Recurring concern
Failure to provide timely clinical follow-up after medication prescribing
- Reports that mention this concern
- 21
- Times this concern has been raised
- 23
- Stated actions linked to this concern
- 35
What this concern includes
Includes timely clinical review after prescribing, assessment of treatment response, adherence or collection monitoring, and escalation when follow-up identifies concern.
What is not included
- Unsafe prescribing, dispensing or administration where no follow-up deficiency is identified
- Generic appointment failures unrelated to prescribed medication
- Medication-specific toxicity or blood-level monitoring governed by a narrower dedicated control
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Reports and published responses 21 reports
See individual reports that have raised this concern, and the actions taken in response
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Concerns raised1
Failure to check with the GP whether medication compliance was being maintained
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- East London NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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East London NHS Foundation Trust
Train relevant clinical staff to use the NHS Summary Care Record and routinely verify prescription issues and collection when adherence is significant to risk management.
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East London NHS Foundation Trust
Implement enhanced monitoring and documented risk-management plans when service users with capacity decline medication, including documented consideration of family involvement.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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East London NHS Foundation Trust
Weekly MDT review, risk-register oversight, escalation and documented accountability are considered sufficient; no further action is required.
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East London NHS Foundation Trust
Routine Summary Care Record checks, enhanced monitoring and escalation processes are considered sufficient; no further action is required.
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Concerns raised1
Failure to conduct medication reviews after overdose disclosures and related concerns
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Your Health Partnership PCN
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
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Your Health Partnership PCN
Amend the self-harm follow-up policy to require medication review and consideration of reducing prescription quantities where ongoing risk exists.
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Your Health Partnership PCN
Amend the self-harm risk-assessment template to record medication review discussions, stockpiling, medication safety, prescription quantity, and medication supervision options.
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Your Health Partnership PCN
Expand the annual proactive self-harm follow-up audit to record medication reviews and discussions about prescribed medication quantities.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Your Health Partnership PCN
NICE Quality Standard 34 does not specifically require medication review following self-harm.
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Concerns raised1
Failure to identify and escalate unrequested antipsychotic medication
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- Essex Partnership University NHS Foundation Trust
- Mid and South Essex NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Essex Partnership University NHS Foundation Trust
Train Mental Health Practitioners to locate current and historical prescriptions in SystmOne.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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Mid and South Essex NHS Foundation Trust
Concerns about care before 6 June 2023 do not relate to the respondent, so it has identified no action concerning them.
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Essex Partnership University NHS Foundation Trust
The Line Manager would not have prescribed medication because prescribing for this case was outside the manager’s remit.
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Concerns raised1
Lack of HRT reviews following initial prescription
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Ashlea Medical Practice
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Ashlea Medical Practice
Introduce and disseminate a written HRT Prescribing Policy requiring timely and ongoing reviews supported by templates and standardised Accurx questionnaires.
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Ashlea Medical Practice
Audit compliance with the HRT prescribing policy in September 2024, including questionnaire use, review timeliness, templates and coding.
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Concerns raised1
Failure to conduct regular medication reviews when prescribing medicines that can depress the central nervous system
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Betsi Cadwaladr University LHB
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Betsi Cadwaladr University LHB
Risk-stratify patients lacking recent medication reviews to prioritise review according to medication-related risk.
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Betsi Cadwaladr University LHB
Develop a Health Board policy defining medication-review standards and risk-priority levels for managed practices.
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Concerns raised1
Lack of a direct pharmacy-to-provider means for reporting stopped methadone collection
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
- Waythrough
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Waythrough
Communicate accurate contact information, including telephone numbers and secure email addresses, to all Community Pharmacies.
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Concerns raised1
Failure of the electronic patient system to flag uncollected or undispensed medication for early identification of non-compliance
Linked response
- NHS England
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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NHS England
Investigate HJIS reporting functions to identify a mechanism for detecting non-collection of in-possession medicines.
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NHS England
Write to Health and Justice regional teams and request commissioners remind prison healthcare staff to monitor uncollected in-possession medicines using available HJIS and local processes.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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NHS England
An automated medication non-compliance flag would not improve safety because it would be seen only when a clinician opens the patient record.
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Concerns raised1
Lack of GP resources for proactively checking collection of prescribed medication
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- Birmingham and Solihull Integrated Care System
- Birmingham and Solihull Mental Health NHS Foundation Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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Birmingham and Solihull Integrated Care System
Proactive monitoring of whether patients collected prescribed medicines cannot be undertaken because pharmacies do not record collection and no such facility exists.
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Birmingham and Solihull Mental Health NHS Foundation Trust
The Trust will not respond to concerns about GPs proactively checking medication collection, leaving the matter to others.
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Concerns raised1
Lack of a procedure for regular monitoring of medication prescribing, collection and response
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Greater Manchester Mental Health NHS Foundation Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Greater Manchester Mental Health NHS Foundation Trust
The GP practice is to provide the response concerning medication prescribing, correspondence handling, pharmacy communication and escalation processes.
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Concerns raised1
Failure to notify relevant professionals of doubt about medication compliance
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- PENTRE LODGE CARE HOME LIMITED
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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PENTRE LODGE CARE HOME LIMITED
Review care-note wording for medication non-adherence and hoarding incidents.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Data last updated 7 September 2026