An investigation by the Care Quality Commission has revealed that the exchange of information on patient medication between hospitals and GPs is often “patchy, incomplete and not shared quickly enough,” and warns that trusts must get up to scratch to meet its criteria for registration next year.

The Commission looked at 280 GP practices in 12 primary care trusts around the country and, while noting “some evidence of good practice”, found areas of serious concern, such a lack of timely and accurate information on changes to medication when patients switch between primary and secondary care, and a failure on the part of some GPs to routinely review new medication following hospital discharge.

Astonishingly, the report found that 81% of GP practices claimed summaries of care information sent by hospitals were incomplete or inaccurate ‘all of the time’ or ‘most of the time’, which could leave patients at risk from subsequent prescription of contra-indicated drugs by GPs and potential reactions.

Furthermore, in half of the trusts data regarding a patient’s drug list was only sent on to the community pharmacist if a ‘high risk’ therapy had been prescribed, or if the patient needed help to remember to take their medicines properly, further increasing the risk of prescribing errors.

At the same time, it seems that some GP practices are failing to systematically provide hospitals with relevant information on patients’ previous drug reactions (24%), other existing illnesses (14%), or allergies (11%) on admission to hospital, which is also worrying as inadequate information on these points increases the chances of hospital doctors prescribing drugs that could potentially be harmful to the patient.

“Not all adverse drug reactions are preventable, but the potential risks are clear. It is important that basic systems to share essential patient details are working effectively to get the right information to clinicians at the right time to minimise these risks,” said CQC chief executive Cynthia Bower, and she stressed that services “have some way to go before this routinely happens in the way it should”.

Despite the obvious importance of such information, it was found that just four of the PCTs surveyed carried out audits on the quality and speed of discharge summaries to keep a check on performance in this area, making it much more difficult to identify areas in most need of attention.

Greater accountability
Consequently, the Commission has urged GPs and PCTs to determine the level of data on patients required by hospitals to minimise potential drug-related incidents, and says trusts must also systematically monitor the flow of information and hold GP practices to account more effectively to improve safety. And Bower says a “change of attitude” is needed in the NHS to better recognise “how important it is for clinicians to pass the baton smoothly between services in order to offer person-centred, integrated care”.

One study estimates that 4% of all hospital admissions are because of preventable medicine-related issues, but from next year a requirement of registration with the CQC will be the effective management of medicines and the commission has promised to “take action where trusts fall short of meeting this”, which could help to substantially improve the situation.