NHSX and NHS Digital must work with GP IT suppliers to ensure “safe and appropriate” digital tools for prescribing, a review has found.
A newly published plan from the government to reduce overprescribing said poor access to comprehensive patient records and a “lack of digital interoperability” had, in part, led to a problem with overprescribing.
A lack of technical standards and quality assessment of digital tools often used to guide clinicians when making decisions around treatment could also lead to risks including fatal medication errors “linked to poor design of electronic health records”, it found.
Further risks include alert fatigue, poor design leading to missed information, and a lack of an audit to follow up on what patients have been prescribed.
To alleviate these risks the report’s authors made a number of recommendations for national digital leaders, including:
- NHSX and NHS Digital should work with GP IT system providers to ensure digital products support safe and appropriate prescribing
- The organisations should also commission research teams to review, develop and evaluate digital decision-support tools
- NHSX and NHS Digital should also ensure the NHS website and the NHS App give people “culturally competent” information about their medication
- Royal Pharmaceutical Society should review prescribing competency frameworks in light of the increase in remote consultations seen during the pandemic
- NHSX and NHS Digital should work with stakeholders and system vendors to support the recording of indications within digital systems
The government-commissioned review estimates around 10% of items dispensed in primary care are inappropriate, with 15% of people taking five or more medicines a day.
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 but continues to be prescribed it.
Dr Keith Ridge, 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.”
The report also recommends the introduction of a new National Clinical Director for Prescribing; system wide changes to improve patient records and improve handovers between primary and secondary care; cultural changes to reduce a reliance on medication including the increase of social prescribing; and the provision of clear information on the NHS website for patients about their medication.
An NHSX spokesperson said: “Better use of integrated IT and digital systems, together with improved data sharing, will play a central role in our efforts to reduce overprescribing in the NHS.
“We are pleased to have the opportunity to contribute to this important and complex issue and will be working with NHS Digital and other partners to fully consider the recommendations from the review.”
Last year 16 NHS trusts received a share of £16million for the introduction of an electronic prescribing system. It was the latest round of a £78million investment announced in February 2018 aiming to achieve the NHS Long Term Plan commitment to eliminate paper prescribing in hospitals and introduce digital prescribing across the entire NHS by 2024.
The Long Term Plan aims to address many of the problems seen in the NHS, such as as improving digital systems, interoperability and access to patient records, and better use of data.
NHS Digital was also contacted for comment.