move comes after the GPC demanded urgent talks with Public Health England (PHE) to resolve problems where GPs were being asked to prescribe antivirals as a preventative measure in care homes, in some cases at very short notice and with limited information, while doubts have also been raised about the clinical justification for prescribing the drugs prophylactically.

In some cases GPs have been told to check patients’ records for renal function and adjust the dose of oseltamivir accordingly, but others received no directions on the need to adjust doses.

Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMC, who has been raising concerns on behalf of GPs in his area regarding antiviral prescriptions for care home residents, told Pulse the significant untoward incident raised further questions about the pressure GPs were being put under to prescribe the medications.

Dr Roblin said: ‘It demonstrates that adverse consequences are happening because prescribers don’t have enough time to take sufficient care. I’m not blaming the GPs, the situation they are being put in by Public Health England is intolerable. If you put people under that pressure then mistakes like this will happen.’

He added: ‘It’s an example of clinical interactions that need to be better thought through and Public Health England needs to learn the lessons. GPs see patients face to face and know how to interact with them, and public health seems to have forgotten how to do that.’

Dr Roblin added that GPs were continuing to experience problems in his area.

He explained: ‘They are phoned up and told the scripts need to be with the pharmacy within an hour. The last person I spoke to about this received a call last night at 6:50pm, when he was the only doctor in the surgery – and that was for prescriptions for 10 to 20 patients. 

‘Having to do that work, when you’ve already got patients waiting, is impossible - you feel under pressure, you’re told you have to prescribe and there isn’t enough time to take sufficient care.’

A spokesman for NHS England said: ‘We were made aware of an issue relating to a residential care home in Nottinghamshire where it appears incorrect doses of oseltamivir may have been administered to patients. No patient has suffered direct harm as a result of this potential error and the matter is now under investigation.’

Public Health England declined to comment.

Readers' comments (6)

  • PHE should prescribe and monitor.

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  • GP given more responsibles,when their numbers have been severely haemmorhaged by PCT NHS England with GMC MPTS's collaboration.
    It bid me to quote a poem by John Milton'What boots it wth uncessant care,
    To tend the homely slighted shephers's trade(In this case Medical Profession)),
    And strictly meditate the thankless muse(GMCMPTS,and other governing bodies);
    Were it not better as others do-Sport with Amarylis in the shade,
    Or with the tangles of Neira;s hair.
    Fame is the spur that the noble spiririt does crave,that last infirmity of the Noble mind,
    to scorn delight and live laborious days'.
    GMC MPTS takes PCTs and their umbrella body,NHS's words unproven as gospel facts and straight put GPs and Doctors through the grind of reassessments ;while NHS have not looked after patients in their not implementing Evidence b|ased medicine.Though pointed out by doctor victims they instead of examining their own biases of accepting unproved NHS's complaints put dovtors through the wrench.BMA also after their recent chambes have lost people like Alan wishart in the Employment Support,destroying their effectiveness as a Union of doctors

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  • Vinci Ho

    Poor evidence
    Poorly thought through logistics
    Lack of leadership
    Recipe of disaster
    Of course, GPs are always the scapegoat in a pile of mess.....

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  • Sorry, why would I want to do that? Care home records are hardly "medical records".

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  • Phil Tidy

    I'm probably missing something here - but shouldn't reviewing prescriptions be something a Pharmacist could be doing do - rather than "force" the GP to check it again when they have things to do that only they can?

    In my experience people who make an error are less likely to see it even when they check it again because they see what they expect to see from the first time around.

    Hence the value of an independent review by somebody else.

    "In some cases GPs have been told to check patients’ records for renal function and adjust the dose of oseltamivir accordingly, but others received no directions on the need to adjust doses."

    Those are precisely the sort of checks a Pharmacist would make on a hospital chart (or should do) and medical colleagues seem to value that and highlight the lack of Pharmacy input when something gets missed.

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  • The pressure put on GPs by PHE to prescribe preventively (and quickly to get in within 48h) for many well care home residents will also be felt by pharmacists designated as Tamiflu dispensers
    Pharmacists will not have up to date renal function results (like many GPs of dementia patients when blood testing becomes a low clinical priority)

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