Postcode lottery for anti-psychotics

GPs in some northern towns are prescribing anti-psychotic medication at more than three times the rate of others, research has revealed.

Analysis of 120 million anonymous NHS records has revealed that medical practices in Rochdale dish out some of the highest levels of prescriptions for schizophrenia and related conditions in England – at 34 per 1,000 residents. In contrast, doctors in York hand out just 10 – among the lowest in the country.

Habits of prescribing

While such regional variations deserve more investigation, the overall use of such drugs should also be reduced across the board, an expert has warned.

Dr Philip Timms, of the Royal College of Psychiatrists, said: “Quite honestly, I think people sometimes get stuck in habits of prescribing. Anti-psychotics have been over-prescribed for years. There’s a lot of interesting work to be done to get some clearer answers about regional differences, but the pressures of the system can lead some colleagues to ingrained habits of thought when it comes to treating patients.”

A team from the University of East London examined the prescription data from 2015-16, extracted those relating to psychotic conditions and broke the results down to local authority level. It shows that overall rates for prescribing drugs for schizophrenia and related conditions are higher in the north than the south – an average of 21 prescriptions per 1,000 people compared to 18. Other hotspots include Manchester, Liverpool, Wigan and Hull, which all record more than 30 prescriptions per 1,000.

Comparison with the equivalent data from 2010-11 shows Selby was among the areas with the greatest increase in prescriptions – with a rise of 11 per cent – while York and Wirral both showed a two per cent fall.

Project leader Prof Allan Brimicombe said: “The aim of this research is to pose questions and there’s definitely a lot more digging to be done. While there may be certain genetic predispositions to developing these conditions, elements of lifestyle are also thought to contribute to them – including drug and alcohol use and environmental stresses such as deprivation. The changes in prescribing levels may reflect mental health policy, but again this requires more research.”

Timms, who until recently worked as a community psychiatrist with homeless people in London, says prescribing levels may vary geographically for a variety of reasons. Incidence of such conditions appear to vary hugely between places, while care pathways may also differ geographically. GPs may not be the ones doing the prescribing in some areas.

He said: “For schizophrenia and other conditions incidence may vary. There are wildly different levels of disorders in different areas. A lot of mental illnesses – as with physical illnesses – are associated with deprivation, and that’s understandable.

“This data is specifically related to GP prescriptions. There could be differences between areas in terms of how much GPs take on the care of psychotic patients. For example in London, patients are often cared for by specialist services and if someone is on a monthly injection most GPs down here won’t do it so these patients disappear from the GP surgery data. That could be different somewhere else.”

Timms is also concerned by the over-use of these powerful medications across the board, something he puts down to conservatism among some in the profession as well as systemic challenges within the mental health system. He believes many doctors have become too fixed in their way of treating patients.

He said: “With my team, nine times out of 10 we could bring down a patient’s dose by a quarter or a third within six months of them leaving the ward, but some in the profession are too ingrained in their prescribing habits and aren’t following the evidence.

“If someone is put on an anti-psychotic the initial decision is generally made by a consultant psychiatrist but after that patients are usually seen by junior colleagues who maybe don’t have the confidence to reduce or stop the medication.

“There aren’t enough doctors, particularly psychiatrists, and as a result of this and other pressures our patients don’t get expert review often enough. No one has the nerve or thinks they have the right or expertise to reduce medication.”