Frail older people in England missing out on vital medicines checks.
Just 59% of " Extremely frail " older people received annual drugs review by GP last year.
**_Almost 75,000 severely frail, older people in England are missing out on vital medicine checks, putting them at risk of hospitalisation, falls and adverse drug reactions, according to an analysis of NHS data.
At least 10% of hospital admissions of frail older people are directly attributable to mismanagement of medicine. But the analysis of all patients aged over 65 in England found that only 59% – 108,507 – of people identified as being extremely frail received their annual medicines review last year.
“Medicines reviews are a crucial part of managing frail patients,” said Nigel Praities, the editor of Pharmaceutical Journal, which conducted the analysis of NHS Digital data. “Tens of thousands of severely frail older people are likely to be missing out on vital medicines checks by their GPs, even though studies show that this group of patients are a significant cause of NHS spend and even a short hospital admission can increase the risk of death.”
The analysis shows that almost 350 GP practices did not assess a single elderly patient in 2018-19. Numbers have fallen by almost half compared with the year before: in 2018-19, only 14% of registered patients aged 65 years and over received a frailty assessment. This is almost half the already low number in 2017-18, when just 26% received an assessment.
Under NHS guidance introduced in October 2017, GPs in England should be routinely identifying frail older people, and those with “severe frailty” should be given an annual medicines review.
The lack of reviews in some patients is a vital missed step, said Henry Woodford, the chair of the British Geriatric Society’s medicine optimisation special interest group and a hospital-based geriatrician.
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“This seems like a very low number [receiving medicines reviews],” he said. “Studies suggest that in frail older people, at least 10% of admissions are directly related to medicines, and that they play a smaller contributing part in many other admissions.”
Prof David Reeves, a senior researcher in primary care at Manchester University, said interviews that his team has conducted with GP practices showed funding was a big problem.
“GPs are concerned about identifying large amounts of need that they are unable to meet because of a lack of available local resources,” he said. “This has resulted in quite a lot of practices paying only lip service to the frailty initiative, which is one reason why the medication review rate is low.”
Another reason is that GPs are already overstretched, he added, and “the government has provided no additional resources to support the initiative”.
But Richard Vautrey, GP committee chair at the British Medical Association, said these figures may say more about coding and recording: “A clinician will review the medication … when they see patients or a prescription is done, but [they] may not necessarily code this,” he said.
A spokesperson for NHS England and NHS Improvement said the lack of medicines reviews in this group of patients would be addressed in the new GP contract from April 2020.
“The importance of medication reviews will be reinforced through the forthcoming primary care network [PCN] service specification on structured medication review, which will start in 2020,” he said.
“This enhanced requirement is being supported through the deployment of thousands of clinical pharmacists into PCNs as part our wider proposals for PCNs to recruit over 20,000 additional staff,” he added._**