The UK government has decided to take action against unnecessary and overprescribing of medicines in primary healthcare centres.
The decision follows a government-commissioned review led by Dr Keith Ridge, the chief pharmaceutical officer for England.
The review found that 10 per cent of the volume of prescription items dispensed through primary care are either inappropriate for that patients’ circumstances, or could be better served with alternative treatments.
Around 6.5 per cent of total hospital admissions are caused by the adverse effects of medicines, it said.
The study added that higher consumption of medicines increases the chances of harmful side effects. Even a blood pressure controlling medicine can increase the risk of falls amongst the frail and elderly.
It described overprescribing as a situation where potential harm outweighs the benefit of the medication. It can happen when a better alternative is available but not prescribed.
Dr Ridge said: “Medicines do people a lot of good and the practical measures set out in this report will help clinicians ensure people are getting the right type and amount of medication, which is better for patients and also benefits taxpayers, by preventing unnecessary spending on prescriptions.”
The report has given six key recommendations, including introduction of a new national clinical director for prescribing to lead a 3-year programme, covering research and training for effective prescribing.
It further suggested system-wide changes to improve patient records and training for general practices (GPs) to improve prescribing processes.
It recommended safe withdrawal of inappropriate medication, and called for cultural changes to reduce a reliance on medicines and support for shared decision-making between clinicians and patients.
The report also insisted on waste reduction in healthcare to help deliver NHS’s net zero carbon emissions.
The government has accepted all recommendations and reforms to pharmacist training is already underway.
Calling it a significant step towards benefiting patients, health minister Syed Kamall said: “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.”
“This is an incredibly important review which will have a lasting impact on people’s lives and improve the way medicines are prescribed,” said health secretary Sajid Javid.
“With 15 per cent of people taking 5 or more medicines a day, in some cases to deal with the side effects of another medicine, more needs to be done to listen to patients and help clinical teams tackle overprescribing,” he added.
Pharmacy reaction
Royal Pharmaceutical Society England chair Thorrun Govind lauded the review saying it will “ensure more effective use of medicines.”
“For too long the healthcare system has focused on the positive effects of adding medicines to a prescription, rather than acknowledging that this can also increase the risk of side effects and interactions between medicines, leading to poor health and costly unnecessary admissions to hospital.
“We need to focus on putting shared decision making between the prescriber and patient at the heart of prescribing, and look at the individual needs and circumstances of each person.”
She added the report not only explores several issues that pharmacists have been highlighting, but also gives a range of solutions to them.
“Pharmacists across the country will be eager to play an active role, working alongside the patients and communities they serve, to reduce the harm that medicines can cause when over prescribed.”
RPS representative on the report’s working group, Lelly Oboh FRPharmS, said it is important to consider a person’s social, physical and mental health needs while prescribing medicines.
She added: “This report will change how we start, stop, monitor and review people’s medicines, with a greater emphasis on having person-centred conversations”.
Association of Independent Multiple Pharmacies (AIMp) has also welcomed the report, but highlighted some complexities in the suggested solutions.
Dr Leyla Hannbeck, chief executive at AIMp, said: “Community pharmacy should be centre stage to these reforms. Any changes are likely to impact on the sector and concentrate disproportionately on cost and will thus have a complex and uneven impact on the network. It is therefore crucial that the sector is engaged with in this journey and be a key influencer in driving the patients’ and public’s expectations.”
She added: “Education, social responsibility, personal accountability and sweeping national cultural changes are necessary.”
Welcoming the report, Nick Kaye, vice chair at the National Pharmacy Association, highlighted the role that pharmacists can play to tackle the overprescribing of medication.
He said: “Community pharmacists could play an increasingly important role in ensuring effective prescribing, for example through Structured Medication Reviews and as independent prescribers. That will improve patients’ access to advice and deploy the expertise of pharmacists to good effect.
“On the flip side of overprescribing is the matter of helping patients get the most from their medicines once dispensed, which is the bread and butter of community pharmacy. New services like the Discharge Medicines Service and the extended New Medicine Service build on this role significantly.”
