Report evidence summary
Stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised. 21
Department of Health and Social Care Request NICE guidance on safe prescribing of dependence-associated medicines and careful withdrawal management.
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Department of Health and Social Care Request a review of NHS overprescribing, concurrent problematic medication use and helping patients stop unnecessary repeat prescriptions.
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Department of Health and Social Care Work with healthcare regulatory partners to improve the safety of medicines supplied online.
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Department of Health and Social Care Commission an evidence review of the scale, distribution and causes of prescription drug dependence and potential responses.
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NHS Mid Essex Clinical Commissioning Group Analyse practice-level controlled-drug prescribing data and monitor progress in opioid deprescribing.
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NHS Mid Essex Clinical Commissioning Group Distribute and promote PrescQIPP webinars and e-learning resources to prescribers.
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NHS Mid Essex Clinical Commissioning Group Include opioid-reduction requirements in the Medicines Optimisation Local Enhanced Scheme for participating practices.
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NHS Mid Essex Clinical Commissioning Group Continue discussing long-term opioid safety through the Medicines Optimisation Committee and seeking GP support for new guidance.
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NHS Mid Essex Clinical Commissioning Group Develop and mobilise a commissioned Management of Prescribed Opioid Dependence Local Enhanced Service providing multidisciplinary support, weaning plans and primary-care education.
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NHS Mid Essex Clinical Commissioning Group Make opioid safety and withdrawal resources, including patient information leaflets, publicly available on the CCG website.
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NHS Mid Essex Clinical Commissioning Group Configure Scriptswitch to flag high-dose opioid risks, provide specialist contact details and link to the opioid resource pack.
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NHS Mid Essex Clinical Commissioning Group Identify 174 patients prescribed oxycodone and amitriptyline and alert their GPs to conduct early medication reviews.
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NHS Mid Essex Clinical Commissioning Group Deliver an Opioids and Safe Prescribing session at the March Time to Learn event.
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NHS Mid Essex Clinical Commissioning Group Revise and publish joint pain guidance incorporating opioid deprescribing, social prescribing and non-pharmacological alternatives.
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NHS Mid Essex Clinical Commissioning Group Add a prescribing-system reminder prompting GPs to ask about over-the-counter codeine products before prescribing codeine.
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NHS Mid Essex Clinical Commissioning Group Publish an open patient letter encouraging self-reduction of low-dose opioids.
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NHS Mid Essex Clinical Commissioning Group Provide learning resources supporting clinicians to identify, assess and respond to medicine dependence and withdrawal.
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NHS England Continue supporting primary care through additional funding, staff and organisational development for vulnerable, high-risk patients.
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NHS England Develop a full understanding of factors contributing to dependence on prescribed medicines and associated serious harm.
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NHS England Establish a review group examining dependence on and withdrawal from prescribed medicines, including opiate prescribing.
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NHS England Ensure appropriate expertise and resources are universally available to support patients dependent on prescribed medicines and reduce associated morbidity and mortality.
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× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Inadequate training and education for general practitioners and GP practices in care for patients dependent on prescribed opiates
Wider context from the report “The General Practitioner who gave evidence told the court that there was a lacuna in the healthcare provided for patients such as the deceased in terms of giving assistance for weaning off addictive prescription drugs such as opiates. It was clear that General Practitioner’s require highly specialised assistance in order to help such patients and agencies within the healthcare system to which to refer them. This was all lacking in this particular sad set of circumstances. The court was informed about a proposed pilot scheme – a substance misuse Locally Enhanced Service for people with dependence to prescribed opiates. There was no assurance that this had commenced or indeed yet been funded. I would like an assurance that this hopeful initiative has got off the ground and indeed I would like to have information about any other initiatives to endeavour to address this dreadful problem. I would also like to hear what strides have been taken to improve training and education for general practitioners and GP practices in this worrying area of care .
” Is this part of a recurring concern? No recurring-concern membership is currently published.
