Editorial: Funding needed to reduce antipsychotic use

Regular readers will know that GP has been investigating antipsychotic prescribing in dementia for some time.

Most recently we revealed that more than half of PCTs in England were failing to commission specialist dementia services to help reduce antipsychotic prescribing (GP, 30 October).

Therefore, it is positive news that the government has said it will implement all of the recommendations from last week's independent report into the use of antipsychotics in dementia.

The DoH is now to impose targets on PCTs to reduce the use of these drugs over the next three years. These targets will be critical to achieving success.

As GP's investigations suggest, without such drivers it is unlikely GPs would see change locally - PCTs have been lamentably poor at improving dementia care thus far.

Last year GP revealed that a quarter of PCTs had closed or reduced dementia services in the preceding three years, even though most trusts said dementia was one of their main priorities (GP, 24 October 2008).

But while the government's commitment to improve this situation is to be commended, there are questions over delivery, key of which is whether the funding exists to achieve this vision.

The DoH believes that specialist services, better-trained nursing home staff and improved access to psychological therapies can all be provided within current funding allocations. It says reduced prescribing of antipsychotics would save money and cut the number of acute episodes in these patients.

The Alzheimer's Society is not so sure. The fact remains that dementia care has been underfunded for years and unless money is ring-fenced it is hard to see how this will change - especially now that PCTs are being asked to find huge savings and the number of people with dementia is rising.

GPs must not be left under increased pressure from PCTs to stop prescribing antipsychotics without suitable alternatives in place. Improved training and investment in services must come first.


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