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GPs will face penalties for prescribing antipsychotics to patients with dementia

08 Feb 2012

GPs will be expected to eradicate antipsychotic medication for patients with dementia or face potential financial penalties under stringent new commissioning indicators.

The target is one of 120 new draft indicators drawn up by NICE in the commissioning outcomes framework for clinical commissioning groups released for consultation last week.

A ‘proportion' of GP practices' income is expected to be linked to CCG performance against the framework under the planned quality premium.

The framework says: ‘The intent of indicator 1.23 is to measure the proportion of people with dementia who are prescribed antipsychotic medication. A threshold of close to zero is expected for this indicator.'

The recommendation adds to pressure on GPs over use of antipsychotics.

Health minister Paul Burstow has vowed to outlaw the ‘silent scandal' of inappropriate prescribing, and punish doctors if a target to reduce the number of elderly care home residents and dementia patients prescribed antipsychotics from 180,000 to 60,000 is not met.

The plans could see GPs who prescribe the drugs without permission facing up to five years in jail under the Mental Capacity Act.

But writing in Pulse last month, Glasgow GP Dr Margaret McCartney said: ‘Witnessing carers trying to keep a loved one at home despite physically aggressive behaviour is heartbreaking – and the stigma of using small doses of medication unnecessary.'

READERS' COMMENTS

Anonymous, GP Partner,
08 Feb 2012
Most antipsychotic initiation is by secondary care or psychogeriatricians. Can't see why this is the GPs "fault". Suggest future audits identify initiator.
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Ulrich Pfeiffer, GP Partner,
09 Feb 2012
More domiciliary visits for our colleagues from psychogeriatrics who will happily advise. Pass the buck and document it.
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Simon Ruffle, GP Partner,
09 Feb 2012
Esteemed community professional to jail-bird responsible for commissioning the downfall of the NHS and the poisoning of the demented. We can fall no lower!

I wonder if Mr Burstow has witnessed first hand the distress caused to a patient and their family by the abnormal behaviour that dementia brings? It is a terminal illness why should we allow pain and distress when we can help it? Some of the symptoms are psychosis-like. Text book medicine isn't real world medicine.
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Anonymous, PCT,
09 Feb 2012
All very well to stop this prescribing when you are not the one left at home with a loved one suffering this hideous illness and cannot cope with the unsafe/dangerous nightly behaviour. No help from the community mental health team who refuse to make a diagnosis or assessment and helpfully also stopped the antidepressants. No help from the hospital who discharged without a careplan in place and increased opoid prescribing in the face of agressive challanges from the patient in spite of the CMHT deciding to stop this cold turkey !
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Martin Seely, Salaried GP,
09 Feb 2012
I have just retired but over the last 5 years all my anti-psychotic prescribing had been initiated by Secondary Care Psychogeriatricians. So will they also be facing a 5 year sentence for initiating this prescribing?
Also from whom do GPs have to get permission to prescribe? surely not the demented patient. Will it be the patient's relative who has no medical training or some overpaid and under-worked manager at the PCT?
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K M Hawking, GP Partner,
10 Feb 2012
The NICE indicators have been released for consultation.
I'd suggest a lot of responses..
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