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GPs to be ranked on antipsychotic prescribing

By Lilian Anekwe

GPs will be ranked according to their prescribing of antipsychotics, after the Government announced it will launch league tables to name and shame high prescribers.

The Department of Health's new drive on tackling dementia, published last week in a revised implementation plan for the national dementia strategy, revealed ministers have asked the NHS Information Centre to draw up league tables to encourage ‘local accountability' in GP prescribing.

Delivering the strategy, care services minister Paul Burstow said PCTs and GP commissioning consortia ‘will be held to account and expected to publish how they are providing quality care for people with dementia'.

‘The first part of this work is to establish and communicate the current position regarding the prescribing of antipsychotic medicines for people with dementia,' the plan states.

‘This data will support localities to determine and publish the outcomes they need to deliver locally, taking into account their current position in reducing the use of antipsychotic drugs for people with dementia.'

‘The aim is to support local areas to prescribe appropriately with a view to achieving overall a two-thirds reduction in the use of antipsychotic medicines over a period of two years from establishing a baseline position.'

A spokesperson for the NHS Information Centre said the organisation had been commissioned to specifically audit dementia patients to see how many of them had been prescribed antipsychotics, and that the audit would probe much deeper and provide far more information than the prescribing data the organisation currently collates.

The NHS Information Centre's latest prescribing data, for the first quarter of 2010/11, shows that more than two million antipsychotics were prescribed in primary care, at a net ingredient cost of £67.3m.

The new strategy comes as a Pulse poll of 170 GPs found that 60% said they were ‘sometimes left with no options but to prescribe antipsychotics to patients with dementia'.

GPs were told last November to regularly review their patients with serious mental illnesses and patients in care homes, and to audit their use of antipsychotics, after a Government report found the drugs were linked with 1,800 excess deaths a year. Recent evidence has also linked antipsychotics with an increased risk of stroke, venous thromboembolism and pneumonia.

GPs were promised more training to encourage them to use alternative treatments where possible, but a recent Pulse investigation found PCTs could often not account for their allocation of the £150m funding they had been given by the DH to implement the National Dementia Strategy.

Dr Ian Greaves, a GPSI in dementia in Gnosall, Staffordshire, said: ‘Highlighting the problem is not enough, the Government needs to offer practical solutions because we often don't know what else to do.'

‘Rather than berating us for prescribing, help us to choose a different way. Give us tools that we can use as alternatives that are practical and support us in our prescribing practice.'

Care services minister Paul Burstow plans to cut antipsychotic prescribing by two thirds