Yes, drugs are overprescribed: but it’s not the fault of GPs

Ministers seem to have found yet another way to bash overburdened GPs (Government review finds 10% of drugs dispensed in England are pointless, 22 September). There is nothing new about overprescribing and the inevitable polypharmacy, which the pharmaceutical industry is not exactly eager to discourage. It has been a problem for decades. But the causes are mostly nothing to do with the GPs themselves.

At medical school it was drummed into us when to prescribe drugs (the “indications”) and when not to (the “contraindications”), but seldom if ever when to stop them (except for side-effects). Patients can be discharged from hospital on all sorts of drugs, but often neither the patient nor the GP are given any indication about how long they should be taken for.

Patients nowadays are often managed by several different specialists at the same time (fragmented care, rather than the more fashionable precision medicine) and a GP will clearly be hesitant to stop a specialist-recommended drug, especially if the patient has been taking it for months or years, a situation made all the more difficult if that patient is no longer being followed up by the specialist. Patients often don’t like stopping drugs that they believe, rightly or wrongly, are life-saving – and they may be suspicious that any recommendation to stop is only to save the NHS money.
Charles Warlow
Emeritus professor of medical neurology, Edinburgh

It would be interesting to see how the chief pharmaceutical officer would fare as a GP for a day. By the time we’ve added preventatives for strokes (antihypertensives, anticoagulants and statins) and osteoporosis (bisphosphonates), alongside essential thyroid, asthma and diabetes drugs, we’re well on the way to the “pointless” polypharmacy alluded to. Then there’s the inevitable antidepressant boom directly linked to the increase in poverty. “Gardening” just doesn’t hack it when you have two low-paid jobs, poor housing and family stress. Of course, drug lists are reviewed by GPs with their patients every day. Just stopping them to below an arbitrary number is at best a gross over-simplification and at worst shows a breathtaking ignorance of evidence-based medicine.
Dr Wendy Outwin

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