Ministers have ordered a crackdown on overprescribing of medicines after a review found one in 10 drugs dispensed by GPs and pharmacists are pointless and potentially harmful.
Family doctors will be told to boost the use of social prescribing, such as gardening, walking or volunteering. They are also being urged to call millions of patients in for medication reviews to see whether there are any pills they can stop taking.
The landmark review, ordered by the government in 2018 and published on Wednesday, concludes that overprescribing is a “serious problem”. As many as 110m medicines handed to patients each year may be unnecessary and even potentially harmful, it suggests.
More than one in six (15%) of people in England now take five or more medicines a day, increasing the risk of adverse effects, the review found. One in 14 (7%) are on eight drugs or more.
About one in five hospital admissions in over-65s, and 6.5% of all hospital admissions, are caused by the adverse effects of medicines. The more pills a person takes, the higher the risk that one or more of these medicines will have an unwanted or harmful effect. Some medicines, such as those to reduce blood pressure, can also raise the risk of falls among the frail and elderly.
The findings follow a report by Public Health England in 2019 which found that a quarter of adults in England are taking potentially addictive prescription medicines, with as many as half of them dependent on the drugs for the long term.
Led by NHS England’s chief pharmaceutical officer Dr Keith Ridge, the new review found that 10% of prescription items dispensed via primary care in England are inappropriate for the circumstances or wishes of that patient, or could be replaced with better, alternative treatments.
Estimated total NHS spending on medicines in England soared from £13bn in 2010/11 to £18.2bn in 2017/18. This represents an average growth of 5% a year – with 1.1bn prescription items dispensed in primary care by GPs and pharmacists every year.
Overprescribing, where patients are given medicines they either do not need or want, or where the potential harm outweighs the benefit of the medication, has increasingly concerned health leaders in recent years. 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 but continues to be prescribed it.
Sajid Javid, the health secretary, welcomed the report. “This is an incredibly important review which will have a lasting impact on people’s lives and improve the way medicines are prescribed,” he said.
“With 15% of people taking five or more medicines a day, in some cases to deal with the side effects of another medicine, more needs to be done to listen to patients and help clinical teams tackle overprescribing.”
The authors said that while they did not want to set a target for cutting overprescribing, a 10% reduction is “realistic”. The review adds: “This would be equivalent to a reduction of around 110m items a year.”
Javid accepted all the recommendations of the review and vowed to take action to prevent medicines being prescribed unnecessarily. Reforms to pharmacist training are already under way, he said. The government will also appoint a national clinical director for prescribing.
The review also recommends “system-wide changes” to improve patient records and handovers between GPs and hospitals, plus a national toolkit and training to help primary care staff improve the consistency of repeat prescribing. Repeat prescriptions make up around three-quarters of all prescription items, the report found, and can be left without review for long periods, increasing the risk of overprescribing.
There must be support for patients who are taken off medicines but struggle to give them up, the review says. GPs must also be empowered to challenge and change prescribing decisions made in hospitals, it adds.
Ridge said that while overprescribing was a “global issue”, it was vital that the NHS ramps up efforts it has already made to tackle the problem.
“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,” he said.
