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Analysis: The whole system needs to change

A call to reduce the prescribing of any drug in the NHS by two-thirds is ambitious, but the case for doing this with antipsychotics in dementia is overwhelming, says Nigel Praities.

A call to reduce the prescribing of any drug in the NHS by two-thirds is ambitious, but the case for doing this with antipsychotics in dementia is overwhelming.

Study after study has shown a substantially raised risk of mortality in dementia patients taking the drugs, and in a report published in 2009 the drugs were linked with an extra 1,800 deaths a year in the NHS.

On the back of this, the Government issued an immediate review of care home prescribing, and followed this up with a ‘call to action' in 2010 and the ‘Prime Minister's challenge on dementia' last year to ensure all patients were reviewed and alternatives to antipsychotics were considered.

A health minister even made a threat of legal action under the Mental Capacity Act for prescribers who did not seek special permission to use the drugs.

Has all of this activity made a difference? Our investigation shows levels of antipsychotic prescribing by GPs are coming down slowly, which should be welcomed, but the overall rate remains relatively high.

Speak to GPs and they will tell you the system is struggling to cope. Care homes and carers have very little capacity to handle aggression in a patient with dementia. GPs are often called only when the situation is urgent and, as our investigation reveals, their access to alternative treatments is, at best, patchy.

Antipsychotic prescribing in dementia is a rare example of experts, NICE, ministers and GP leaders agreeing what needs to be done. But institutional barriers continue to prevent the rapid improvement everyone wants to see.

 

Nigel Praities, is Pulse's acting deputy editor

@nigelpraities

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