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Poor prescribing may be a problem but GPs are not the culprits

I fully agree with Professor Sir Michael Rawlins that doctors' prescribing is a major problem and that people should be worried, but I completely disagree with his premise that GPs are the culprits (News, December 8).

The vast majority of GPs are conscientious and knowledgeable and care for the welfare of their patients and I should be surprised if the error rate in GP prescribing is

anywhere near 0.1 per cent of scripts ­

never mind 10 per cent.

His concern should be directed at the discharge polypharmacy scripts issued by overworked and under-informed junior hospital doctors. I retired from general practice earlier this year but one of the major concerns of my erstwhile partners and myself was the high rate of prescribing errors we regularly encountered on the 'discharge flimsies'. These were sometimes potentially lethal, resulting in frequent telephone calls to the hospital to clarify the situation.

Had anything adverse happened, who do you think would be carrying the can? Certainly not the hospital doctor with his all-encompassing crown indemnity. The buck, as always, stops with the patient's GP.

Last year my wife sought reassurance that our late aunt, who at the time was in a general medical ward, was not on any lithium preparation ­ it being contraindicated in her case. Reassurance was duly (and haughtily) given by the SHO with the further comment: 'All she is on is bendrofluazide and Priadel.'

I rest my case!

Dr Stanley Steinberg


 · It is good to have someone of Professor Rawlins's eminence taking an interest in poor-quality prescribing.

He is absolutely correct that 'doctors should be competent to prescribe before they start doing so' but I think he is misguided in seeing this as purely a GP problem and in assuming pharmacists will do any better.

In my six-partner practice we are all finding a heavily increased workload generated by the need to double-check the discharge prescriptions of patients recently discharged from hospital. We regularly detect irrational and dangerous drug combinations. Only today I received notification of a patient discharged on aspirin, clopidogrel and diclofenac.

I am not sure this is a safe combination even with the co-prescription of lansoprazole!

I understand that pharmacists are trained in pharmacology and dispensing but I believe the average pharmacist has less training and experience in prescribing than the average GP. Drug regimes are getting more complex and patients' problem lists are lengthening ­ therefore the opportunities for error are increasing exponentially.

It will always be safer to have a system of double-checking and I appreciate my local pharmacist alerting me to my errors, but I do not accept these mistakes are evidence that I lack basic prescibing skills.

This is another example of the academic prejudice that the majority of GPs are incompetent and that we are the obvious cause of clinical error within the NHS and that anyone else could do a better job.

The professor is right to be concerned and his suggestion that input from a pharmacist can be helpful is perfectly reasonable, but his implication that the majority of us need to go back to elementary prescribing school is unwarranted and offensive.

My practice does, in fact, employ a pharmacist to advise us on prescribing policy. We appreciate his expertise which is complementary to our own. I guess even Professor Rawlins would sometimes get it wrong if he had to sign off the 45,000 items I prescribe annually.

Dr Paul Aspinall

Kettering, Northamptonshire

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