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Lack of specialised assistance and referral agencies for general practitioners supporting patients dependent on prescribed opiates
Wider context from the report “The General Practitioner who gave evidence told the court that there was a lacuna in the healthcare provided for patients such as the deceased in terms of giving assistance for weaning off addictive prescription drugs such as opiates . It was clear that General Practitioner’s require highly specialised assistance in order to help such patients and agencies within the healthcare system to which to refer them . This was all lacking in this particular sad set of circumstances . The court was informed about a proposed pilot scheme – a substance misuse Locally Enhanced Service for people with dependence to prescribed opiates. There was no assurance that this had commenced or indeed yet been funded . I would like an assurance that this hopeful initiative has got off the ground and indeed I would like to have information about any other initiatives to endeavour to address this dreadful problem. I would also like to hear what strides have been taken to improve training and education for general practitioners and GP practices in this worrying area of care.
” Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Request NICE guidance on safe prescribing of dependence-associated medicines and careful withdrawal management.
Verbatim wording from the response “In addition, the Department asked the National Institute for Health and Care Excellence (NICE) to develop guidance on the safe prescribing of drugs associated with dependence” Source location 2019-0369-Response-from-the-Department-of-Health-and-Social-Care
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Request a review of NHS overprescribing, concurrent problematic medication use and helping patients stop unnecessary repeat prescriptions.
Verbatim wording from the response “The report acknowledged that work to tackle this issue has already started or is planned. For example, England’s Chief Pharmaceutical Officer, Dr Keith Ridge, was asked by the Secretary of State for Health and Social Care, Matt Hancock, to review overprescribing in the NHS, problematic use of multiple medications concurrently, and how to help patients come off repeat prescriptions they no longer need.” Source location 2019-0369-Response-from-the-Department-of-Health-and-Social-Care
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Work with healthcare regulatory partners to improve the safety of medicines supplied online.
Verbatim wording from the response “In the UK, strict legal requirements apply to the retail sale and supply of medicines for example, Prescription Only (POM) and Pharmacy (P) medicines may only be legally sold or supplied to the public through registered pharmacy premises, by or under the supervision of a pharmacist and POMs may only be sold or supplied in response to a prescription from an authorised healthcare professional (such as a doctor, dentist, or certain trained nurses and pharmacists). Legal controls apply without distinction to medicines sold online and much is being done by healthcare regulators to protect the public and improve the safety of medicines online. The Department is working closely with healthcare regulatory partners to support this work.” Source location 2019-0369-Response-from-the-Department-of-Health-and-Social-Care
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Commission an evidence review of the scale, distribution and causes of prescription drug dependence and potential responses.
Verbatim wording from the response “In 2017, Public Health England (PHE) was commissioned to conduct an evidence review to identify the scale, distribution and causes of prescription drug dependence, and what might be done to address it. PHE’s report of the review was published in September 2019¹.” Source location 2019-0369-Response-from-the-Department-of-Health-and-Social-Care
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Analyse practice-level controlled-drug prescribing data and monitor progress in opioid deprescribing.
Verbatim wording from the response “Actions now being undertaken to implement the recommendations from the PHE report include:” Source location 2019-0369-Response-by-Mid-Essex-CCG
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Distribute and promote PrescQIPP webinars and e-learning resources to prescribers.
Verbatim wording from the response “4) Signposting to webinars and e-learning” Source location 2019-0369-Response-by-Mid-Essex-CCG
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Include opioid-reduction requirements in the Medicines Optimisation Local Enhanced Scheme for participating practices.
Verbatim wording from the response “1) Inclusion of opioid reduction within the Medicines Optimisation Local Enhanced Scheme” Source location 2019-0369-Response-by-Mid-Essex-CCG
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue discussing long-term opioid safety through the Medicines Optimisation Committee and seeking GP support for new guidance.
Verbatim wording from the response “6) Engagement with GPs” Source location 2019-0369-Response-by-Mid-Essex-CCG
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop and mobilise a commissioned Management of Prescribed Opioid Dependence Local Enhanced Service providing multidisciplinary support, weaning plans and primary-care education.
Verbatim wording from the response “• Working closely with our local substance misuse service provider, mental health trust and local pain consultants to develop a Management of Prescribed Opioid Dependence Local Enhanced Service, more details of which are provided below.” Source location 2019-0369-Response-by-Mid-Essex-CCG
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Make opioid safety and withdrawal resources, including patient information leaflets, publicly available on the CCG website.
