The dangers of GPs reviewing psychiatric medication
I am just back from what should've been a routine trip to see my GP -- my twice-yearly medication review. In the past, this has been a rubber-stamping exercise. But now, with GP Commissioning, it's become a whole new ball game, and one which needs to be exposed. It began innocuously enough:
GP: "Have you been to see your consultant recently Ian?"
GP: "You are on an awful lot of medication, Ian. Was he happy with your medication?"
But then ...
GP: "I going to make some changes to your tablets today, Ian".
The reason -- none given but easily figured out once I'd rifled through my trusted copy of the British National Formulary (every mental health journalist has one -- most patients should too) -- to save the NHS money.
In the case of my anti-psychotic, swapping from a 6mg tablet to two 3mg tablets was enough to save around £20 a month, according to the BNF. That seems harmless enough -- it's more hassle for me and the chemist to deal with twice as many tablets, but no change to the medication or the dosage.
What came next, I wasn't prepared for.
GP: "Ian, I see you are on escitalopram 15mg. You have been on citalopram [a similar drug] in the past. I think 20mg of this would be the same thing. I am going to change you to that!"
Shocked, stunned face - even 40mg citalopram left me suicidal!
Escitalopram is an "isomer", the purest form of citalopram. Is is from the same manufacturer, but it is far, far more powerful and the only antidepressant which has kept me from suicide over the past several years. Now I am a mental health journalist, my dad is the retired chief hospital pharmicist, and my mum is a retired former A&E and Intensive Care ward sister.
So he wasn't going to get away with this. I have already made a contemporaneous note to give to my consultant psychiatrist and care coordinator when I next visit the local CMHT clinic on Wednesday. This would have saved just £15 a month, or thereabouts, according to the BNF, yet put my life in danger.
What if I weren't clued up on psychiatric meds? If I were in relapse and unable to stand up for myself? If I came from a non-medical background and profession? If I trusted my GP to do what was right for me and not his commissioner's budget?
Is my situation a one-off or could it happen to you?
It seems this is not an isolated case - I know of someone who relied on Z-drugs and had those removed without warning from their repeat prescription list. Again, GPs are trying to withdraw people abruptly from diazaepam and other benzos. Mine is an extreme example -- if you are unstable on medication and seriously unwell it is unlikely your GP would be carrying out a med review -- you'd be under the a CMHT -- so I don't want to cause alarm.
I would like you to help me out with this one for a possible future story. If your GP is now solely responsible for your medication, or reviews it aggressively, please let me know using the form below or email email@example.com. I am in meetings and appointments much of the week and on holiday next week but will endeavour to respond to you as soon as I possible can nevertheless -- I don't really do holidays(!).
The mental health community needs to take action now to ensure that GP Commissioning doesn't lead to a two-tier mental health service -- one in secondary care where consultants put patients first, and one in primary care where GPs put their budgets first. I am on a lot of medication -- some of which is extremely expensive still as it's proprietary -- my GP was happy to make his savings today but warned as I left the surgery: "One step at a time, Ian. We'll change them one step at a time." No, I thought, no you won't. So my consultant will be writing to him this week!
Over to you ...