The GMC has recently published the results of the PRACtICe study examining prevalence and causes of prescribing errors in general practice. This study follows on from the GMC’s 2009 EQUIP study, which investigated the rate of prescribing errors made by Foundation Years doctors in secondary care. The EQUIP study identified an 8.9% error rate in the almost 125,000 junior-doctor-issued prescriptions reviewed.
The PRACtICe study reviewed over 6,000 prescriptions written by GPs and concluded that prescribing errors in general practice are common “involving around one in 20 of all prescription items”. On a more positive note, only one in every 550 prescribed items was associated with a serious error.
The authors advise that “many of the types of error identified in the PRACtICe study could have been prevented with better training in safe prescribing in general practice”. Their recommendations are:
1) Better GP training in safe prescribing;
2) Greater attention to safe prescribing in GP’s continuing professional development;
3) Improved clinical governance, including audits and reporting of adverse prescribing events through the National Reporting and Learning System;
4) Effective use of the safety features in clinical computer systems;
5) Improved safety systems within general practices, including review of the systems in place for repeat prescribing, medication monitoring and minimising interruptions to clinical staff.
What exactly does “a prescribing error” mean?
The nationally agreed definition of a prescribing error is: ”A clinically meaningful prescribing error occurs when, as a result of a prescribing decision or prescription writing process, there is unintentional significant
1) reduction in the probability of treatment being timely and effective, or
2) increase in the risk of harm,
when compared with generally accepted practice”.
Will a prescribing error result in a doctor facing GMC fitness to practise proceedings?
Possibly. The GMC exists solely to protect patients and will take action if there is reason to suspect that a doctor’s fitness to practise is impaired. Its policy statement on the meaning of fitness to practise acknowledges “All human beings make mistakes from time to time. Doctors are no different. While occasional one-off mistakes need to be thoroughly investigated and any harm put right, they are unlikely in themselves to indicate a fitness to practise problem.”
However, the GMC also makes clear that “serious or persistent failures” to meet the standards expected of the profession “will put your registration at risk”. A question of fitness to practise is likely to arise if a doctor’s performance has either harmed patients or put patients at risk of harm.
The examples provided by the GMC include “a series of incidents that cause concern”, or “cases that arise from a single clinical incident”. Therefore, it appears clear that either persistent, low-level prescribing errors or a single, serious prescribing error could result in a GMC investigation.
Andrea James is head of healthcare regulatory at George Davies Solicitors LLP, former in-house solicitor to the General Medical Council and specialises in advising doctors. Click here for further details.