Verbatim wording from the response “• Building on previously developed resources to support safe management and withdrawal of opioids and making these publicly available on the CCG website, including patient information leaflets on the safe use of opioids.” Source location 2019-0369-Response-by-Mid-Essex-CCG
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Configure Scriptswitch to flag high-dose opioid risks, provide specialist contact details and link to the opioid resource pack.
Verbatim wording from the response “2) Inclusion of pop-up information message on Scriptswitch®” Source location 2019-0369-Response-by-Mid-Essex-CCG
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Identify 174 patients prescribed oxycodone and amitriptyline and alert their GPs to conduct early medication reviews.
Verbatim wording from the response “In response to this letter, we have used Eclipse Live to identify 174 patients in mid Essex on oxycodone and amitriptyline and have sent an alert message to each patient’s registered GP encouraging an early medication review. We have also added onto Scriptswitch® (a prescribing support system which runs on GP practices’ clinical systems) a reminder to GPs to ask about over the counter codeine or codeine-containing products when they are considering prescribing any codeine.” Source location 2019-0369-Response-by-Mid-Essex-CCG
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Deliver an Opioids and Safe Prescribing session at the March Time to Learn event.
Verbatim wording from the response “A session on Opioids and Safe Prescribing is also planned at the CCG’s Time to Learn event in March. These are quarterly events organised by the CCG for all surgeries in mid Essex, with paid clinical cover to allow GPs to attend in normal working hours, where practices can take part in collective learning and share best practice.” Source location 2019-0369-Response-by-Mid-Essex-CCG
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Revise and publish joint pain guidance incorporating opioid deprescribing, social prescribing and non-pharmacological alternatives.
Verbatim wording from the response “5) Revised Pain Guidance” Source location 2019-0369-Response-by-Mid-Essex-CCG
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Add a prescribing-system reminder prompting GPs to ask about over-the-counter codeine products before prescribing codeine.
Verbatim wording from the response “In response to this letter, we have used Eclipse Live to identify 174 patients in mid Essex on oxycodone and amitriptyline and have sent an alert message to each patient’s registered GP encouraging an early medication review. We have also added onto Scriptswitch® (a prescribing support system which runs on GP practices’ clinical systems) a reminder to GPs to ask about over the counter codeine or codeine-containing products when they are considering prescribing any codeine.” Source location 2019-0369-Response-by-Mid-Essex-CCG
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Publish an open patient letter encouraging self-reduction of low-dose opioids.
Verbatim wording from the response “3) Open letter to patients encouraging self-reduction of low dose opioids” Source location 2019-0369-Response-by-Mid-Essex-CCG
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide learning resources supporting clinicians to identify, assess and respond to medicine dependence and withdrawal.
Verbatim wording from the response “• Providing a range of learning resources to help clinicians develop their knowledge of, and competence to identify, assess and respond to, dependence or withdrawal associated with some medicines and the support needs of people experiencing problems with withdrawal or dependence.” Source location 2019-0369-Response-by-Mid-Essex-CCG
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue supporting primary care through additional funding, staff and organisational development for vulnerable, high-risk patients.
Verbatim wording from the response “It is important to acknowledge the current pressures on primary care. NHSE continues to support primary care with additional funding, staff and organisational development to ensure time and resources are available to care for these vulnerable patients who are potentially high risk and will often need input from the most experienced staff.” Source location 2019-0369-Response-from-NHS-England-and-NHS-Improvement
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop a full understanding of factors contributing to dependence on prescribed medicines and associated serious harm.
Verbatim wording from the response “NHSE is committed to fully understanding contributing factors to this serious problem and ensuring that all appropriate expertise and resources are universally available to support these patients and reduce the likelihood of future associated morbidity and mortality.” Source location 2019-0369-Response-from-NHS-England-and-NHS-Improvement
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Establish a review group examining dependence on and withdrawal from prescribed medicines, including opiate prescribing.
