Exclusive: GPs demand urgent overhaul of 'unsafe' NHS prescribing system

Millions of GP prescriptions cannot be traced to the individual doctor that issued them because the NHS has failed to overhaul a system that is a relic of the 1950s, GP leaders have warned.

Flaws in the way prescribing codes are assigned to GPs means that locums are forced to use other doctors' codes to prescribe, leaving no recordable trace of their prescribing and attributing responsibility to doctors who did not prescribe the treatments.

National Association of Sessional GPs (NASGP) chairman Dr Richard Fieldhouse warned that the current system ‘made a mockery of prescribing data’ and could lead to problems with safety, medicolegal risk and revalidation.

It also means attempts to track individual GP prescribing – as has been proposed by NICE with antibiotic prescribing – would be inaccurate using current data, as many doctors are prescribing under other doctors’ names, he said.

GPC prescribing subcommittee deputy chairman Dr Bill Beeby told GPonline this was a ‘vitally important issue’ and warned that the accountability problems extended beyond locums. He called the current prescribing system a relic of the 1950s that urgently needed to be brought 'into the 21st century'.

GP prescribing

The GPC has been pressing for a simple solution, which would involve using GPs’ GMC numbers on prescriptions. The move is understood to have the support of leading GP organisations, regulators and NHS administrators. GMC numbers on prescriptions could be paired with an organisation number to identify which practice the prescription was issued at.

Under the existing model, prescription numbers  known as a doctor’s index number (DIN) – are assigned to GPs working in England and Wales by the Health and Social Care Information Centre (HSCIC). These six-digit codes are used when doctors sign off prescriptions for patients.

But each GP’s DIN is tied to the practice they work at by being assigned through their employing organisation. Locums, who do not work at a permanent practice, therefore cannot be given one, and codes cannot be transported with them to different practices.

In most cases, they must use prescribing codes of the doctor for whom they are providing locum services.

With an estimated 17,000 locums working in general practice, this means millions of prescriptions are being signed off by anonymous locums under other doctors’ names.

Prescribing costs

‘Every prescription I've ever made in the last 20 years has been done in someone else’s name – and it’s the same for every other locum,’ Dr Fieldhouse said.

‘The NHS spends billions a year on prescriptions, and yet it doesn’t know who’s actually prescribing them.

‘When patient data is being put on the NHS spine it’s not showing the actual person that did the prescribing, it’s only showing which prescription pad was used. We assume that the person whose name is on the prescription is who gave it but it could have been anybody. Other GPs and unnamed locums could have logged in under that GP’s name.

‘Even GPs within a practice can use different numbers. The system registers prescriptions as by the patient’s registered GP, not necessarily the GP who’s actually seen that patient on that day.

‘It just makes a mockery of prescribing data. It doesn’t equate to who actually did it. It could have been a locum, a partner, a salaried GP or a GP registrar. It could have been the receptionist – we know in some surgeries receptionists are authorised to generate prescriptions. They can type into the system under a random GP’s name.’

NHS accountability

The NASGP has been campaigning for years for all GPs – including locums – to be assigned personal prescribing numbers, he said.

Such a system would also help provide a more accurate portrayal of the number of GPs working as locums in England, as they are currently largely ignored in official census data.

Dr Fieldhouse said: ‘It would be really good to have a database for locums, a system to which they can register, get a prescription number, see their prescribing data and access support and information.’

The GPC is calling for a system in which a doctors’ unique GMC number is used to identify the individual who authorised a prescription coupled with a place or organisation code to determine where the cost should be allocated.

Dr Beeby said: ‘My most recent conversation with the responsible person at the DH, I was informed that the present block is the "lack of a business case".'

He said this was 'almost beyond belief' given support from NHS, regulatory and professional groups, the simplicity of the solution and its applicability across out-of-hours services and hospitals.

‘It's not just a locum issue, but one of accountability in general, making a small modification to prescriptions to bring it into the 21st century. The present system was OK in the 1950s, but no longer.’

Although DIN numbers are assigned by the HSCIC, it said it does not manage the system and any decisions to update DINs would be in the hands of the DH.

The DH did not respond to requests for comment by the time of publication.

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