England’s most senior doctor says unnecessary prescriptions are costing the NHS £1bn a year
Eleanor Haywood Health correspondent
Gerry Gajadharsingh writes:
“I have written before about the effects of polypharmacy, on several occasions, but this article focusing on England’s most senior doctor, who is also suggesting that 10% of all GP prescriptions are unnecessary. At a cost to the NHS of nearly £1 billion, this is surely something to look at, in addition to the negative effects it can have on patients’ when they take multiple drugs, especially as they get older. One third of the over 80’s are on at least eight different medications per day.
As we emerge from the pandemic, there is one thing that the article doesn’t consider, the effects that multiple medications have on our immune systems. I wonder if it’s a coincidence, that the older you are you have an increased risk of developing more serious COVID-19 infection. Well, there is no doubt that age in itself, has a negative effect on the immune system, but I also suspect that multiple medications in this age group will not be helping either. In some elderly patients, that I am testing who have received both initial vaccines, a booster vaccine, and many of them catching SARS CoV2, especially with the omicron variant, most of them have good levels of spike protein antibodies, but some of them do not show reactive T Cells. Maybe it’s a coincidence, but it’s these people who seem to be taking multiple medications. It’s only anecdotal evidence, but I’ve not seen anyone out there really looking into this perspective from a research perspective.
Figures suggest that one in five hospital admissions for over-65s are caused by the adverse effects of medication. Admissions caused by side effects cost the NHS £2 billion a year.
As the saying goes, there’s no such thing as a free lunch. Medications are often necessary when used appropriately. For many people it’s probably easier to take a medication, rather than address any underline lifestyle concerns. Nothing in medicine is without risk and as always, it’s a balance of the risk benefit scenario, preferably on an individual basis.
The problem with lifestyle is that you have the usual culprits, alcohol, recreational drugs, too much caffeine, too much stress, obesity, poor diet, sleep disturbance and lack of exercise. We are all free to choose what we do.
But people are overwhelmed with information, and we exist in a soundbite era, the media sometimes does a disservice, when they’re trying to help people understand better approaches to their lifestyle, but don’t give complete information or worse inaccurate information.
When I see a new patient for the first time, the Diagnostic Consultation lasts for one hour and sometimes that amount of time is even not enough! A large part of my job is education of patients, taking time to explain how things work in their bodies and how making better lifestyle choices can have a positive impact on their health and can often help them reduce or stop medications, if they are no longer necessary.
Whilst I wouldn’t agree with all of the alternatives to medication at the end of the article, again it’s far too simplistic, at least it’s a starting point
To be fair to GP’s it takes 2 to tango, patients also have a responsibility to look at alternatives to medications where possible”
Doctors must stop doling out “a pill for every ill” as it leaves millions of patients hooked on drugs they do not need, England’s most senior doctor has said.
Ten per cent of all GP prescriptions are unnecessary, meaning about 114 million drugs are dispensed needlessly each year at a cost to the NHS of nearly £1 billion.
More than eight million adults take at least five pills a day, with thousands ending up in hospital owing to the harmful side effects of medication they are taking inappropriately.
Professor Sir Stephen Powis, the NHS medical director, said that the problem worsened during the pandemic as a lack of GP access meant patients had fewer medication reviews.
Speaking at the NHS ConfedExpo conference, he said: “The approach of ‘a pill for every ill’ should never be a starting point for treating patients.
“With figures suggesting around 10 per cent of prescriptions are not needed, and the pandemic undoubtedly having an impact as people have spent long periods of time at home, reducing unnecessary prescriptions which can increase the risk of harm and cause unwanted side effects is more important than ever.”
Last year 1.14 billion items were dispensed by community pharmacists in England after prescriptions from GPs or nurses — a 3 per cent rise on the year before. Commonly over-prescribed medications include statins and drugs that lower blood pressure, both of which can be replaced by lifestyle changes. Cognitive behavioural therapy can serve as an effective alternative to Zopiclone, a sleeping tablet prescribed 417,000 times a month.
Elderly patients are the worst affected by overprescribing , and one third of over-80s take more than eight medicines. Using so many pills can have catastrophic side-effects when the drugs interfere with each other, while other common medications such as blood pressure pills increase the risk of falls.
Figures suggest that one in five hospital admissions for over-65s are caused by the adverse effects of medication. Admissions caused by side effects cost the NHS £2 billion a year.
Powis said: “That is why the NHS is taking action to slash unnecessary prescriptions, rolling out expert pharmacy teams across the country who can give advice to patients so that the NHS can make best use of resources while maximising other treatment options too.
“Importantly, cutting unnecessary prescriptions could also save millions of pounds which could be reinvested into NHS care.”
NHS guidelines state that patients should have medication reviews at their GP surgery at least once a year, providing an opportunity for them to be weaned off unnecessary drugs. But many overstretched GPs struggle to find the time to fully assess a patient’s medication or give them advice on how to stop taking pills.
Stop dishing out antidepressants, doctors told
Pharmacists and medical bodies will join to launch a campaign, Beyond Pills, today to curb the “overprescribing epidemic”. They say social prescribing — such as sending patients for gardening or art classes as an alternative to antidepressants— should be embedded in medical training. A study led by Dr Keith Ridge, former chief pharmaceutical officer for England, said this would have benefits “comparable to a new blockbuster medicine”.
Dr Michael Dixon, chairman of the College of Medicine, said: “Medicine, as we know it, is no longer affordable or sustainable. Nor is it able to curb the increase in obesity, mental health problems and most long-term diseases.”
Caroline Abrahams, head of Age UK, said: “Many older people live with multiple and complex health problems and too often the option they’re given is to take increasing amounts of medication.
“This can happen over many years leaving older people taking excessive amounts of drugs with little regard given to whether or not they are actually improving their lives.
“Prescribing too much medicine also means that older people are less likely to take them properly causing even more harm and reducing their chance of staying well.”
Common over-prescribed medicines and potential non-drug alternatives
Statins 7.1 million prescriptions a month.
Alternative Exercise and diet to reduce cholesterol
Zopiclone (sleeping tablet) 417,000 prescriptions a month
Alternative Cognitive behavioural therapy for insomnia
Folic acid 770,000 prescriptions a month
Alternative Eat more vegetables
Drugs to lower blood pressure 6.5 million prescriptions a month
Alternative Lifestyle changes such as reducing salt intake
Sertraline (antidepressant) 1.9 million prescriptions a month
Alternative Cognitive behavioural therapy
Bronchodilator inhalers for lung disease 2.6 million a month
Alternative Referral to a Breathing Clinic