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Half of drug switching schemes 'pose threat to patient safety'

Almost half of GPs are coming under such pressure to switch patients to cheaper drugs that they believe safety is being put at risk, a Pulse investigation reveals.

More than 90 per cent of GPs are coming under pressure from their primary care organisations to save money by switching patients to cheaper treatments.

But the survey reveals PCOs are taking starkly differing approaches to switching, with 41 per cent of GPs describing pressure to switch as 'strong', 37 per cent as 'moderate' and 16 per cent as 'light'.

As many as 38 per cent of GPs said the pressure had compromised their own ability to take clinical decisions.

Even more – 42 per cent – thought their PCO's drug-switching scheme was not

consistent with maintaining patient safety.

Dr Jane Blockley, a GP in Manchester, said switching schemes 'ride roughshod over the concept of individual attention to patients and patient choice'.

She added: 'Every blanket switch increases the risk of patient confusion and increases the risk of non-compliance, and consequent morbidity.

'It is inevitable that when prices change in the not too

distant future we will be changing them all again, so pot-

entially the patients will be exposed to those risks again and again.'

Some GPs reported direct experience of patient harm caused by switching of drugs such as statins (see story on right).

But Dr Neal Maskrey, director of evidence-based therapeutics at the National Prescribing Centre, said statin switching schemes were 'not only desirable but necessary'.

He added: 'I am in many ways pleased to hear PCTs have a clear focus on this issue. 

'If we wish to see a continuation in the downward trend in cardiovascular mortality we need to use low-cost statins more widely in people at moderate risk.'

Dr Peter Swinyard, a GP in Swindon and member of the GPC prescribing subcommittee, said he was 'saddened' by the survey results – and urged GPs who had concerns to write to the medical director of their PCT.

He added: 'There are certain circumstances where cheaper drugs will give you better bang for your buck – for example statins.

'But I wish PCTs would factor in the whole cost of extra blood tests, investigations, recalling patients and doctor time. PCTs are only interested in their bottom line.'

'My patient nearly died'

safety fears

Dr Simon Cooke has 'definite concerns about patient safety' after one of his patients suffered renal failure following switching of statins.

The patient, who had a

kidney transplant and was on cyclosporin, 'effectively went into renal failure with significant toxicity'. He only recovered after the simvastatin was stopped

and he was switched back to atorvastatin 10mg.

Dr Cooke, a GP in Norwich, said: 'I look at patients and choose the best drug for them – in terms of the fewest side-effects, what they'll take and then cost, in that order. 'Some of the prescribing advice that PCTs issue is farcical. PCTs are often too dogmatic, and lose sight of the fact that as a GP I'm making a considered choice based on an individual patient.'

Norfolk PCT issued directions that GPs should try to switch all patients on atorvastatin 10mg to simvastatin 40mg, and Dr Cooke's computer system didn't flag up any contraindication with cyclosporin.

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