Verbatim wording from the response “A review group has been established in response to the recent Public Health England review of dependence on, and withdrawal from, prescribed medicines. The group has senior NHS E/I input including Keith Ridge (Chief Pharmaceutical Officer) and Nikki Kanani (Medical Director for Primary Care) as well as other system stakeholders. It will include opiate prescribing. I do not have details of the case other than as outlined in your Regulation 28 report but hopefully the following” Source location 2019-0369-Response-from-NHS-England-and-NHS-Improvement
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Ensure appropriate expertise and resources are universally available to support patients dependent on prescribed medicines and reduce associated morbidity and mortality.
Verbatim wording from the response “NHSE is committed to fully understanding contributing factors to this serious problem and ensuring that all appropriate expertise and resources are universally available to support these patients and reduce the likelihood of future associated morbidity and mortality.” Source location 2019-0369-Response-from-NHS-England-and-NHS-Improvement
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Postgraduate GP training curricula are set by royal colleges and faculties, with GMC approval of curricula and assessment systems.
Verbatim wording from the response “The curricula for postgraduate specialty training, which includes training for GPs, is set by individual royal colleges and faculties, and the GMC approves curricula and assessment systems for each training programme. Training curricula for doctors emphasise the skills and approaches that a doctor must develop in order to ensure accurate and timely diagnoses and treatment plans for their patients.” Source location 2019-0369-Response-from-the-Department-of-Health-and-Social-Care
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Specialised services for people dependent on prescription medicines are the responsibility of local commissioners.
Verbatim wording from the response “Finally, the provision of specialised services to support people dependent on prescription medicines is a matter for local commissioners. I am aware that the Mid-Essex Clinical Commissioning Group (CCG) has responded to your report explaining the services that are in place locally to support patients and GPs. This includes the new Management of Prescribed Opioid Dependence Locally Enhanced Service (referenced in your report), that is anticipated to be in place from 1 April 2020. I am advised that other measures are being taken locally to promote better prescribing and reduce the amount of opioids being prescribed.” Source location 2019-0369-Response-from-the-Department-of-Health-and-Social-Care
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Undergraduate GP education curricula are set by individual medical schools and must meet standards monitored by the GMC.
Verbatim wording from the response “In relation to the education and training of GPs on supporting patients dependent on prescribed medicines, it is for individual medical schools to sets their own undergraduate medical curriculum. These have to meet the standards set by the General Medical Council (GMC), which monitors and checks to make sure that the standards are maintained.” Source location 2019-0369-Response-from-the-Department-of-Health-and-Social-Care
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Extending the existing service to support prescribed-opioid dependence was not possible, so an alternative service model was developed.
Verbatim wording from the response “To address this gap in services, Mid Essex CCG agreed in November 2018 to fund a service to support GPs and patients dealing with this issue. Initially the CCG was hoping to work with Essex County Council to extend the existing STaRS service to include patients dependent upon prescribed opioids. Unfortunately after an extended dialogue with the Council and also directly with Essex Partnership University Trust (the provider of STaRS) it became apparent that this would not be possible and so the CCG has been working with local GPs and pharmacists to develop an alternative service model.” Source location 2019-0369-Response-by-Mid-Essex-CCG
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Commissioning substance misuse services is a public health responsibility of local authorities.
Verbatim wording from the response “The ‘pilot’ scheme referred to by ████████ at the request is a local service that the CCG has been seeking to introduce to support patients with a dependency upon prescribed medicines. Whilst the commissioning of substance misuse services is one of the public health responsibilities of Local Authorities, the Essex Specialist Treatment and Recovery Service (STaRS) commissioned by Essex County Council only provides advice and support to help GPs manage patients dependent on prescribed opioids. STaRS will only see people for adjunctive problematic use of prescribed and/or over-the-counter medications, if their primary problematic substances are alcohol or illicit drugs.” Source location 2019-0369-Response-by-Mid-Essex-CCG
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How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Specialist support beyond general practice is usually delivered through services commissioned by clinical commissioning groups.
Verbatim wording from the response “Many of these patients will require input beyond ‘conventional’ general practice, usually via a CCG commissioned service that could take the form of a Locally Commissioned Service (in effect an enhanced GP service) or through a contract with an alternative provider, usually across a CCG footprint.” Source location 2019-0369-Response-from-NHS-England-and-NHS-Improvement
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