• Commissioners call for national plan to tackle health risks of antipsychotic drugs
  • City and Hackney CCG believes patients at risk due to gaps in national policy
  • Local audit found more than 1,000 patients on antipsychotics not receiving regular health checks

A national strategy is needed to tackle health risks linked to antipsychotic drugs because current policy is letting tens of thousands of people fall through the gaps, commissioners in London are warning.

Commissioners and clinicians in City and Hackney found more than 1,000 patients in their area who were on these drugs without having regular medication reviews or health checks. They warned that, if their findings applied across England, 100,000 patients could be in the same position. 

Although NHS England funds GP practices to carry out regular health checks on patients who are on the serious mental illness register, this excludes patients who are prescribed antipsychotics without having an SMI diagnosis — which typically covers psychoses, schizophrenia or bipolar active disorder. 

An audit by City and Hackney Clinical Commissioning Group, carried out in July 2019 and shared with HSJ, found 1,200 patients in the area were taking antipsychotics but did not have a formal SMI diagnosis.

The audit found most of these patients were not receiving regular health checks and a significant number may have benefited from having their medication reduced. The medication can cause significant weight gain and increased risk of diabetes.

Patients had been on the drugs for an average of six years, but some had been on the medication for more than 20 years. In most cases, medication was started in secondary care, abroad or privately.

Individual reviews carried out with psychiatrists at East London Foundation Trust have now resulted in 25 per cent having their medication stopped completely, and a further 17 per cent having their medication reduced.

More were recommended to reduce or stop, but were unable to. The CCG has since implemented an incentive scheme for all its GP practices.

A national problem

The local commissioners believe there could be 100,000 patients across England who are taking the drugs without being recently reviewed or assessed. 

City and Hackney CCG’s mental health director, Dan Burningham, said: “There is a double whammy with this patient group. Firstly, you’re on the medication without a diagnosis, and secondly, you’re not receiving the physical health check.

“I think it’s a national problem, but it is not covered by the current national framework. There’s 195 CCGs so there’s potentially 100,000 people across England, who could be receiving antipsychotics without a psychotic diagnosis.”

The CCG believes the current framework should be broadened out to all those with a chronic mental illness.

The GP lead for the project, Helen Drew, said: “Before this audit it never would have occurred to me to stop an antipsychotic. It wouldn’t have occurred to me it was my role, and I think most GPs probably feel like that.

“But that means if somebody is discharged from secondary care on antipsychotics they’re going to end up on them forever until somebody has the thought to reduce or stop them.”

Asked for his view, Martin Marshall, chair of the Royal College of General Practice, said: “It is unclear whether the patients identified by this report are on other registers, such as a dementia register, and therefore would be called for an annual health check and medication review via this route — but if there are patients [across England] who are not on a register, and therefore missing out on this, then it needs to be addressed as a matter of urgency.”

Meanwhile, for patients with an SMI diagnosis, national data indicates just 30 per cent received a health check in 2018-19, against a target of 60 per cent.

NHSE was approached for comment.

Click here to read the audit report by Helen Drew, Laura Woodhouse, Amaia Portelli, and Peter Sheils.