NHS needs better trained prescribers

Doctors are to be formally tested on their knowledge of medicines before they graduate, it has been announced.

The British Pharmacological Society (BPS) says that prescribing is the core business of the NHS, but skill levels have lagged for too long and known problems have not been addressed.

The Society says current training in prescribing medicines is far too "piecemeal" and more needs to be done to raise standards, with the initial focus on education to improve the skills of future prescribers.

The recommendations follow hard on the heels ofa study commissioned by the General Medical Council (GMC), published earlier this month, which found one in ten hospital prescriptions contain errors.

Most errors, resulting from poor hand writing, transcription errors, incompleteness or need to interpret, do not result in harm to patients, but the GMC study found doctors rely heavily on pharmacists and nurses to pick up on their prescribing mistakes before harm is caused.

The NHS National Patient Safety Agency in September reported that prescribing and medication errors are on the increase. NPSA figures show that drug errors caused at least 37 deaths and 63 cases of severe harm in 2007.

To help improve experience of prescribing as part of medical training the BPS says it is developing a national prescribing assessment, together with a website students can practise their skills, including "dragging and dropping" the right drug doses onto virtual patients.

The Prescribe eLearning portal is being developed jointly with the Medical Schools Council and the DH, to support all those who are trying to develop the knowledge and skills required to prescribe in the health service.

The BPS welcomed the GMC-commissioned study but said there needed to be far more focus on ensuring medical students are properly educated. It also announced that it will fully back the GMC’s call for a standardised prescribing form across the NHS, but added “much more could be done to improve prescribing in UK hospitals, by education and changes in the working environment”.

Improved education to improve prescribing skills provides the central recommendation of the BPS report, but it says that in tandem there must also be systemic improvements, such as a standardised prescribing form and more focus on the introduction of electronic prescribing and decision support.

The Society cited research on around 2,500 students carried out few years ago found they had typically only filled out a hospital prescription card five or six times during their entire degree. Yet, following graduation, they are then expected to write out 50 or 60 prescriptions a day.

Professor Simon Maxwell, chairman of the BPS prescribing committee, said prescribing was the "core business of the NHS" and the evidence of a problem with its quality was "now overwhelming".

"We recognise that the majority of prescriptions are appropriate, safe and effective (but) the evidence is now unequivocal that there are problems," he said. "One of the concerns the BPS has is that there is somewhat of a culture of acceptance that medication errors happen but they are stopped by the good actions of nurses and pharmacists."

The BPS says that problems with prescribing have been known about for too long, but previously ignored: “We believe that a corner has been turned. After many years of indifference and denial, most professionals now accept that standards of prescribing have fallen below expectation and must be improved.”

Prof Maxwell said the NHS could and must do a lot better on prescribing and that current error rates would not be acceptable in safety focused industries such as aviation.

As part of its recommendations the BPS has published its 10 principles of good prescribing.