Exclusive GPs look set to face severe sanctions for prescribing antipsychotics to older patients – including the possibility of jail – after a Pulse investigation revealed PCTs are failing to implement a major NHS programme seen by ministers as key to their campaign to cut use of the drugs.
The ‘call to action' on antipsychotics was launched last June by the NHS Institute for Innovation and Improvement and the Dementia Action Alliance, with GPs, hospitals and mental care teams supposed to conduct a clinical review of all dementia patients on antipsychotics, consider alternative treatments and agree a care plan by 31 March.
In a speech last November, health minister Paul Burstow described the call to action as a ‘turning point' in the Department of Health's campaign to reduce antipsychotic prescribing by two-thirds. In the same speech, Mr Burstow warned he would review progress this month and if that target was not met he would take ‘whatever steps necessary' to cut anti-psychotics prescribing, including amending the Mental Capacity Act to permit imprisonment of those who prescribed the drugs without permission.
But a survey of PCTs by Pulse has found the call to action has gone unheard in many areas, with some PCTs admitting they have yet to review a single patient.
Out of responses received from 32 trusts, just one has come close to meeting the target, with Sandwell PCT having reviewed and drawn up care plans for 97% of patients.
The vast majority - 26 PCTs – said they had no idea how many patients had been reviewed since the call to action, although eleven said programmes were in place and six expected that 100% of patients would be reviewed by the deadline.
North East Lincolnshire Care Trust admitted that a ‘relatively low' 10% of their patients with dementia had been reviewed, and NHS Outer North East London cluster said it had yet to review a single patient in response to the call to action and would be tackling the target from April.
A spokesperson said: ‘We are running audits as part of the medicines management section of the QOF in 2012/13.'
A Department of Health spokesperson said the minister's threat of legal action still stood: ‘We want to reduce the level of anti-psychotics prescribing for people with dementia by two-thirds. The national audit of anti-psychotics prescribing will report its findings on progress on this later this year.'
Dr John Hague, a GP in Ipswich, Suffolk with an interest in mental health, said it was important patients on antipsychotics were reviewed, but also that PCTs gave GPs additional support – such as having a liaison psychiatry service.
He said: ‘It should be a priority, we know that, but you can't just take people off and expect magical things to happen, because they are not going to.'