Action on overprescribing of medicines

Ministers are announcing action to prevent medicines being prescribed unnecessarily, following a new review led by Dr Keith Ridge CBE, Chief Pharmaceutical Officer for England.

The review of overprescribing (published 22.09.21) found 10% of the volume of prescription items dispensed through primary care in England are either inappropriate for that patient’s circumstances and wishes, or could be improved by prescribing alternative treatments.

Overprescribing describes a situation where people are given medicines they do not need or want, or where potential harm outweighs the benefit of the medication. It can happen when a better alternative is available but not prescribed, the medicine is appropriate for a condition but not the individual patient, a condition changes and the medicine is no longer appropriate, or the patient no longer needs the medicine.

Around 1 in 5 hospital admissions in over-65s and around 6.5% of total hospital admissions are caused by the adverse effects of medicines. The more medicines a person takes, the higher chance there is that one or more of these medicines will have an unwanted or harmful effect.

The review sets out a series of practical and cultural changes to make sure patients get the most appropriate treatment for their needs while also ensuring clinicians’ time is well spent and taxpayer money is used wisely. This includes shared decision making with patients about starting or stopping a medicine, better use of technology, ways to review prescriptions more effectively, and considering alternative medicines which would be more effective.

Ministers have accepted all recommendations and work will now begin to implement them, with reforms to pharmacist training already underway.

The key recommendations from the review are:

• the introduction of a new National Clinical Director for Prescribing to lead a 3 year programme including research and training to help enable effective prescribing;
• system-wide changes to improve patient records, improve handovers between primary and secondary care, develop a national toolkit and deliver training to help general practices improve the consistency of repeat prescribing processes;
• improving the evidence base for safely withdrawing inappropriate medication (deprescribing), and updated clinical guidance to support more patient-centred care. This would include ensuring GPs have the data and medical records they need, and are empowered to challenge and change prescribing made in hospitals;
• cultural changes to reduce a reliance on medicines and support shared decision-making between clinicians and patients, including increasing the use of social prescribing, which involves helping patients to improve their health and wellbeing by connecting them to community services which might be run by the council or a local charity.
• providing clear information on the NHS website for patients about their medication and the creation of a platform for patients to be able to provide information about the effectiveness and the adverse effects of their medicines; and
• the development of interventions to reduce waste and help deliver NHS’s net zero carbon emissions. The review also calls for more research to investigate the reasons why overprescribing is more likely to affect older people, people from ethnic minority communities and people with disabilities.

Dr Keith Ridge CBE, chief pharmaceutical officer for England, said:

Medicines do people a lot of good and the practical measures set out in this report will help clinicians ensure people are getting the right type and amount of medication, which is better for patients and also benefits taxpayers, by preventing unnecessary spending on prescriptions.

This report recognises the strong track record of the NHS in the evidence-based use of medicines, thanks to the clinical expertise of GPs and pharmacists and their teams, and our achievements to date in addressing overprescribing which is a global issue.

Continuing to tackle overprescribing requires a whole system approach involving clinicians and patients, so we can continue to build the change we all wish to see in how medicines are used for the benefit of patients, and with medicines production and use a major driver of greenhouse gas emissions – contributing to the NHS’s net zero ambition.

Health Minister Lord Syed Kamall said:

The causes of overprescribing medicines are complex due to a range of systemic and cultural factors. Significant progress has been made in this area in recent years, thanks to the hard work of GPs, pharmacists and their teams.

The review concludes that key to stopping overprescribing is ensuring that patients are prescribed the right medicines, at the right time, in the right doses – known as ‘medicines optimisation’.

This includes the rapid expansion of clinical pharmacists working alongside GPs to review medication, and the move to more personalised care, shared decision making between patients and staff and the scaling up of social prescribing.