Last Updated on June 13, 2016

New guidance has been launched to support prescribing healthcare professionals to review inappropriate prescriptions for people under their care who have a learning disability and/or autism. The Stopping Over Medication of People with Learning Disabilities toolkit comes as NHS England and Rt Hon Alistair Burt MP, Minister of State for Community and Social Care, joined forces with five professional bodies and the Challenging Behaviour Foundation (CBF) to pledge sustained action to tackle the over-prescribing of psychotropic drugs to people whose behaviour is challenging.

Multiple psychotropic drug use often starts at a specialist level, which is then passed onto primary care for long-term management. Research published last year found that, in too many cases, these prescriptions are repeated without adequate review.

An estimated 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant or both without appropriate clinical justification. Long-term use of these drugs can lead to significant weight gain, organ failure and, in some cases, death.

The Stopping Over Medication of People with a Learning Disability (STOMPLD) pledge has been signed by the Royal Colleges of Nursing, Psychiatrists and GPs, as well as the Royal Pharmaceutical Society, the British Psychological Society and NHS England.

It commits each to ‘work together, and with people with a learning disability and their loved ones, to take real and measurable steps to stop over-medication’, and is intended to mark the beginning of a series of actions by the signatories over the coming months.

Professor Sir Bruce Keogh, NHS England’s National Medical Director, said, ‘Reducing use of powerful drugs whenever we can is a good thing. We have managed this successfully in dementia; it’s now time to bring similar benefits to patients who have a learning disability.’

The new pamphlet, co-designed by NHS England and the Royal College of GPs, will support and encourage family doctors and their teams to review prescriptions of people on their patient list, and ensure that psychotropic drugs are only continued where the person poses a severe risk to the safety of themselves and others, and all other alternatives have been exhausted.

Dr Matt Hoghton, Medical Director for the Royal College for GPs Clinical Innovation and Research Centre, said, ‘Working collaboratively between healthcare professionals and carers is really important in tackling the appropriate use of psychotropic drugs in our patients with learning disabilities, and signing this pledge is an important commitment to ensuring they receive the best possible care.

‘Whilst GPs rarely initiate these medications, they have a key role to play in reviewing and ensuring our patients with learning disabilities are only taking drugs if they need to, and that their records indicate why they are taking them, so this guidance is welcome.’

Research commissioned by NHS England and delivered in three reports from the Care Quality Commission, Public Health England and NHS Improving Quality last year found that:

• There is a much higher rate of prescribing of medicines associated with mental illness amongst people with a learning disability than the general population, often more than one medicine in the same class, and in the majority of cases with no clear justification;
• Medicines are often used for long periods without adequate review, and;
• There is poor communication with parents and carers, and between different healthcare providers.

Individuals and their loved ones who are concerned with a current prescription are encouraged not to stop taking medication immediately, but to consult their doctor or supervising clinician. Information for patients and their families and carers who believe they may be affected is available on the NHS England website (also in easy read). In summary, the advice to patients is as follows:

• Don’t stop taking medicines or change them without professional medical advice first; doing so could be dangerous.
• Speak to the person responsible for prescribing these medicines as soon as possible, and ask for them to be reviewed.  This will usually be the GP, specialist doctor, pharmacist or nurse prescriber.
• Please remember that not all medicines that are prescribed to treat people with learning disabilities are antipsychotic or sedative medicines – if someone has concerns, please check and speak to the person responsible for prescribing them (GP, specialist doctor, pharmacist or nurse prescriber).
• Also, antipsychotic and sedative drugs can be effective in treating some people with learning disabilities when used appropriately.

Stopping Over Medication of People with Learning Disabilities is available to read on NHS England’s website here.