Exclusive: GP prescribing system has 'failed to learn lessons from Shipman'

Flaws in the primary care prescribing system - highlighted earlier this week by GPonline - show that the NHS has failed to take on board recommendations from the inquiry into serial killer Harold Shipman, according to a senior GP.

GPonline reported earlier this week that millions of GP prescriptions cannot be traced to the individual doctor that issued them, undermining the accuracy of prescribing data and potentially creating problems with safety, revalidation and medico-legal issues.

But GP leaders have also warned that this flaw in the primary care prescribing system not only denies GPs accurate information about their own clinical work, but could help doctors mask malpractice.

The Learning from tragedy report, released in the wake of the Shipman Inquiry, called for ‘collection and collation of information on private prescribing of controlled drugs’ so that a repeat of his crimes could not take place.

Shipman Inquiry

GPC prescribing subcommittee deputy chairman Dr Bill Beeby told GPonline: ‘One of the focuses of the Shipman report was that prescribing should be more identifiable.

‘I'm not suggesting it’s widespread, but if someone was to misbehave and prescribe a little bit extra here and a little bit extra there – and if they worked in two or three locations, the current system doesn’t tie up any of their prescribing in these different locations, either in separate practices or in out-of-hours.'

Dr Beeby has been calling on the DH to usher in an improved system for seven years, suggesting that GMC numbers should be used to identify prescribing.

In current system, locum GPs are ineligible to be given their own prescribing number, or doctor index number (DIN), because these are only assigned through an employing organisation.

A locum GP must therefore hand out prescriptions using another doctor’s name and prescribing number.

GP prescribing

Although they sign off prescriptions with their own name, Dr Beeby warned this only reveals that it was authorised by a different doctor to the one named, as it is very difficult to identify someone based on their signature alone.

This also only becomes apparent when individual prescriptions are scrutinised. When looking at large-scale trends, all prescriptions made under a doctor’s name and DIN would be assumed to have been made by that doctor.

‘Not only do [locums] not have their own data, it means anything they do that’s weird or quirky corrupts my data as well,’ he said. ‘It renders my data useless on top of their data. It’s a real mess.

‘Being able to identify the prescriber enables you to look at trends in prescribing habits. If you don’t know where you sit in relation to your peers, you could be doing something out of kilter.

‘They could spot if they have been prescribing more of a particular drug, and they could then be more self-aware about what sorts of things they should be prescribing when they go into practices.’

GMC number

Additionally, once a GP has been given a DIN, it is theirs for life. Despite this, they must be given a new one when they start work at a new practice, as they are also practice-specific. This means that an individual doctor can have more than one active DIN, which are not linked together in the system as belonging to a single doctor.

Both of these situations create opportunities for a doctor to wilfully conceal malpractice by hiding the extent of their prescribing behind other doctors' codes or by using a suite of different codes that have been assigned to them, Dr Beeby warned.

‘Just using your GMC number and a separate code to identify the area code for the cost code would get around most of this,' he said.

‘You would be able to track your prescribing and aggregate it quite easily – without a lot of effort you could get a prescribing audit based on your own GMC number. It would allow people to look for trends and uncover people who might otherwise get hidden in the system.’

The DH is responsible for managing the current prescribing system. A spokeswoman said: ‘All prescribers must personally sign their prescriptions, making it possible to identify the prescribing doctor if required.’

Photo: Chris Savile/UNP

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