Chris Lancelot: Why we need a central prescribing database

The Care Quality Commission (CQC) is concerned about the communication of prescribing information between primary and secondary care. Drug lists can be out of date; many practices don't have a protocol for reviewing the patient's medication after discharge; and updating medication in primary care is sometimes left to administrative staff.

This is all potentially dangerous. Up to 4 per cent of hospital admissions may be due to preventable medication-related problems.

Part of the CQC's solution is for GPs to review patients' medication immediately after discharge, preferably with the patient present; they also think that increased use of the summary care record (SCR) will improve information quality.

The CQC is right about poor communication. However, the SCR is merely a copy of part of the patient's record (which may already be inaccurate). The CQC's suggestion that 'GPs should do more' won't help either: we have enough to do already without adding further administrative work.

So why not change the prescribing system so it is automatically up to date? Currently, prescribing information is stored in many different places, such as the practice computer and in hospital records. These separate databases can easily get out of sync - the underlying problem.

Instead, the NHS should keep all drug data on a single, central database and, crucially, require all prescribing, both NHS and private, to be performed directly from this shared database. By all means retain individual practice, private or secondary care computer systems, but when a prescription is being created or dispensed the computer would actually be working directly on the central medication record.

All prescribing changes, wherever made, would immediately appear on this central record, which would therefore invariably be complete, accurate and up to date.

Good information management like this could increase medical care quality while reducing administration. A single, shared prescription database should have been the first concern of Connecting for Health, rather than the present convoluted and expensive structure. How many lives have been lost because no one thought to put it in place?

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