The burden of overprescribing and adverse drug effects falls on older patients

Overprescribing of medication is a serious problem in health systems that has grown dramatically over the last 25 years, according to a new government review that estimates that at least 10% of the total number of prescription items in primary care need not have been issued.

Led by Chief Pharmaceutical Officer for England Dr Keith Ridge CBE, the review says the burden of overprescribing weighs particularly heavily on older people, who are more likely to be taking multiple medications.

This is because as people get older, so the body’s reaction to medicines changes, which means the dose might need to be changed or the medicine stopped altogether. But sometimes that does not happen, and patients can suffer adverse effects such as falls due to low blood pressure or low blood sugar. This can have very real and negative impacts on older people’s day-to-day functions and activities.

It also found that 15% of people are taking five or more medicines a day, increasing the risk of adverse effects and around one in five hospital admissions in over-65s are caused by the adverse effects of medicines.

Practical and cultural changes needed to tackle overprescribing

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.

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.”

RCGP defends GPs over overprescribing criticism

The Royal College of GPs said that once again the media were criticising GPs, this time for their prescribing skills and called on the four governments of the UK to invest properly in general practice and provide better support for GPs in delivering patient care.

Professor Martin Marshall, Chair of the Royal College of GPs, said: “Prescribing is a core skill for GPs and many of our nurse and pharmacist colleagues in primary care, and doing whatever we can to prescribe the most appropriate medicine for our patients, in an evidence-based way, is something we strive to do on a daily basis – and in the vast majority of cases, this review shows this is happening.

“With our growing and ageing population, with more patients living with multiple, chronic conditions, many people are taking several medications in order to manage their various health illnesses, and the interaction between various medicines is something prescribers will take into account. In most cases, these medicines are necessary, appropriate and of benefit for the patient – but the aspiration to reduce the number of medications a patient is taking, where safe and possible, is a good one.

“GPs will only ever prescribe medication to patients in conversation with them, and after a frank discussion about the risks and benefits of the treatment – and when alternative options have been explored. What GPs and other members of the practice team often need, however, is better access for their patients to alternative, non-pharmacological treatments, which can be patchy across the country.”

He added that the College welcomed some of the recommendations in this report, particularly the commitment to provide further resources and training to support appropriate prescribing in primary care, and the development of clinical guidelines to support patient-centred care.

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.