Prescription rule change puts onus on care staff to monitor medication

Social care workers in England and Wales will have to spend more time monitoring the medicine intake of frail and older people because of changes to the way GPs issue prescriptions.

The changes could also make it more confusing for older people to keep track of what medication they should take for clinical conditions.

The British Medical Association has advised GPs to stop prescribing monitored dosage systems (MDS) – boxes that contain pre-packaged daily doses of pills for periods of a week or month – to patients who fail a disability assessment. Legal advice suggests that continuing to prescribe MDS for such patients could be illegal because the boxes are not considered an NHS service.

The guidance has been prompted by a surge in the number of requests to GPs from care homes, social services departments and carers for MDS to be prescribed to frail patients who do not have a disability.

Instead of using MDS people will have to monitor their own doses of drugs or rely on care staff to do so.

The guidance followed a request for clarification from the BMA’s Welsh branch, which is in talks with the Welsh assembly government over the issue.

But Dr Andrew Dearden, chair of the BMA’s Welsh GPs’ committee, said it applied to England too. “Legal advice from the UK committee is that GPs who write prescriptions for non-NHS services knowing that service is not an NHS one could be acting illegally.”

MDS ‘protect the service user and the worker’
In Torfaen, south east Wales, the use of MDS is a key part of a project where domiciliary workers help clients, such as those with dementia or who are isolated, administer their medication.

Stewart Greenwell, social services director at Torfaen Council, said people without a disability also benefited. “It protects the service user because they know what they are taking and protects the member of staff from being accused of acting inappropriately. Safe medication taking is one of the criteria that a person and their family often use to determine whether they feel safe and can carry on living independently.”

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British Medical Association

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Derren Hayes

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