In general practice an estimated 1.7 million serious prescribing errors occurred in 2010. This was presented in a report to the General Medical Council following the PRACtiCE study in 2012. I could go on and describe the number of patients who are admitted to hospital caused by avoidable adverse reactions to medicines, the number of medication incidents reported to the NPSA that involved actual patient harm, the £500,000,000 or more we spend on care for patients who have missed their desired outcomes from medicines and the £300,000,000 of medicines we waste every year.
I say that we don’t care. Perhaps we do, but obviously not enough to do something about it. So what are we thinking? What are we doing? Where is the culture of seeing problems and sorting things out? Or are we still denying problems exist and still trying to find someone to blame?
There is a section in the GP registration criteria with the CQC about medicines. Now the CQC are an organisation that have reported serious shortcoming in prescribing policy and systems for years and nobody has listened. And we hope that this is enough to change practice. Excuse me – most repeat prescribing systems are managed in general practice by trained receptionists – sorry but that is true. Doctors sign a hundred prescriptions in 5 minutes without more than a cursory glance. Some practices have prescribing policies, others ‘adopt’ one written by the deceased PCT and very occasionally they may carry out an audit of something. Most practices do not have a medicines reconciliation policy even though the CQC reported this years ago. And the review of medication is usually a computer based exercise with few patients given the time for a thorough review. And now CCGs have limited ability to review and audit the systems and why should they?
Who is responsible for not taking action to reduce the number of serious prescribing errors in general practices? Buggered if I know. Obviously safety is everyone’s business – there that should placate the population.
Now this may be too obvious:
- If I wanted to assure the quality of a prescribing system – I would put a pharmacist in charge.
- If I was worried about reviewing patients medication – I would get a pharmacist to do it.
The first question is what is the solution?
- The CCG has a responsibility to improve primary care. The Head of Medicines Optimisation in the CCG is responsible for the quality of prescribing.
- The GP practice should have part of a pharmacist on head count, working for the practice to ensure that the prescribing systems are safe and providing assurance to the CQC.
- The pharmacist will deliver face to face medication reviews in all elderly patients and those on multiple therapies.
- The pharmacist will lead the liaison with local community pharmacists to improve the effectiveness of Medicines Use Reviews (funded within the community pharmacy contract) and feedback on prescribing issues.
The second question is how can this be funded?
- CCGs should either co-fund or pump-prime funding within general practice. This may be considered a quality initiative, fundable out of prescribing savings, funded out of improved outcomes or from reorganising the way that pharmaceutical support is currently provided. It could be a national issue with the usual hypothecated budget. (just in case Mr Hunt reads this). But JDI.
- If you wanted to be radical, include elements in the QOF and the community pharmacy contract that ‘makes’ them work together on this issue of safety
The third question is can it be done?
- There are several examples of pharmacists employed within general practice managing prescribing systems. Dr Dev Malhota, for example describes their practice pharmacist as the ‘engine room’ of the practice. They do it and they have done for years.
- There are pharmacists who would be available to do this job. PCTs ‘divested’ quite a few in the transition to CCGs. Training and support should be straightforward.
So – if you read this blog – prove that we do care about 1,700,000 serious prescribing errors in general practice. Do something about it now!