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GPs buried under trusts' workload dump

Anxiety and sleeping drugs prescribing highest in deprived areas, study shows

Patients in the most deprived areas of England are prescribed the highest volumes of benzodiazepines and z-drugs, according to an in-depth study which also found that the association could not be explained by factors such as age of population or social status alone.

A team from Warwick University compared rates of prescribing in CCGs in 2017 with levels of socioeconomic deprivation and found a clear association with benzodiazapines and z-drugs and location in ‘underserved areas’. 

In 2017, more than 14.6 million prescriptions of benzodiazepines and z-drugs were written in England but practices in the least deprived areas prescribed fewer benzodiazepines than those in every other category, the research showed.

Overall the rate of prescribing of benzodiazepines and z-drugs was on average a significant 45% higher in the most deprived GP practice populations compared with the least deprived at 288 versus 198 prescriptions per 1,000 patients.

The strong association remained after taking into account sex and age differences in practice populations.

Analyses showed that the combination of deprivation score, proportion of male patients and number of over 65s could only explain around a fifth of the variability in total benzodiazepine and z-drug prescribing found.

Writing in Family Practice, the researchers said there was ‘a preponderance of higher prescribing rates in coastal regions, but no clear north-south divide’ and that social status alone could not explain the findings.

It comes as a review from Public Health England acknowledged that GPs were often under ‘great pressure’ to provide access to medicine which has the potential to be addictive.

The review found that over 11 million adults in England were prescribed addictive drugs between 2017 and 2018.

Study leader Dr Saran Shantikumar, from Warwick Medical School, said: ‘The key result we found was there was an association between the amount of benzodiazepines prescribed in GP practices and the level of deprivation of people served by that practice.

‘What we can’t tell from our analysis is which people within a given practice are getting those prescriptions.’

He added that a recent report from Public Health England suggested that, if anything, individual patients from the least deprived practices were more likely to be prescribed these drugs.

‘So we’re left with a conundrum: if fewer patients from the most deprived practices are being prescribed benzodiazepines, why do they tend to be prescribed higher volumes of them?’

He said one potential explanation is a systemic difference in reasons behind the prescribing in practices which might lead to those in more deprived areas being more likely to have repeat prescriptions.

‘What clinicians can do is be aware that they may have patients who have been on these tablets for a long time and are potentially at risk, so it is worth actively thinking about whether a patient needs to continue taking those tablets or if there are alternative strategies.’

Readers' comments (5)

  • Groundbreaking research, and yes the Pope does shit in the woods.

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  • Lol, thought that was bears!
    You beat me to it

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  • Twenty five years in a top-ten deprivation area postcode.
    1. Doctors are too busy dealing with their patient's multiple physical, emotional, legal and social pathologies to deal with yet another problem.
    2. Patients have less effective coping skills and limited strategies other than drugs, alcohol, more drugs.
    3. A few quid from selling the sleepers down the pub is a lot of money for people living on benefits.
    4. Doctors get reluctant to say no after two or three nocturnal episodes of brick through the window.

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  • Wow, the GPs never knew that.
    Stelvio is right.
    The patients from deprived areas also presents more often, are more demanding for prescriptions of OTC drugs, they more likely to complain as they are inherently unhappy and DNA QoF making surgeries less profitable, less able to attract staff and GPs that work there suffer more.

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  • was there an link with number of sick notes and pip claims?•
    currently:
    antidepressants 7.3 million people (17% of the adult population)
    • opioid pain medicines 5.6 million (13%)
    • gabapentinoids 1.5 million (3%)
    • benzodiazepines 1.4 million (3%)
    • z-drugs 1.0 million (2%)
    its a good read as a report though with some interesting studies quoted.

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