Repeat prescribing and SMR overhaul as review finds one in 10 scrips unnecessary

[Northerner]

A government-commissioned review led by chief pharmaceutical officer Dr Keith Ridge found that 'it is possible that at least 10% of the total number of prescription items in primary care need not have been issued'.

Reductions in prescribing of antibiotics over recent years and work to tackle overprescribing in care homes suggested that 'a reduction in the volume of prescription items in primary care of 10% is realistic' - equivalent to around 110m items a year, the review said.

The review highlighted a sharp rise in overall prescription items issued in primary and community care in recent decades, rising from 10 per head in 1996 to 20 per head in 2016. It said numbers of patients on multiple medications had also risen markedly - with 15% of the population now taking five or more medicines daily, and 7% taking eight or more medicines daily.

NHS prescribing​

Overprescribing is 'rarely the result of a faulty diagnosis', the review said, with the scale of the problem linked to 'weaknesses in the healthcare system and culture, not the skills or dedication of individual healthcare professionals'.

Repeat prescribing and SMR overhaul as review finds one in 10 scrips unnecessary

Repeat prescribing and use of structured medication reviews in general practice are to be overhauled after a review found one in 10 prescription items issued in primary care may be unnecessary.

www.gponline.com

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[trophywench]

Mmmmm - I recall them doing this in 'care' situations about 10 ish years back. The example was given of someone being on a statin and now having terminal disease. Is there any necessity to try and prevent a future heart attack when the patient will soon shuffle off their mortal coil within the next few months?However if the patient still has some mental capacity it can cause them stress they don't need by removing a daily pill their doctor and others have in the past assured them would help em live longer! Or - they develop a mistrust of the carers cos they've always had to take tablet X at Y o'clock 'so they clearly aren't doing their job properly'.

Of course I approve the ethos - but it often isn't a simple thing to do !

(Bit like some un-medically trained clerk removing a pump users sporadic need for insulin pens from our repeat prescription list as we haven't ordered one for the last 12 months ........ )

 

[Bruce Stephens]

Of course I approve the ethos - but it often isn't a simple thing to do !

Yes, the basic idea is sound: have an occasional review to make sure the patient really needs all these things. (I used to take a daily low dose aspirin which my GP removed once the evidence changed. Makes complete sense for me not to bother with that.) I'm sceptical of the possible savings claimed.

Feels a bit like the claims a while ago that local authorities could save half of their costs which turned out to be based just on switching mobile phone contracts (a small part of the costs, and the things designed to be complex enough that people can't choose the best one for them in advance).

(Bit like some un-medically trained clerk removing a pump users sporadic need for insulin pens from our repeat prescription list as we haven't ordered one for the last 12 months ........ )

Yes, and that's surely the kind of stupid thing that'll happen. Rarely, I hope.

 

[trophywench]

Ah, well, see - you are entirely wrong about the aspirin!

Walk into a pharmacy and ask the price of a tub of low dose aspirin, pennies for a tub containing about 6 months supply at one a day.

However - ask a GP to sign a prescription for the smaller amount of aspirin tablets, so X amount of GP time, the dispensing charge by the pharmacy which must be paid by the surgery, the staff costs of the pharmacy, the printing ink, the paper, the bag they put it in and the name label they stick to it , add your own phone bill and time taken to request the scrip - and you have a huge cost in comparison to the actual price of the ruddy pills!

 

[Bruce Stephens]

and you have a huge cost in comparison to the actual price of the ruddy pills!

I'm still sceptical. This was just one 28-day packet of pills along with three or four others, so I doubt it would have cost that much.

And generally I'm sure that's the case: they're not really worrying about someone getting one item on prescription regularly, they're worried about pensioners getting a dozen when nobody's really considering if they still need that antibiotic or even considering how likely it is that the patients are taking the pills as prescribed anyway. (I know my grandfather was struggling a lot managing his 4 or 5 daily.)

 

[grovesy]

Yes, the basic idea is sound: have an occasional review to make sure the patient really needs all these things. (I used to take a daily low dose aspirin which my GP removed once the evidence changed. Makes complete sense for me not to bother with that.) I'm sceptical of the possible savings claimed.

Feels a bit like the claims a while ago that local authorities could save half of their costs which turned out to be based just on switching mobile phone contracts (a small part of the costs, and the things designed to be complex enough that people can't choose the best one for them in advance).


Yes, and that's surely the kind of stupid thing that'll happen. Rarely, I hope.

I too was taken off low dose Aspirin when the evidence changed a few years ago.

 

[Leadinglights]

I think there is the other side of the coin as well, my daughter when going her GP rotation when at med school had a case where somebody was supposed to be on multiple medications but had only asked for one on the repeat request, she rang him and he said his wife had passed away and she had always dealt with his meds and that was the only one he knew how to spell.
We have a tub full of left over meds from when things have been changed and are not sure what to do with them, I suppose return them to the pharmacy but they will just get thrown away probably.

 

[trophywench]

Definitely return them to pharmacy - yes they get incinerated - but at least don't get chucked onto landfill which is far worse.

 

[Northerner]

🙂