One in 10 prescriptions 'unnecessary', government review finds

Around 110 million prescription items a year 'need not have been issued', according to a government-commissioned report on overprescribing.

 Recent NHS initiatives have helped stem the growth in overprescribing but the problem remains at 'unacceptable' levels. | GETTY IMAGES
Recent NHS initiatives have helped stem the growth in overprescribing but the problem remains at 'unacceptable' levels. | GETTY IMAGES

A review led by chief pharmaceutical officer Dr Keith Ridge has recommended measures to tackle 'unacceptable levels' of overprescribing in the NHS.

The review concludes that reducing the volume of prescription items in primary care by 10% - equivalent to around 110 million items a year - is 'realistic', based on reductions already achieved in antibiotic prescribing and overprescribing in care homes.

To achieve this goal, the review calls for an expansion of the use of structured medication reviews (SMRs) in primary care, effective review of repeat prescribing and increased provision of alternatives to medications, among other measures.

The review highlights 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.

Healthcare culture

The problem of overprescribing is not linked to 'the skills or dedication of individual healthcare professionals,' said the report, but to 'weaknesses in the healthcare system and culture'.

Problems that led to overprescribing reported by clinicians consulted as part of the review included the lack of availability or long waits for non-medical treatments, and a lack of co-ordination with prescribing decisions by other clinicians, including the absence of notes to explain why medications had been prescribed.

The review highlighted weaknesses in the 'exchange of information between primary and secondary care' and the inability of some hospital services to record prescribing electronically. It pointed to errors caused by delayed, incomplete or missing hospital discharge letters, the need for more evidence and guidance on non-medical treatment options, and concerns over healthcare targets that 'often focus only on a single condition', when patients need a holistic review.

Among recommendations backed in full by ministers, the review called on the RCGP to work with the Royal Pharmaceutical Society to 'develop a national toolkit to help practices improve the consistency of repeat prescribing processes and support this with training resources for GP practice reception and administration teams'.

In addition to expanding SMRs and overhauling repeat prescribing, other key recommendations from the review include the appointment of a new national clinical director for prescribing, changes to improve patient records and improve handovers between primary and secondary care and cultural changes to promote shared decision-making between patients and doctors.

Clinical expertise

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.

'This report recognises the strong track record of the NHS in the evidence-based use of medicines, thanks to the clinical expertise of GPs and pharmacists and their teams, and our achievements to date in addressing overprescribing which is a global issue.

'Continuing to tackle overprescribing requires a whole system approach involving clinicians and patients, so we can continue to build the change we all wish to see in how medicines are used for the benefit of patients.'

Professor Martin Marshall, chair of the RCGP, said: 'Prescribing is a core skill for GPs and many of our nurse and pharmacist colleagues in primary care, and doing whatever we can to prescribe the most appropriate medicine for our patients, in an evidence-based way, is something we strive to do on a daily basis – and in the vast majority of cases, this review shows this is happening.

'With our growing and ageing population, with more patients living with multiple, chronic conditions, many people are taking several medications in order to manage their various health illnesses, and the interaction between various medicines is something prescribers will take into account. In most cases, these medicines are necessary, appropriate and of benefit for the patient – but the aspiration to reduce the number of medications a patient is taking, where safe and possible, is a good one.

He added: 'We welcome some of the recommendations in this report, particularly the commitment to provide further resources and training to support appropriate prescribing in primary care, and the development of clinical guidelines to support patient-centred care.'

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