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Nurse prescribers urged to review psychotropic scripts

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Nurse and medical prescribers have been urged to help stop the so-called “chemical restraint” of patients with learning disabilities.

Organisations representing health professionals, including the Royal College of Nursing, have signed a joint pledge to stop the “over-medication” of people with learning disabilities and autism.

“Reducing use of powerful drugs whenever we can is a good thing”

Bruce Keogh

It has the backing of the RCN, the Royal College of Psychiatrists, the Royal College of GPs, the Royal Pharmaceutical Society, the British Psychological Society, NHS England and the government.

In addition to the pledge, guidance has been launched today to encourage and support prescribers to review inappropriate prescriptions for people under their care who have a learning disability.

A pamphlet (see attached PDF below) is intended to help primary care teams to review prescriptions and ensure psychotropic drugs are only continued where a patient poses a severe risk to safety and all alternatives have been exhausted.

Both initiatives were revealed today at a summit in London on taking “sustained action” to tackle the over-prescribing of psychotropic drugs to people whose behaviour is challenging.

NHS England noted that multiple psychotropic drug use often started at a specialist level and was then passed onto primary care for long-term management.

However, it said research published last year showed that, in too many cases, such prescriptions were repeated without adequate review.

“This pledge should be an opportunity for health and medical professionals to work more closely together”

Annie Norman

The research, published in three reports by the Care Quality Commission, Public Health England and NHS Improving Quality, also found there was often poor communication with parents and carers, and between different healthcare providers.

In addition, it identified a much higher rate of prescribing of drugs associated with mental illness among people with a learning disability than the general population – often more than one medicine in the same class, and in the majority of cases with no clear justification.

NHS England said an estimated 35,000 adults with a learning disability were being prescribed an antipsychotic, an antidepressant or both without appropriate clinical justification.

Long-term use was linked to significant weight gain, organ failure and, in some cases, death, it warned.

The Stopping Over-Medication of People with a Learning Disability (STOMPLD) commits each organisation to “work together, and with people with a learning disability and their loved ones, to take real and measurable steps to stop over-medication”.

It is intended to mark the beginning of a series of actions by the signatories over the coming months.

“Signing this pledge today is an important commitment to ensuring they receive the best possible care”

Matt Hoghton

Professor Sir Bruce Keogh, NHS England’s medical director, said: “Reducing use of powerful drugs whenever we can is a good thing. We have managed this successfully in dementia; it’s now time to bring similar benefits to patients who have a learning disability.”

Annie Norman, RCN professional lead for learning disabilities and criminal justice, said: “It is simply not acceptable that people with a learning disability are being prescribed anti-psychotic drugs without appropriate clinical justification.

“Learning Disability nurses are highly skilled nurses who care and treat people with complex mental and physical needs and can support people without automatically relying on medication by using a whole host of interventions,” she said.

“This pledge should be an opportunity for health and medical professionals to work more closely together to provide a more person centred approach to the care of people with learning disabilities, to give them a better quality of life,” said Ms Norman.

Dr Matt Hoghton, medical director for the RCGP Clinical Innovation and Research Centre, added: “Working collaboratively between healthcare professionals and carers is really important in tackling the appropriate use of psychotropic drugs in our patients with learning disabilities, and signing this pledge today is an important commitment to ensuring they receive the best possible care.”

The STOMPLD Pledge was signed by the following organisations, and supported by the Challenging Behaviour Foundation:

  • Royal College of GPs – Dr Matt Hoghton
  • Royal Pharmaceutical Society – Sandra Gidley
  • Royal College of Psychiatry – Dr Ashok Roy
  • Royal College of Nursing – Ann Norman
  • British Psychological Society – Prof Peter Kinderman
  • Department of Health – Rt Hon Alistair Burt MP
  • NHS England – Hazel Watson

The STOMPLD Pledge reads:

“Over-medication, and then lack of review, is a historic problem, but one that nobody knew the true scale of until recently.

It is estimated that on an average day in England, between 30,000 and 35,000 people with a learning disability are being prescribed powerful drugs, with serious potential side effects, without clinical justification and for too long. This is often despite evidence-based alternative interventions being available.

This inequality in care is unacceptable, and it is incumbent on clinicians and every other professional involved in an individual’s care to ensure they are acting in their patient’s best interest at all times.

We, the undersigned, representing professionals from across the NHS, therefore pledge to work together, and with people with a learning disability and their loved ones, to take real and measurable steps to stop over-medication.

We will each set out the actions our individual organisations will take towards this shared aim, and report regularly on the progress we have made – ensuring that we can be held to account.”

NHS England

Nurse prescribers urged to review psychotropic scripts

The pledge

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