Prescribing for people with learning disabilities must change

Sandra Gidley 3by Sandra Gidley, Chair, English Pharmacy Board

Early last week three separate reports from the Care Quality Commission, Public Health England and NHS Improving Quality were released and painted a poor and depressing picture of the level of prescribing of antipsychotics and antidepressants in those with learning disabilities.

Following the release of the reports, I co-signed, on behalf of the RPS English Pharmacy Board, a letter from NHS England stating that the scale of the problem was unacceptable and that an emergency summit was being arranged to agree how to tackle the problem. The letter was also signed by the Royal College of Psychiatrists and the Royal College of Nursing.

A significant part of the problem is inappropriate prescribing – there’s a much higher rate of prescribing of medicines associated with mental illness amongst people with learning disabilities than the general population.  Public Health England estimates that up to 35,000 people with learning disabilities are being prescribed an antipsychotic, an antidepressant or both, without appropriate clinical justification.

This is exacerbated by a lack of joined-up working amongst professionals.  When medicines are prescribed by different doctors in different settings for different episodes of challenging behaviour, they get added to a patient’s prescription and often remain on it without review.  This means an individual ends up taking more and more medicines – far more than are necessary to manage their behaviour.

Interactions between these medicines can seriously affect quality of life.  Side-effects can include sedation, obesity and diabetes with long-term consequences to health.

These most vulnerable of patients deserve better and it’s a scandal that there is no regular system of medicines review.  At the emergency summit, RPS committed to producing prescribing guidelines to help reduce inappropriate prescribing.  The summit also aims to produce a Call to Action, similar to that which was produced to tackle the over-prescribing of anti-psychotics in dementia patients.

Pharmacists could play a much bigger role in ensuring patient safety through regular person-centred medicines reviews, working in an integrated team with the patient and their carers. Pharmacists see these prescriptions all the time and I’m sure all of us feel no-one should be taking medicines unless there are clear, documented and reasoned explanations for their continued use.

The current system fails to deliver this fundamental standard of care for people with learning disabilities.  Health professionals and the government now have an opportunity to re-commit to delivering the care vulnerable adults so clearly need.

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