Enhancing medicines safety for people with learning disabilities and autism through STOMP

Healthcare professionals will be familiar with ‘The Oliver McGowan mandatory training on learning disability and autism’. This training serves as a powerful reminder of the devastating consequences related to inappropriate prescribing and emphasises the need for reform in how we manage medicines for individuals with learning disabilities and autism. People with a learning disability are estimated to be 16 times more likely — and autistic people seven-times more likely — to be prescribed antipsychotic medicines, compared with the general population^​1​. Addressing this disparity is at the heart of ‘Stopping over medication of people with a learning disability and autistic people’ (STOMP), a national NHS England work programme to stop the inappropriate prescribing of psychotropic medicines^​1​. 

At Richford Gate Medical Practice, part of Hammersmith and Fulham Partnership, we have a notably large cohort of registered patients with learning disabilities and autism. The health and care provision for this often-disadvantaged cohort is a high priority at the practice, and we are always looking for new ways to deliver a higher standard of care for patients. Audits were considered, in line with the STOMP initiative, with the objective of reviewing patients with learning disabilities and autism to ensure their psychotropic prescriptions were appropriate, necessary and regularly reviewed. The audit included conducting virtual or face-to-face reviews, where appropriate, with the goal of implementing planned and supervised dose reductions or the discontinuation of inappropriate psychotropic medicines.

As a trainee pharmacist, I had the opportunity to conduct this audit in collaboration with the learning disability lead GP at the practice, supported by the lead pharmacist. Over the course of four weeks, from September 2024 to October 2024, the audit focused on identifying and reviewing patients with a known learning disability or autism who were prescribed psychotropic medicines specifically targeting for main classes: antidepressants, antipsychotics, benzodiazepines and mood stabilisers. These medicines influence the brain’s chemistry and can significantly affect a person’s mood, thoughts, perceptions and behaviours. Psychotropic medicines also carry the risk of being inappropriately prescribed for individuals with intellectual disabilities, often as a means of managing challenging behaviour^​2​. Therefore, it was important to ensure that these medicines were used only when appropriate and with full consideration of the patient’s individual needs.

Using the practice’s electronic health record system, we conducted searches and identified 46 patients within these categories. Leveraging pharmacists’ expertise in medicines management, we systematically assessed which patients could benefit from dose reductions or the discontinuation of psychotropic medicines, as well as those due for a review. Each week, these cases were presented to the learning disability lead GP, whose regular involvement with these patients provided a thorough understanding of their medical histories and individual circumstances. This collaborative approach ensured well-informed decisions about which patients were suitable for dose reductions and which patients required treatment continuation. 

Despite having a notably large cohort of patients with learning disabilities and autism, only three out of 46 patients who met the criteria were deemed suitable for a dose reduction trial by their GP or psychiatric team. As a learning disability-friendly practice, we strive to provide comprehensive healthcare through regular health checks and mental health reviews tailored to this cohort. While our efforts in managing these patients were evident, as only three patients were identified, the STOMP audit demonstrated its value by recognising that these individuals could benefit from further dose reductions. As these patients can often have multiple complex health and social needs, it can be difficult to focus on specific areas of best practice, such as medication reviews, during time-constrained consultations. This audit provided an essential opportunity to prioritise and address psychotropic medicines management in a targeted and effective way. Through discussion with the learning disability GP, who has built trusted relationships with individuals, their families and carers, we were able to contribute to the holistic approach that the practice aims to deliver and take steps together to help reduce health inequalities.

An essential outcome of this audit was creating a complementary focused systematic review of these patients on psychotropic medicines that may benefit from dose reduction or the cessation of these medicines. With the searches now embedded in the electronic health record system, we have an automated and established mechanism to ensure ongoing, structured reviews of these patients. This tool provides valuable support for clinicians involved in the care and review of these patients. In addition, the audit will now be conducted annually at our practice to prevent the unnecessary long-term use of psychotropic medicines and enhance patient-centred care for the benefit of this often-disadvantaged cohort.

This audit demonstrates additional steps that can be taken to prioritise medicines safety for people with learning disabilities and autism. It highlights the potential for increased awareness and the implementation of similar audits across GP practices, which contributes towards the national effort to reduce overmedication and improve the quality of care for those with learning disabilities and autism. We hope this discussion raises awareness of the value of performing the STOMP audit and supports the knowledge and education in primary care around this significantly important area of health.

Halima Butt, trainee pharmacist, Richford Gate Medical Practice

Yahya Khan, lead learning disability GP, Richford Gate Medical Practice

Kaly Mohammad, lead pharmacist, Richford Gate Medical Practice