NHS Stockport Clinical Commissioning Group
NHS / Health Body
Action Planned
AI-generated response summary
• The CCG will remind all GPs in Stockport of the importance of recording clear and detailed notes explaining the basis for any change to prescribing frequency.
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Dear Ms Mutch Mr Clive Miles (RIP) Regulation 28 I refer to your letter dated 16 December 2019 and acknowledge receipt of the Regulation 28 report in relation to this case: I was saddened to read of the circumstances of the death of Mr Miles and would ask that you pass on my sincere condolences to his family. You report concern in relation to the following: The decision to change the prescribing frequency from weekly to monthly and whether this was appropriate Limited evidence of risk assessment to support the decision Iam not aware of which GP practice the patient was registered at ad do not have access to this gentleman's consultation records: Therefore my response is not specific to this patient; rather it is based on the scenario of any patient in similar circumstances: I hope this will be acceptable: The decision to amend the frequency of prescribing is based on the clinician's judgement at the time of the consultation: Unfortunately, there is no standard risk assessment tool that is currently evidenced to be effective The tools that are available are either not specific enough or not sensitive enough. This essentially means that assessment of risk is a clinical
decision based on the clinician's perception at the time: For your reference I have included a link to a a report dated April 2018 entitled 'Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data' which I hope will be useful to you:- httpsiLLwwwncbinlmnih gov Lpmclarticles/PMC5921289L Whenever a decision is made to amend prescribing frequency my expectation is that there would be a detailed consultation note to explain the reason for the change ad the factors considered in reaching that decision. Clearly if the notes in this case were lacking then there is a need for reflection at that practice; I have assumed that your report has also been shared with the practice concerned: You refer to the appropriateness of the decision to move to monthly prescribing; this is difficult point for me to address based on the information available to me: What I can say is that patients can spend a considerable time in managing the process of ordering and collecting weekly medications ad that this is often a factor in the request to change to monthly prescribing: Stockport CCG is committed to learning and with this case in mind I will ensure that all GPs across the Stockport patch are reminded of the importance of recording clear ad detailed notes explaining the basis on which any change to prescribing frequency has been made: Iam sorry that my response is not patient specific but I the information provided will be helpful to you and that you are satisfied that the issues raised within your report have been addressed:
decision based on the clinician's perception at the time: For your reference I have included a link to a a report dated April 2018 entitled 'Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data' which I hope will be useful to you:- httpsiLLwwwncbinlmnih gov Lpmclarticles/PMC5921289L Whenever a decision is made to amend prescribing frequency my expectation is that there would be a detailed consultation note to explain the reason for the change ad the factors considered in reaching that decision. Clearly if the notes in this case were lacking then there is a need for reflection at that practice; I have assumed that your report has also been shared with the practice concerned: You refer to the appropriateness of the decision to move to monthly prescribing; this is difficult point for me to address based on the information available to me: What I can say is that patients can spend a considerable time in managing the process of ordering and collecting weekly medications ad that this is often a factor in the request to change to monthly prescribing: Stockport CCG is committed to learning and with this case in mind I will ensure that all GPs across the Stockport patch are reminded of the importance of recording clear ad detailed notes explaining the basis on which any change to prescribing frequency has been made: Iam sorry that my response is not patient specific but I the information provided will be helpful to you and that you are satisfied that the issues raised within your report have been addressed: