First reported 14 Jul 2016•Latest report 7 Jan 2025
Definition
What this concern includes
Includes failures of clinical guidance, decision criteria or supporting processes specifically governing whether medication should be continued, paused or discontinued, including guidance on treatment duration, remission-related discontinuation and medication-specific risk considerations.
Not included
Excludes general medication prescribing, administration, monitoring or supply failures where continuation or discontinuation guidance is not the unsafe condition.
Excludes guidance deficiencies concerning a single named clinical condition or treatment pathway when that condition or pathway provides the more specific supported boundary.
Excludes generic clinical-policy updating, training or evidence-review failures unless they directly impair guidance for medication continuation or discontinuation decisions.
Excludes decisions to continue or discontinue medication that are clinically disputed but not linked to unclear, absent or inconsistently applied guidance.
Reports
6
Distinct published reports
Individual concerns
6
A report can raise multiple concerns
Date range
2016–2025
First to latest report issue date
Stated actions
6
Described in published responses
Reports over time
Reports 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.
National Institute for Health and Care Excellence4
NHS England3
Department of Health and Social Care1
Greater Manchester1
Medical Centre1
Medicines and Healthcare products Regulatory Agency1
Royal College of General Practitioners1
Warwick Hospital1
Executive non-departmental public body6
Domiciliary care provider1
Healthcare site1
Health professional body1
Medicines and medical devices regulator1
Ministerial department1
Social-care provider1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Gloucestershire
Concerns raised1
Inadequate guidance on persisting with or switching SSRI medication when there is no benefit or adverse side effects
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Provide a Mental Health toolkit containing evidence-based guidance on medical and psychological treatments for depression and anxiety.
Stated by Royal College of General PractitionersStated completedThe respondent said that this action was complete when they made their response on 9 January 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
Medication side-effect and SSRI safety concerns are best addressed initially by the MHRA, with NICE considering action after collaborative work concludes.
Stated by National Institute for Health and Care ExcellenceRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Existing NICE guidance addresses suicide-risk warnings, treatment review and switching antidepressants when SSRIs are ineffective or cause side effects.
Stated by Royal College of General PractitionersExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Manchester South
Concerns raised1
Lack of national guidance for primary care clinicians on assessing whether to prolong anticoagulation for elderly immobile patients
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Review guidance on stopping and starting VTE prophylaxis to determine whether an update is warranted.
Stated by National Institute for Health and Care ExcellenceStated plannedThe respondent said that this action was planned when they made their response on 5 November 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Existing national guidance addresses discharge VTE risk assessment and prophylaxis decisions, although it does not advise starting prophylaxis de novo in the community.
Stated by National Institute for Health and Care ExcellenceDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Manchester South
Concerns raised1
Lack of clear guidance on discontinuing nilotinib or similar drugs when patients are in remission
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
The MHRA is considered more appropriate to comment on guidance concerning continued tyrosine kinase inhibitor treatment after remission.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Clinical practice issues, including prescribing and treatment decisions, are outside the medicines regulator’s remit.
Stated by Medicines and Healthcare products Regulatory AgencyOutside remitThe respondent said that this matter was outside its role or authority.
Warwickshire
Concerns raised1
Lack of clear guidance for clinicians on pausing DOACs
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Further consider the issues raised through guideline surveillance to determine whether the VTE guideline requires updating.
Stated by National Institute for Health and Care ExcellenceStated plannedThe respondent said that this action was planned when they made their response on 8 August 2024.
Action
Update the Oral Anticoagulant Guideline with a link to the UK Clinical Pharmacy Association perioperative medicines guidance.
Stated by The TrustStated completedThe respondent said that this action was complete when they made their response on 8 August 2024.
Action
Further update the Oral Anticoagulant Guideline to provide clearer guidance on DOAC management.
Stated by The TrustStated plannedThe respondent said that this action was planned when they made their response on 8 August 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
Position
Responsibility for responding to concerns about national DOAC guidance lies with NICE, which develops evidence-based NHS guidelines.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Publishing national clinical guidance on pausing direct oral anticoagulants is outside NHS England’s remit.
Stated by NHS EnglandOutside remitThe respondent said that this matter was outside its role or authority.
Position
NICE is responsible for relevant national guidance on pausing Apixaban and direct oral anticoagulants.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Guidelines cannot cover all clinical circumstances and do not specifically address pausing direct oral anticoagulants.
Stated by National Institute for Health and Care ExcellenceUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
National guidance on perioperative DOAC management is available, although the Trust considers its own guidance requires greater clarity.
Stated by The TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Milton Keynes
Concerns raised1
Lack of guidance on when to recommence Warfarin after head injury
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Consider extending the head-injury guideline’s scope to examine evidence and develop recommendations on restarting warfarin during the 2017 update.
Stated by National Institute for Health and Care ExcellenceStated plannedThe respondent said that this action was planned when they made their response on 31 October 2016.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Specific recommendations on restarting Warfarin after head injury cannot be made without extending the guideline’s scope.
Stated by National Institute for Health and Care ExcellenceUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Manchester South
Concerns raised1
Lack of standard directions for managing requests to restart a discontinued medication
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Legal responsibility for prescribing lies with the doctor who signs the prescription.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
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Includes failures of clinical guidance, decision criteria or supporting processes specifically governing whether medication should be continued, paused or discontinued, including guidance on treatment duration, remission-related discontinuation and medication-specific risk considerations.
