A draft NHS England report on overprescribing leaked to HSJ [paywall], proposes that the law should require wider access to healthcare data, in a bid to improve patient safety.
The review carried out for health secretary, Matt Hancock, highlights the issue of poor interoperability between NHS computer systems, which means clinicians cannot see or understand what medications patients are taking or when a medication should be reviewed.
According to report author, chief pharmaceutical officer Keith Ridge, prescribers should be identified in the electronic health record (EHR) so they can be contacted by other clinicians. He adds that a free-text box should be created in EHRs so clinicians can explain why a certain medication has been prescribed.
In the report, Ridge calls for “wider access” in order to ensure that “many eyes” view prescribing data and spot any problem and for prescribing apps to make their data openly available.
He also recommends that private providers should be required to share prescribing data and private and secondary care prescribers should be able to add prescribing information to patients’ GP care records.
The report advises that NHSX create a mechanism to flag data “blocking” and investigate potential policy or legislative interventions. It also proposes a “data barriers notification system” to allow mistakes in records to be easily highlighted.
WHY IT MATTERS
The report raises concerns that poor communication with medical staff means patients are not able to make informed decisions about the medications they receive, and prescribing may be influenced by “perverse” financial incentives.
It also says that the use of technology may be inadvertently driving overprescribing because of the ease of selecting multiple prescription items “with one-click.”
“Shared records enable clinicians at the point of care to access information, to provide better safer care for patients. The NHS lags behind other sectors in the interoperable transfer of information between systems. Work on interoperability is now a priority for NHSX and facilitating the digital transfer of information from hospital to GP is an early priority,” the report says.
THE LARGER CONTEXT
The review into overprescribing was commissioned by Hancock in December 2018, to address the issue of ‘problematic polypharmacy’ where a patient is taking multiple medications unnecessarily and to ensure patients are taking the most appropriate treatment for their needs.
In England, the estimated total NHS spending on medicines grew from £13 billion in 2010 to 2011 to £18.2 billion in 2017 to 2018. This is an average growth of around 5% a year – with 1.1 billion prescription items dispensed in primary care by GPs and pharmacists.
ON THE RECORD
A spokesperson for NHS England said: “This was an uncorrected draft report, which after it has been properly fact checked will be published in due course.”