HL Deb 21 July 1988 vol 499 cc1487-9

3.25 p.m.

Lord Sefton of Garston asked Her Majesty's Government:

Whether they will ensure that before any repeat prescriptions are made of the benzodiazepines mentioned in Current Problems 21, the GP concerned shall re-examine the patient and that a data sheet warning of any side effects will be given to the patient.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Skelmersdale)

My Lords, professional decisions of this type are the responsibility of the doctor concerned. Many general practitioners already operate repeat prescribing control systems which ensure their patients are regularly reviewed. GPs must also use their judgment in deciding how much to tell a patient about the possible side effects of a particular drug.

Lord Sefton of Garston

My Lords, will the Minister accept that his reply will give serious concern to people who either are patients or have relatives with this problem? The circular to which I refer was published in January 1988. It refers to the effects of a short period of taking the drug Ativan. Some of its effects can lead to suicide and aggressive behaviour. The circular recommends to doctors that it should not be prescribed for longer than four weeks. Since January hundreds of people have been represcribed this drug without the doctor seeing them. Have we reached the stage where we can no longer trust doctors to exercise proper responsibility in this respect?

Lord Skelmersdale

My Lords, while we share the concern that has been expressed over the prescribing of benzodiazepines we believe that such concerns are best addressed by the medical profession in the first instance. That is why the Government are determined that the chief medical officer should hold discussions with the relevant professional bodies about the prescribing of these drugs. We must get this matter into proportion. There are several medical conditions for which these drugs are appropriate.

Baroness Gardner of Parkes

My Lords, will the Minister confirm that most medical practitioners—indeed, I believe all on the national health list—receive circulars from the department which clearly set out the side effects of any drug of this type? Moreover, general practitioners now, particularly the newer ones, will have undergone an additional three years' vocational training which is of enormous value. I am sure the remark about not trusting doctors will not be upheld by most Members in this House.

Lord Skelmersdale

My Lords, I am interested in my noble friend's remarks. She is of course right. The DHSS funds the distribution to doctors of the British National Formulary, which is issued twice a year and has been since the early 1980s. The Drug and Therapeutics Bulletin and the Adverse Drug Reactions Bulletin have both recently carried articles, in July 1987 and June 1986 respectively.

Lord Ennals

My Lords, without necessarily supporting the comments made by my noble friend, may I support his constructive proposals? Does the Minister accept that there is now a major problem in diazepines and tranquilliser addiction? It is almost always due to ill-advised repeat prescriptions. Does the Minister accept from me that the task of escaping from this addiction is a major challenge which requires a great deal of support for those who are seeking to break from something so addictive?

Lord Skelmersdale

My Lords, I am advised that these drugs are not always addictive. However, having said that, I go along with what the noble Lord, Lord Ennals, said. I firmly believe that it would be inappropriate to ban benzodiazepines. They are clinically useful for patients suffering from anxiety or insomnia where treatment is given for short periods of time. I add that they are much less addictive than barbiturates which they replaced for much the same purpose.

Lord Ennals

My Lords, my noble friend did not suggest that this form of medication should be prohibited.

Lord Skelmersdale

My Lords, no. I was merely reinforcing his non-suggestion.

Lord Peston

My Lords, I ask the Minister to bear in mind that the issue is not benzodiazepines themselves but repeat prescribing which seems to be growing at a very rapid pace. If this is happening, can the Minister either use his good offices to emphasise the seriousness of the matter to the medical profession or alternatively do something about giving medical training to doctors' receptionists who seem to be the principal persons whom patients see for these drugs?

Lord Skelmersdale

My Lords, I have no doubt that all these matters will be raised by the chief medical officer at the talks to which I have referred. We and the medical profession are anxious to control the level of repeat prescribing and I believe that to be generally welcomed throughout your Lordships' House. Many doctors recognise the need for a regular review of repeat prescriptions and they operate their own control systems. The health departments already monitor instances of prescribing that seem to be excessive, using information from the prescription pricing authorities. Discussions with the profession are taking place about how information concerning repeat prescribing can be improved. This will enable doctors to exercise a greater level of control. I stress that this is principally a problem for the doctors. We will do everything in our power to help.

Lord Sefton of Garston

My Lords, I thank my noble friend on the Front Bench for confirming the purport of my question which was about represcribing. In January 1988, doctors were told to be very careful and to monitor the use of Ativan and various other drugs in that category because they are dangerous and addictive. Since January 1988—

Noble Lords

Question!

Lord Sefton of Garston

My Lords, do noble Lords wish me to make a speech? Since January 1988 many doctors have been continually represcribing this drug through the receptionist. In view of that will the Minister take some firm steps to ensure that no represcribing takes place without the patient being seen by the doctor?

Lord Skelmersdale

My Lords, as I sought to illustrate earlier, that is not always appropriate. The number of prescriptions for drugs dispensed by community pharmacists in Great Britain shows a steady decline. From a peak of 31 million in 1979 the number of prescriptions has fallen to about 25 million in 1986. Pressure is continuing on this point.

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