This site is intended for health professionals only


Minister warns GPs could require PCT permission to prescribe antipsychotics – or face jail



GPs could have to seek permission from PCTs and local authorities to prescribe antipsychotic drugs for dementia patients – and could even face jail if they prescribe without permission – as part of a Government crackdown on drugs being used as a ‘chemical cosh’.

Health minister Paul Burstow has vowed to outlaw the ‘silent scandal’ of inappropriate prescribing of antipsychotics, and punish doctors if a target of reducing the number of elderly care home residents and dementia patients prescribed antipsychotics from 180,000 to 60,000 is not met.

The plans could see GPs that prescribe the drugs without permission facing up to five years in jail under the terms of the Mental Capacity Act.

In a speech to the Dementia Congress in Liverpool yesterday, Mr Burstow said a 2009 review had concluded that antipsychotic drugs were being prescribed far to often as a first resort, that two thirds of prescribing was inappropriate, and that they were shortening people’s lives.

An estimated 1,800 people died prematurely as a result of taking the drugs every year, he said.

He told the conference: ‘I’m determined to hold the system to account. It is a silent scandal that I won’t tolerate.’

Mr Burstow said he would review the target once the Dementia Action Alliance had finished reviewing patients in March. If necessary, he pledged to set in train legislation to change the Deprivation of Liberty Safeguards in the Mental Capacity Act – normally used where patients need to be detained – to include inappropriate prescribing of antipsychotics for dementia patients.

‘Parliament has put in place deprivation of liberty safeguards in the Mental Capacity Act. The Act’s purpose is simple: to protect the best interests of the individual, their dignity, their distinctiveness,’ he said.

‘Antipsychotic drugs prescribed against the evidence, without clear clinical justification, amount to a deprivation of liberty.’

If extended, the Act would force GPs to apply for permission from a primary care trust or local authority before prescribing the drugs.

Dr Bill Beeby, chair of the GPC´s clinical and prescribing subcommittee said: ‘It´s quite likely that most of us prescribed more antipsychotics for dementia patients than we should have done before the evidence about risk of stroke and premature death came out. But most of us have now reviewed our prescribing and have changed our practice.’

He added: ‘We should not prejudge the audit and data search that´s taking place. Let´s wait for the results and then sit down and discuss it properly. To make threats before then is not the right way to do things.

‘As for making the prescribing of a drug illegal – if that policy is followed, where does it stop? That would have unknown consequences in terms of the care of individual patients. Many people would not be prescribed medication which they actually need which could actually increase suffering.’

The announcement follows a study by researchers at Warwick Medical School which suggested 84% of care home residents were taking four or more medications and more than a third were prescribed eight or more drugs.