UK Ministers have announced action to prevent medicines from being prescribed unnecessarily, following a new review led by the Chief Pharmaceutical Officer for England.
The government will take action to prevent medicines from being prescribed unnecessarily in England, as a new review highlights the impact of overprescribing.
Led by Chief Pharmaceutical Officer for England Dr Keith Ridge CBE, the government-commissioned review into overprescribing found 10% of the volume of prescription items dispensed through primary care in England are inappropriate for that patients’ circumstances and wishes or could be better served with alternative treatments.
Around 1 in 5 hospital admissions in over-65s and around 6.5% of total hospital admissions are caused by the adverse effects of medicines. The more medicines a person takes, the higher chance there is that one or more of these medicines will have an unwanted or harmful effect. Some medicines, such as those to reduce blood pressure, can also increase the risk of falls amongst the frail and elderly.
The review sets out a series of practical and cultural changes to make sure patients get the most appropriate treatment for their needs while also ensuring clinicians’ time is well spent and taxpayer money is used wisely. This includes shared decision making with patients about starting or stopping a medicine, better use of technology, ways to review prescriptions more effectively, and considering alternative medicines which would be more effective.
Ministers have accepted all recommendations and work will now begin to implement them, with reforms to pharmacist training already underway.
The key recommendations from the review are:
- the introduction of a new National Clinical Director for Prescribing to lead a 3-year programme including research and training to help enable effective prescribing
- system-wide changes to improve patient records, improve handovers between primary and secondary care, develop a national toolkit and deliver training to help general practices improve the consistency of repeat prescribing processes
- improving the evidence base for safely withdrawing inappropriate medication (deprescribing), and updated clinical guidance to support more patient-centred care. This would include ensuring GPs have the data and medical records they need, and are empowered to challenge and change prescribing made in hospitals
- cultural changes to reduce a reliance on medicines and support shared decision-making between clinicians and patients, including increasing the use of social prescribing, which involves helping patients to improve their health and wellbeing by connecting them to community services which might be run by the council or a local charity
- providing clear information on the NHS website for patients about their medication and the creation of a platform for patients to be able to provide information about the effectiveness and the adverse effects of their medicines; and
- the development of interventions to reduce waste and help deliver NHS’s net zero carbon emissions
The review also calls for more research to investigate the reasons why overprescribing is more likely to affect older people, people from ethnic minority communities and people with disabilities.
Health and Social Care Secretary Sajid Javid said:
“This is an incredibly important review which will have a lasting impact on people’s lives and improve the way medicines are prescribed.
“With 15% 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.
“I look forward to working with Dr Keith Ridge and our dedicated NHS teams to deliver on these recommendations.
Dr Keith Ridge CBE, Chief Pharmaceutical Officer for England, 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, and with medicines production and use a major driver of greenhouse gas emissions – contributing to the NHS’s net-zero ambition.”
Duncan Rudkin, Chief Executive of the General Pharmaceutical Council, said:
“This important report sets out changes which will help improve how medicines are prescribed for patients.
We look forward to working with the Chief Pharmaceutical Officer for England and his team, as well as the new National Clinical Director for Prescribing and other relevant regulators, to take forward its recommendations.
“Pharmacists, pharmacy technicians and the wider pharmacy team in all settings are already working closely with prescribers and with their patients to help make sure that people get the right medicines, at the right time, in the right doses.
“The report recognises that pharmacists and pharmacy technicians across England will also have a vital part to play in taking forward the actions outlined to improve patient care. We know there is also work underway in Scotland, as outlined in the Achieving excellence in pharmaceutical care strategy and in Wales as part of delivering A healthier Wales long term plan, to help make sure that patients only get the medicines they need.
“As this report highlights, pharmacists are increasingly taking on greater responsibilities for helping to make sure that patients get the most appropriate treatment for their needs, including through working as independent prescribers.
“We are working with stakeholders to introduce major changes to the initial education and training of pharmacists so that in the future all pharmacists joining our register will be independent prescribers from the point of registration. We will also shortly begin a consultation that proposes changes to enable more pharmacists already on our register to begin training as an independent prescriber at an earlier stage.
“The report also highlights that there will be further demand for pharmacy technicians with the skills and knowledge to help deliver the report’s recommendations. We will work with key stakeholders to consider how the education and training of pharmacy technicians needs to develop to meet this demand and the future needs of patients and the public.
“This review proposes system-wide changes to improve the use of patient records, which we fully support. It is essential that pharmacists working in all settings, including community pharmacy, can both access and update patient records, to make sure everyone involved in the patient’s care knows what medicines they are taking. We are considering what further work we can do to support improvements in the quality of record-keeping in pharmacies.
“We also fully support the focus in this review on shared decision-making with patients and the public on starting or stopping a medicine, as well as making sure that patients have all of the information they need about their medicines. We emphasise the importance of this happening in our standards and guidance for pharmacy professionals, to support person-centred care.”
Nick Kaye, Vice Chair at the National Pharmacy Association said:
“This is a highly significant report. Medicines are the single most widespread healthcare intervention, so it’s vital that their use is optimised, to help patients and to ensure value for money for the NHS.
“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. The clinical skills of all pharmacists, not just those working in GP practices, need to be brought to bear further on this important agenda.
“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.
“In implementing the report’s recommendations, the principle of shared decision-making will be very important, so that the focus is always on getting the best from medicines and never on denying access to medicines, which serves to exacerbate health inequalities.”
Chair of the RPS in England Thorrun Govind said:
“We welcome this review which outlines what needs to happen to stop overprescribing across healthcare and ensure more effective use of medicines. Many of us take more medicines than we need and this can have a hugely negative impact on our health.
“As science advances and people live with complex and multiple conditions, they are prescribed an increasing number 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.
“This report explores many of the issues that pharmacists have been highlighting for a long time and gives a range of solutions. 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:
“Using medicines is an important aspect of health care that helps people to live better lives. It’s vital that we take a holistic approach that considers a person’s social, physical and mental health needs so they are only prescribed medicines that enable them to achieve the outcomes that are most important to them.
“As people get older, the more long-term conditions they have, the more medicines they are prescribed to manage them. Our current culture and the way our systems are set up favour the use of medicines as a ‘one size fits all’ to manage these conditions. They continue to be prescribed long after they are wanted or needed, resulting in harmful effects, a reduced quality of life, unnecessary admissions to hospital and medicines wastage.
“This report will change how we start, stop, monitor and review people’s medicines, with a greater emphasis on having person-centred conversations, which include listening to people’s’ perspectives and sharing decisions about their priorities, preferences, risks and benefits of taking medicines.
“I welcome the report and look forward to the changes that it will bring for the benefit of our patients and the NHS. “Our role as pharmacists is essential to ensuring that medicines are safe and effective for people who take them and there are ample opportunities in the report for pharmacy ‘together’ to collaborate with other partners to implement the recommendations.
“We will make every conversation count by keeping people at the centre of their care when we undertake structured medication reviews, prescribe or dispense medicines, provide medicines information and advice, so that they get the medicines they need and are willing to take.”