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At the heart of general practice since 1960

Rawlins attacks GP script mistakes

By Emma Wilkinson

Most GPs lack basic prescribing skills and a pharmacist should be drafted into every practice to cut hospital admissions caused by GP mistakes, claims the head of the Government's National Institute for Clinical Excellence

Professor Sir Michael Rawlins says GPs make significant errors in more than one script in 10 ­ and pharmacists may need to take over some of their prescribing.

GP leaders and academics said his accusations were based on outdated research.

Dr Mary Church, co-chair of GPC Scotland, said: 'I would challenge the assertion GPs don't know what they are doing. Prescribing is core to what we do. We are professional people who keep up with education.'

Asking pharmacists to check every decision was a 'ridiculous' idea, she said.

Sir Michael, chair of NICE, told Pulse that 'in many circumstances' GPs did not have appropriate prescribing skills. 'It is a major problem. Everybody should be worried.'

Greater use of standardised computer prescribing and better undergraduate training were needed, he added.

In an opinion piece published in Quality and Safety in Healthcare (December), he said: 'Doctors should be competent to prescribe before they start doing so ­ and their competence should be demonstrable. Anything else would be a nonsense in the public's view.'

The article ­ co-authored by Professor Nick Barber, professor of pharmacy practice at the London School of Pharmacy ­ said: 'If the skills were there in the first place, prescribing error would not be as common as it is.'

The claim that 11 per cent of scripts contain an error was questioned by Professor Greg Rubin, who led an analysis of errors during 12,400 consultations in 10 practices, published in the same journal. It detected prescribing mistakes in 1.8 of 1,000 consultations.

'GPs are extremely good at writing prescriptions,' said Professor Rubin, professor of primary care at the University of Sunderland.

But Professor Tony Avery, professor of primary health care at the University of Nottingham and a GP in the city, said his research on 4,093 medical admissions showed almost one in 20 was caused by 'preven-table drug-related morbidity'.

He said he had some sympathy with Professor Rawlins's view but added: 'It's easy to criticise, but GPs are working under phenomenal pressure.'

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