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Two major national studies, conducted by staff in the Unit and colleagues from a number of other institutions, provide the most comprehensive estimate to date of the prevalence of prescribing errors in general practice in England. These studies identified a number of strategies for reducing these prescribing errors that have been endorsed by the General Medical Council (GMC). Other impacts from these studies include increased public understanding and debate through media coverage, changes to GP education to be implemented by the Royal College of General Practitioners (RCGP), improvements to computerised prescribing decision support for general practitioners and increased awareness of the medication safety role of primary care pharmacists.
Research undertaken on prescribing strategy by the Centre for Medicines Optimisation (School of Pharmacy) is embedded in NHS policy for medicines management. Keele's bespoke reports for the West Midlands Region provided the template for national performance management of primary care prescribing. Linked educational outreach studies established the use of community pharmacists as change agents. Both of these approaches are referenced in separate National Audit Office reports. In addition, Keele piloted risk sharing between pharmaceutical companies and the NHS, now adapted in DH Joint Working Guidelines and NICE policy. Their work on effective shared care is referenced in the 2013 GMC guidance on good practice in prescribing. These principles have been adapted for their WHO government level reports.
Research by the University of Southampton has contributed significantly to reducing the global threat of antibiotic resistance. A series of both conventional placebo-controlled and novel open design trials has influenced a number of important national clinical guidelines for Respiratory Tract Infections (RTIs) and the implementation of novel prescribing strategies that discourage unnecessary antibiotic prescription. As a direct result of the research, delayed prescribing for all acute respiratory infections is a tool in the everyday practice of the UK's GPs. Southampton's work in this field has informed international guidelines currently in place in the United States, Israel and the European Union.
Research by Cardiff University is contributing to initiatives within the NHS and across Europe to safely reduce unnecessary antibiotic prescribing and thus help contain antimicrobial resistant bacteria. Our researchers conducted observational studies of prescribing patterns linked to local resistance data and qualitative research with GPs and patients on their perceptions of acute respiratory tract infections and antibiotic use and resistance. This enabled the Cardiff team to develop clinician training and patient education resources (covering issues such as communication skills, point of care testing, and typical duration of infections) to reduce unnecessary prescribing. Our trials proved these interventions were effective, at times cutting prescribing by as much as two-thirds. Our research has provided the basis for new clinical guidelines, antibiotic stewardship initiatives and policies, and educational tools for clinicians and patients that are being used in the UK and internationally.
Patient safety research from Manchester Pharmacy School at the University of Manchester (UoM) has reduced prescription errors in primary and secondary care. Pharmacists using our indicators with patients' electronic health records (aimed at preventing drug-related morbidity in general practices) reduced the odds of prescribing and monitoring problems by at least 22%. These indicators are now incorporated into `medicines optimisation' software for general practice computer systems. The EQUIP study led changes in the recommended design of hospital prescription charts, an annual national assessment of prescribing competence of medical students and the employment of extra hospital pharmacists to prevent the 9% of prescriptions with errors from harming patients.
Our research has: i) increased public and professional knowledge and understanding of the prevalence, nature and causes of prescribing errors in general practices; ii) led the General Medical Council to recommend improvements to GP education and training; iii) led to the Royal College of General Practitioners to revise its curriculum to increase the emphasis on safe prescribing; iv) led one of the major GP computer system suppliers to make safety improvements; v) identified an IT-based intervention that is effective at reducing prescribing errors; vi) led to the roll-out of the intervention in over 800 general practices.
Leeds researchers first proposed and tested the concept of a pharmacist-led clinical medication review and showed its effectiveness in care homes. This led to a collaborative study on medicines' safety in care homes which showed seven out of ten residents, on any one day, had at least one medication error. As a direct result, there was a ministerial-led summit, and the Department of Health (DH) issued a `Health Alert' requiring NHS trusts to take immediate action, citing the study findings. This was followed by several national initiatives to take forward the recommendations of the study, including a DH commissioned initiative involving Royal Colleges, the National Care Forum, the Health Foundation and Age UK. Prototype tools developed on the basis of our research and with Leeds input were reported in 2012 and are now being evaluated for national roll out.
Research at the University of Manchester (UoM) has, and continues to have, a direct impact on pharmacy policy and practice. From 1993, our work on the contribution of pharmacists to primary health care has helped improve patients' access to medicines and pharmacies. Our `Care@TheChemist' trial led to changes in the national pharmaceutical contract and now almost 5,000 pharmacies offer the service to several million primary care patients. Our skill mix research is used to inform regulatory control of pharmacies and our wider workforce research continues to inform national governments about how to forecast future requirements for pharmacist numbers.
University of Bradford research into medication error management has directly impacted upon policy and practice, informing changes to mitigate potential harm across the 49 children's hospice services in the UK. Implementation of a research-informed medicines management toolkit co-produced by the Bradford team and Children's Hospices UK (now Together for Short Lives) resulted in hospices identifying key vulnerabilities and using guidance from the toolkit to make significant service improvements. This impact of this research has resulted in changes in both practice and behaviour by strengthening systems for error reporting including the analysis of contributory factors — staff are now identifying more errors and near misses, consequently leading to a reduced risk to the children.
Research conducted at the University of Aberdeen into the treatment of depressive disorder in primary care has directly led to the revision of health care policy by the Scottish Government Health Department. The work initiated debate over the validity of tools for the assessment of depression, contributing to revision of the Quality and Outcomes Framework (QOF), a system for the performance management and payment of GPs in the NHS in the UK. The findings are now being discussed in commentaries on the development of forthcoming disease classification systems for depression in the US (Diagnostic and Statistical Manual DSM-revision V) and Europe (International Classification of Disease — ICD revision 11).
Therefore the claimed impact is on: health and welfare; changes to public policy and on impact on practitioners and services.