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Gold, incentives and meh

GPs forced to undertake training in 'motivational interviewing'

Exclusive GPs must undergo compulsory training in motivating patients to take their prescribed medicines, as part of a CCG scheme aimed at reducing hospital admissions from improper medication use.

NHS Lambeth CCG has told practices that all prescribers, including non-medical prescribers, must undergo a two week course on motivational interview techniques for medicines adherence before December.

But GPs have said they are being treated like ‘children’ and that compulsory training was ‘a further nail in the coffin’ of GP professionalism, and takes up appointment time that should be spent with patients discussing alternatives to prescribing.

The email, circulated to practices by the medicines optimisation team at Lambeth CCG, states: ‘As part of the 2014-15 Medicines Optimisation Plan, all prescribers are required to undertake motivational interview technique training on Medicines Adherence as offered by Future Learn/Kings College London.’

It adds: ‘Please circulate this message to all prescribers (including non-medical prescribers) in your practice to ensure they have access to the training.’

The CCG says that GPs must register before the end of August or inform the medicines optimisation team who will arrange alternative training ‘as all prescribers need to undertake training’.

The online course, run by Kings College London’s Institute of Pharmaceutical Science, requires two hours of GP time per week in order to ‘enhance’ GP understanding of medicine adherence.

It states GPs will ‘gain increasing awareness of where in your own day-to-day consultations you can apply these techniques and approaches to better support patient self-management of medicines and effect behaviour change’.

Former RCGP chair Professor Clare Gerada, whose Hurley Group practice received the communication from Lambeth CCG, told Pulse: ‘It’s a further nail in the coffin of professionalisation, being a professional means being able to determine your learning needs.’

Dr Gerada added: ‘To insist that every GP does it - albeit only a two-hour  [a week] online programme - goes with the information governance, the hand-washing governance, all of the stuff now which is two to three hours of online trainin. It’s a further nail in the coffin.’

‘It’s more work, for what benefit? Actually, what we should be doing is spending more time with our patients to make sure that we don’t prescribe medicines, not that we make them take medicines, but that we don’t prescribe.’

‘And a motivational interview is a good technique, but only if you choose to want to do it, also insisting on the format of how you learn: it’s something you do to children.’

Pulse reported in May that, as part of the same medicines optimisation scheme, Lambeth CCG would be investigating practices who went over their prescribing budget, particularly those who overspent on care home prescribing.

A spokesperson for NHS Lambeth CCG told Pulse: ‘As with other healthcare professionals, prescribers are required to participate in  continued professional development  to maintain high quality care for patients.’

‘As medicines adherence is a priority in NHS Lambeth CCG, the Lambeth Borough Prescribing Committee took the decision to include training as part of the medicines optimisation plan for all prescribers,  to support  them in identifying and addressing  medicines adherence issues and to put patients at the heart of the decision-making process around medication. GPs sit on the Committee alongside medicines colleagues.’


Readers' comments (26)

  • Arrogant, authoritarian, unprecedented, unproven.
    And negligent and illogical to force practices to use their limited human resources which overall will have negative impacts. It is immoral to investigate overprescribing without also investigating under prescribing. This heavy handedness is about cutting costs and increased rationing for NHS patients, with 'medicines adherence' being used to further restrict our clinical freedoms that are essential for optimising patient care.

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  • I think there is loads of international evidence to support the fact that patients don't take their meds properly.
    7.12pm: isnt helping patients with "adherence" only supporting them to take what you have prescribed using your clinical freedom, rather than stockpiling the meds in their cupboards?

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  • 1 all cpd should be free regardless, if it's not , it's not worth doing,
    2 if Lambeth is in the top 10 prescribing then why ch age it. Motivational interviewing is not going to work.
    3 most crappy prescribing actually is due to secondary care not giving crap on what happens in the wider community, and most wastage is usually due to constant change on medications done when pts attend opa usually just after they have collected a repeat script .or when they get admitted as an emergency. There is nothing at all you can do about it. Life is unfair etc etc

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  • Even if it is an enhanced service money is being taken away from another pot. It's incredible that the CCG is actually supporting this! GPs must not support dictats & just say No!

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  • The usual knee jerk responses to a sensationalist headline. Di has clarified the situation very well; there is no obligation to do this - it is an enhanced service, yet still there is "outrage" from anon from Clapham.

    Personally,I would much rather spend my time learning to earn some ES pennies than some of the pointless QP activities of the past or the current admission avoidance DES which has absolutely no evidence base whatsoever.

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  • We are sinking under a welter of non-evidence based interventions. I want to be freed up to offer patient care, not bogged down in more of these worthy but ill judged schemes. Where was the consultation on this one?

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  • There is a whole pile of this waiting in the wings I hope - smoking and alcohol, addiction, counselling,CHD,CKD etc just to name a few. Great stuff. Keep it coming to this namby pamby lot of GPs that we are now. Thanks GPC.

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  • This is fluffy nannying of the "we must do something, here is something, we must do it" sort.

    It's a waste of time and money.

    Patients will carry on wasting medicines for one simple reason - they aren't paying for them.
    If people had to pay a huge whack for every med, and no excuses for being unemployed or pensioner, they would either take the meds or they wouldn't keep getting them and srtockpiling them, they would stop asking for them.

    The problem is purely and simply the result of one policy - the free/subsidised prescription policy. Therefore no other intervention can affect its outcome, only a change to the policy that causes the problem will alter the outcome.

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  • What if you havent got the motivation to be motivated to motivate others?

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  • Enhanced services are not voluntary. The money they earn is not a bonus on top of an already satisfactory income. Practices are so hard up that enhanced services are core, often critical, income. To say that practices can choose to ignore it pretends that all practices have a choice, and many do not, they simply can't afford not to take part.

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