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Government to ‘take action’ after finding 10% of medicines ‘overprescribed’


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Ministers have pledged to ‘take action’ on overprescribing after an official review concluded that 10% of medicines dispensed in primary care in England were not needed.

The Department of Health and Social Care (DHSC) said this would include GP practice training and moves to alternative treatment options including social prescribing.

It will also mean ‘ensuring GPs have the data and medical records they need’ and ‘are empowered to challenge and change prescribing made in hospitals‘, it added.

This comes as a Government-commissioned report, published today, said that 15% of people are now taking five or more medicines a day, with one in five hospital admissions among over-65s caused by adverse effects of medicines.

Ministers have ‘accepted all recommendations’ from the review, which was led by Chief Pharmaceutical Officer for England Dr Keith Ridge.

The review was commissioned in 2018, after NHS figures showed a 5% year-on-year growth in spending on medicines from £13 billion in 2010/11 to £18.2 billion in 2017/18.

Key recommendations in the report include:

  • changes to improve patient records;
  • routinely recording clinical indications at the point of prescribing;
  • improving handovers between primary and secondary care;
  • expanding structured medication reviews (SMRs) carried out by PCNs;
  • developing a national toolkit and deliver training to help general practices improve the consistency of repeat prescribing processes; and
  • cultural changes to reduce a reliance on medicines while increasing the use of social prescribing and other evidence-based alternatives to medicines.

It also said that NICE and professional bodies should include ‘recommendations for reviewing and discontinuing medicines where appropriate’ in their guidelines and that the MHRA should use ‘post-marketing surveillance’ to ‘support deprescribing’.

The changes will be overseen by a new National Clinical Director for Prescribing, who will lead a three-year programme including research and training to help enable effective prescribing.

The report also recommends ‘deprescribing’ based on improved evidence base for ‘safely withdrawing inappropriate medication, with clinical guidance to be updated to ‘support more patient-centred care’.

Plans also include publishing ‘clear information’ on the NHS website for patients ‘about their medication’ and setting up ‘a platform for patients to be able to provide information about the effectiveness and the adverse effects of their medicines‘.

The DHSC also intends to develop ‘interventions’ to ‘reduce waste’, as part of the NHS’s net zero carbon emissions.

And it intends to commission more research investigating the reasons why overprescribing is ‘more likely to affect older people, people from ethnic minority communities and people with disabilities’.

Health minister Syed Kamall said: ‘This vital review is a significant step forward which will benefit patients across the country, and we will help ensure busy primary care teams are supported with improved systems and resources.

‘Whether it’s helping to change a culture of demand for medicines that are not needed, providing better alternatives and preventing ill-health in the first place, we will take a range of steps to act on this review.’

RCGP chair Professor Martin Marshall said he welcomed some of the report’s recommendations, in particular the ‘commitment to provide further resources and training to support appropriate prescribing in primary care and the development of clinical guidelines to support patient-centred care’.

He added: ‘With our growing and ageing population, with more patients living with multiple, chronic conditions, many people are taking several medications in order to manage their various health illnesses, and the interaction between various medicines is something prescribers will take into account.

‘In most cases, these medicines are necessary, appropriate and of benefit for the patient – but the aspiration to reduce the number of medications a patient is taking, where safe and possible, is a good one.’

GPs and practice teams need ‘better access’ to ‘alternative, non-pharmacological treatments, which can be patchy across the country’, he said.

Professor Azeem Majeed, professor of primary care at Imperial College London and a GP in Clapham, told Pulse it is ‘essential to reduce inappropriate polypharmacy in primary care’.

He said: ‘This requires support from NHS England, such as the provision of pharmacists to carry out regular medication reviews of patients.’

Additional reporting by Costanza Pearce

READERS' COMMENTS [16]

Mad Dog Munro 22 September, 2021 9:05 am

In my day I had a team of scribes to unfurl the vellum and parchment patient records and cross reference the prescriptions (carefully recorded in a high Runic by my favourite druid).

Just cant get the staff these days.

Yarp !

Robert Vaughan 22 September, 2021 9:27 am

Only 10%?
Half the adults over 16yrs of age in the UK are taking daily prescribed medication.
At a recent biannual eye test for spectacles the optician asked me ‘what medicines do you take?’ rather than ‘do you take anything?’, the answer is none, sums it up really.

Turn out The Lights 22 September, 2021 9:35 am

Get rid of NICE/CQC and QOF less pressure and bullying to follow guidelines.Give clinician some autonomy to deal with the patient in front of them.

Dylan Summers 22 September, 2021 9:37 am

The Guardian has this to say: “They [GPs] are also being urged to call millions of patients in for medication reviews to see whether there are any pills they can stop taking.”

Hopefully the implication that this will require additional 1-1 patient-clinician contact is incorrect, since clearly there is no capacity for extra reviews in primary care.

