GPs face greater prescribing scrutiny under plans to cut medication errors

Health and social care secretary Jeremy Hunt will today unveil a new system for tracing GP prescribing errors, after a review commissioned by the Department for Health and Social Care (DHSC) estimated that 627 deaths a year are caused by medication mistakes in primary care.

The system will link primary care prescribing data to hospital admissions and enable the NHS to see whether a prescribing error has led to an admission. In a speech to the Global Patient Safety summit in London today Mr Hunt will say it is his mission ‘to make the NHS one of the safest healthcare systems’.

RCGP chair Professor Helen Stokes-Lampard welcomed the plans but warned that the new measures must not be used to ‘admonish’ GPs. She said that the long-term solution to addressing medication errors was 'a properly-funded NHS with enough staff to deliver safe patient care'.

The system will initially focus on how medicines may be contributing to admissions for GI bleeding. The DHSC said that ‘doctors will, for example, be able to trace whether a patient prescribed a non-steroidal anti-inflammatory drug on a regular basis ended up in hospital with a gastro-intestinal bleed because they were not given something to protect their digestive system’.

The first range of indicators will be published this spring and then widened to cover more medicines.

Mr Hunt will also announce other measures aimed at reducing medication errors including new protections for pharmacists and pharmacy technicians to prevent them being prosecuted for ‘genuine medication mistakes’.

The roll out of electronic prescribing systems in hospitals will also be 'accelerated', which the DHSC said would help reduce medication errors ‘by up to 50%’. Currently only a third of trusts have an electronic prescribing system in place.

The DHSC also plans to work with doctors, nurses and pharmacists to examine how systems can be changed to help reduce errors, which will include looking at how the design of medication packaging might increase the risk of doctors making mistakes.

Medication errors

The announcement comes as new research commissioned by the DHSC suggested that there are 237m errors a year relating to prescribing, dispensing, administering or monitoring medicines in the NHS in England, although 72% of these cause no harm.

The research, which was carried out by the Universities of Sheffield, Manchester and York, estimated that 66m potentially 'clinically significant errors' occur per year, 71% of which are in primary care. It estimated that avoidable adverse drug reactions in primary care that lead to a hospital admission result in 627 deaths a year, which cost the NHS £83.7m, and that around half of these involve a GI bleed.

Across the NHS, avoidable advese drug reactions cause 712 deaths a year, contribute to 1,708 deaths and cost the health service £98.5m.

The researchers said that error rates in the UK were 'similar to those in other comparable health settings such as the US and other countries in the EU'.

'Error rates per patient in primary care are the lowest but the burden of errors is the second highest due to the size of the sector,' they added.

According to NHS Digital figures 1.1bn items were dispensed in primary care in 2016.

Learning culture

Mr Hunt is also expected to say: ‘We are taking a number of steps today, but part of the change needs also to be cultural: moving from a blame culture to a learning culture so doctors and nurses are supported to be open about mistakes rather than cover them up for fear of losing their job.'

RCGP chair Professor Helen Stokes-Lampard said: ‘GPs already use systems designed to help them prescribe safely, but the college would welcome any additional resources or technology that will help to further minimise the risks of making a medication error. Systems better linking prescribing data in primary care to hospital admissions, sound like a particularly good and necessary step forward.

‘What is essential, is that highlighting that prescribing errors do occasionally happen is not used to admonish hardworking NHS staff – including GPs – for making genuine mistakes, but to address the root cause, and in general practice that is intense resource and workforce pressures, meaning that workloads and working hours are often unsafe for GPs and our teams.

‘New measures to help reduce prescribing risk are certainly helpful, but the long-lasting solution to this is a properly funded NHS with enough staff to deliver safe patient care.’

GPC chair Dr Richard Vautrey said: ‘We hope these plans will lead to improved systems in hospitals and community settings that reduce the possibility of errors as much as possible.

‘GP practices are facing increasing demand on their services, with patients presenting with increasingly complex health problems, so the government needs to continue to work with us to establish a workforce strategy including enabling practices to expand their multi-disciplinary team to help meet patients' needs. 

‘This includes the greater involvement of pharmacists working in, or linked to, practices and surgeries.’

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