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GPs buried under trusts' workload dump

Government overprescribing review aims for GPs to challenge hospital decisions

The Government has ordered a review into overprescribing of medicines in the NHS, which it said would empower GPs to challenge decision making by hospital colleagues.

The pharmacist-led project is tasked with looking into ways to cut unnecessary prescribing with a particular focus on older patients taking multiple medicines.

It will also look at improving the management of repeat prescriptions and how to use digital technology to reduce overprescribing.

Announcing the review, which will be led by Chief Pharmaceutical Officer Dr Keith Ridge, the Government said it wanted to create 'a more efficient handover between primary and secondary care, for example ensuring GPs have the data they need and feel able to challenge and change prescribing made in hospitals'.

NHS figures show a 5% year-on-year growth in spending on medicines from £13 billion in 2010/11 to £18.2 billion in 2017/18.

Three particular areas the review will investigate is where prescriptions are given when other forms of care may be appropriate, where there is potential overlap with patients being prescribed multiple drugs for the same condition, and where repeat prescriptions are rolled over for years without review.

Health secretary Matt Hancock said poorly managed prescribing can lead to serious issues for patients such as increased admissions to hospital or antibiotic resistance.

‘As we invest an extra £20.5 billion a year into our NHS we want to empower doctors and pharmacists to use the data available to ensure patients get the medicines they need and stop taking those that no longer benefit them.

‘We also need to back our GPs to move towards alternatives such as social prescribing, so we can offer more tailored healthcare that focuses on prevention to stop people from becoming ill in the first place – improving care and reducing the burden on the NHS.’

Dr Andrew Green, BMA GP Committee prescribing lead, said they would work constructively with the Department of Health and Social Care to ensure it identifies the right problems and proposes effective solutions.

‘It is vital that as GPs we receive the support required from allied professionals to help us de-prescribe where we can, we simply do not have sufficient workforce to do this on our own.’

He added that GPs had an absolute right to question the advice of hospital colleagues over whether a prescription is appropriate.

Professor Helen Stokes-Lampard, Chair of the RCGP, said GPs are highly trained to consider the physical, psychological and social factors potentially impacting on the health of individual patients – in conversation with them – when making a decision to prescribe.

And she added GPs also conduct regular medication reviews with patients on long term medication.

‘GPs do not want patients to be taking drugs that are of little or no value to their health, and if patients are taking medication unnecessarily, it is important that this is addressed, we will actively contribute to the consultation and we look forward to seeing and considering the recommendations made in this forthcoming report as to how best to do so.’

Professor Azeem Majeed, professor of primary care at Imperial College London, said that because of an ageing population and greater compliance with guidelines, polypharmacy is becoming more common.

‘From a practical perspective, a pharmacist-led process is probably better because GPs would have very limited time to do this work. 

‘But the pharmacist has to be an integral part of the clinical team and have access to the patient’s full medical record; and be able to discuss any proposed changes both with the patient and also with the rest of the clinical team. 

He added that hospital staff have a key role because many drugs are started by hospital specialists with the expectation that GPs will then take on the prescribing and monitoring.

‘It’s also worth bearing in mind that although over-prescribing is a problem, so is under-prescribing. For many conditions, for example, heart failure, patients often start treatment late in the course of their illness and do not have intensive enough therapy.’

What the review will look at

  • Addressing ‘problematic polypharmacy’ – where a patient is taking multiple medicines unnecessarily;
  • Creating a more efficient handover between primary and secondary care, for example ensuring GPs have the data they need and feel able to challenge and change prescribing made in hospitals;
  • Improving management of non-reviewed repeat prescriptions – including encouraging patients to ask questions about their treatment to ensure they don’t remain stuck on repeat prescriptions which are no longer needed;
  • The role of digital technologies in reducing overprescribing;
  • The increased role for other forms of care, including social prescribing.

Source: Department of Health and Social Care

 

Readers' comments (14)

  • Just to be clear,pharmacists as highly trained responsible and indeed sane professionals would require to be paid

    Any suggestion of the GP being paid will result in the usual weeping wailing and gnashing of teeth by the insane fundamentalist brigade,as contravening the principle of limitless duty of care.

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  • David Banner

    So....a consultant cardiologist suggests an expensive drug, but the GP overrules, fearing sanctions for breaking the budget.
    The patient (hey, remember them?) is denied important treatment and rightly complains.
    Who is going to take the blame (only 1 guess, please).
    Ridiculous and fatuous nonsense, but the real agenda here is putting the boot into beleaguered GPs for not “controlling” their drug budgets.

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  • Easy make the hospital pay and be responsible for any new initiated drug from their much bigger budget.While we are forced to shoulder the risk and cost this will not work Mr Handjob.

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  • thus transgender prescribing remains the responsibility of specialists.I will have to change the advice on the GMC website, sack some of my staff and probably resign

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  • National Hopeless Service

    Head, brick wall, beat......

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  • '...empower GPs to challenge decision making by hospital colleagues.'

    Good GP's already do this. An increasing amount of secondary care prescribing is very poor from people with no generalism experience and I regularly ignore the 'advice' - telling my patients why.

    This is also partially why I dislike patients being copied in to letters by consultants. It takes far more time to undo the poorer recommendations. Future shared electronic prescribing will also be bad for this.

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  • Already do it - as prescriber up to me to decide whether to do it or not

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  • Could not Dr Andrew Green, of the BMA, take the revolutionary step of amending his statement to read :
    'It is vital that as GPs we receive the support required from SPECIALISTS AND HOSPITAL STAFF to help us de-prescribe where we can, we simply do not have sufficient workforce to do this on our own.’
    or is BMA still spineless pawn in the pocket of the consultants committee???

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  • One problem is hospital doctors prescribe common drugs with no idea of the cost. An example is liquid nitrofurantoin in paeds. When the cost was pointed out the consultant happily agreed to change with an expression of shock at the cost compared to capsules. They need the say computer system we have....
    We can always decline expensive meds and ask they do it themselves from their budget.

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  • We should probably just do away with all hospital doctors and just have GPs run the show. Isn't that the way we are heading as we seem to do everything for free?

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