David Church 22 September, 2021 11:40 am

Would Professor Majeed please note that all patients currently in promary care have been discharged from a hospital service : the uneccessary polypharmacy that needs addressing is the initiations in Hospital Services.
He ought to stand up for General Practice and make the Consultants put right what they have done wrong, and not accept dumping of poor Hospital prescribing onto GP services.
As it is GPs are already working hard to correct the Hospital initiated surplus spend, but fast as we are trying to bail out the bath; others in Hospitals are turning more taps on!
Additionally, patients are encouraged to demand more prescribing by TV adverts, OTC medications, and Noctors being given prescribing rights without the same training as GPs.

Mr Marvellous 22 September, 2021 1:27 pm

I guess ‘90% of medications prescribed entirely appropriately’ doesn’t make for such a good headline.

Azeem Majeed 22 September, 2021 2:17 pm

David Church – 22 September, 2021 11:40 am

General practice has no better friend than Azeem Majeed.

https://blogs.bmj.com/bmj/2021/09/21/gps-should-not-be-made-scapegoats-for-the-political-failings-under-funding-and-shortages-of-essential-staff/

The Prime Minister 22 September, 2021 2:29 pm

THE “OVERPRESCRIBING” IS SOMETIMES DOWN TO DEMANDS FROM PATIENTS TO PRESCRIBE X, Y OR Z SO THEY DON’T HAVE TO BUY OVER THE COUNTER “OR THEY WILL MAKE A COMPLAINT”………AS WELL AS DAFT REQUESTS FROM SECONDARY CARE WHICH GPs “MUST DO” BECAUSE THEY ARE THE “CLEVER DOCTORS”………

THIS IS ALL MIXED MESSAGES……STAND UP TO PATIENTS BUT AT THE SAME TIME GROVEL TO PATIENTS………MAKE YOUR MIND UP GOVERNMENT !!!!

John Graham Munro 22 September, 2021 3:02 pm

Dylan Summers——-yet time is still found to have Practice Meetings and Staff Training Sessions

Patrufini Duffy 22 September, 2021 3:04 pm

I thought the NHS loves medicalistion and drug stuffing? You love a statin don’t you? And some sertraline? I’d work on cocaine and alcohol drugs first.

James Weems 22 September, 2021 4:33 pm

Don’t they realise they many patients actively pursue meds…it’ll take a culture change amongst a pill popping society.

John Glasspool 22 September, 2021 8:00 pm

Don’t worry chaps: they are going to appoint a “Czar” which means that either nothing will happen, or the “problem” will get worse. Anyone remember Darzi Centres?

David Banner 22 September, 2021 8:16 pm

Medication reviews (which we all do any way) are just as likely to result in increasing the number of drugs as reduce them.
Apparently GPs underdiagnose and undertreat depression, yet we are also guilty of chucking antidepressants around like confetti. Make yer minds up, lads.
Plus we’re missing half the hypertensives, and undertreating those we do discover.
And if you do recklessly stop the statins etc, who carries the can when they stroke out?
Furthermore, how annoying is it when you stop the 3 laxatives started as an inpatient then have to reissue when the patient demands them again?
And that 10% figure looks like it was pulled out of someone’s rectum, but it’s another handy headline stick to beat us feckless GPs with.

David Ansell 22 September, 2021 9:05 pm

What doex the government mean by overprescribing?
Most doctors would dispute these very broad definitions
Put simply, overprescribing is where people are given medicines they don’t need or want, or where harm outweighs benefits. It occurs in every healthcare system in the world. It occurs in several ways: • the patient is prescribed a medicine, when there would have been a better alternative. An example of this would be a patient being given a medicine to reduce their blood pressure when changes to diet and lifestyle would be more appropriate for them •

Well we could stop all antihypertensive, anti diabetics, and cholesterol lowering agents if we got people to eat less, eat less junk food, lose weight and reduce salt..
The group also includes all people with chronic pain, who we should stop all medications.
This is just a plain stupid analysis, unrealistic and unachievable.
This report is written by a pharmacist and not a practising clinician.

Garbage in, garbage out

Neil Tallant 22 September, 2021 9:19 pm

Devils are in the detail and not in headlines. 10% seems to be a universal figure applied to drug prescribing and expenditure for decades. How many “Prescribing initiatives” have been devised, trialled and then lost in the annals of time?
Can we please therefore assume that 90% of prescriptions issued are appropriate and feel a little better about ourselves.
There is a clear distinction between a drug Prescribed and a drug (repeatedly) Dispensed. There is a very perverse incentive for pharmacies to dispense and an ever ongoing clinical staff shortage to monitor. (interesting that the review was carried out by the pharmaceutical officer) If real change is to be made then please look at the barn door obvious before embarking on yet another incentive driven review.

Mad Dog Munro 23 September, 2021 9:11 am

Time is still found to have Practice Meetings and Staff Training Sessions

In my day we communicated telepathically with each other in Surgery by donning tinfoil balaclavas.
Not ideal, one realises, so we always had the back up system: yoghurt pots connected by catgut.

Those were the days.

Yarp ! Yarp !