Jeff Gilbert
Around 10% of items dispensed through primary care in England are either inappropriate for patients’ circumstances or wishes, or could be better served with alternative treatments, a major review into overprescribing in the NHS has found.
The government-commissioned review, led by Keith Ridge, chief pharmaceutical officer for England, estimated that 15% of people are taking five or more medicines per day day, putting them at increased risk of adverse events and hospitalisation.
The review, which was first announced in December 2018, sets out a series of changes to make sure patients get the most appropriate treatment for their needs.
These include introducing a “interoperable consolidated patient medication record” that all healthcare professionals can access; asking the National Institute for Health and Care Excellence and professional guideline-forming bodies to include recommendations for discontinuing medicines, where appropriate; and expanding the use of structured medication reviews to more patients.
The review also recommends the introduction of a national clinical director for prescribing, increased use of social prescribing, an improved evidence base for safely withdrawing inappropriate medication, and better handovers between hospitals and the community.
“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,” said Ridge.
“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.”
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.
Sajid Javid, health and social care secretary, said: “This is an incredibly important review, which will have a lasting impact on people’s lives and improve the way medicines are prescribed. I look forward to working with Dr Keith Ridge and our dedicated NHS teams to deliver on these recommendations.”
Overprescribing describes a situation where people are given medicines they do not need or want, or where potential harm outweighs the benefit of the medication. It can happen when a better alternative is available but not prescribed, the medicine is appropriate for a condition but not the individual patient, a condition changes and the medicine is no longer appropriate, or the patient no longer needs the medicine but continues to be prescribed it.
