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Pharmacists are increasingly working in UK general practices, presenting an opportunity for practice teams to benefit from their additional professional skills and comprehensive knowledge of medicines. This article examines how pharmacists are helping to reduce inappropriate and inequitable prescribing in general practice and suggests ways in which their contribution can be optimised. [ABSTRACT FROM AUTHOR]

Unchecked antimicrobial resistance is lethal and carries a high economic burden on the global economy. Primary care is central to the success of health service antibiotic stewardship programmes, as most of these infections are managed in the community. This article examines a pioneering programme that aims to reduce resistance to antibiotics commonly used to treat lower urinary tract infections. [ABSTRACT FROM AUTHOR]

Pharmaceutical waste is a serious threat to both human health and the environment. This article discusses the impact of pharmaceutical waste, and explores the possibility of reusing unwanted medicines to mitigate the problem and the current barriers to implementation. [ABSTRACT FROM AUTHOR]

Delayed antibiotic prescribing in primary care can be a useful strategy to help manage patient expectations and reduce antibiotic consumption. This project surveyed GP practices in Cornwall and Isles of Scilly Integrated Care System to identify current approaches to the use of delayed antibiotic prescriptions, as well as the incentives and barriers to implementation. [ABSTRACT FROM AUTHOR]

As Head of Effective Prescribing and Therapeutics for the Scottish Government, Dr Alpana Mair is responsible for advising ministers on the safe, sustainable and effective use of medicines. Here, she talks to Joy Ogden about her work tackling polypharmacy and ensuring the focus is on what matters to the patient when prescribing. [ABSTRACT FROM AUTHOR]

Prescribers in prisons and other secure settings play a key role in supporting the well‐being of prisoners. As part of our series on medicines optimisation in people with additional needs, this article discusses the issues healthcare professionals should consider to ensure safe, optimised prescribing for people who are imprisoned. [ABSTRACT FROM AUTHOR]

Professor Tony Avery OBE is a GP, National Clinical Director for Prescribing and Professor of Primary Health Care at the University of Nottingham. Here, he speaks to Joy Ogden about how his clinical practice and research on improving prescribing safety in primary care complement his leadership role in the implementation of the National Overprescribing Review. [ABSTRACT FROM AUTHOR]

There are many factors that can impact the safety and effectiveness of medicines in people with a learning disability. As part of our series on medicines optimisation in people with additional needs, this article discusses the important issues to consider when prescribing for people with a learning disability. [ABSTRACT FROM AUTHOR]

Monoamine oxidase inhibitors (MAOIs) are generally only initiated by specialists because of safety concerns, making GPs more wary of these medicines. This article discusses the important side‐effects and interactions of MAOIs and how these can be minimised, and explains why MAOI prescribing may be safer than we are led to believe. [ABSTRACT FROM AUTHOR]

Since the pandemic, remote medical consultations have become a routine part of healthcare provision. But the concept of remote consultations mediated via communication technology is not as new as we might expect, and was in fact predicted a century ago. [ABSTRACT FROM AUTHOR]

Reducing inappropriate antibiotic prescribing in primary care is a key element of antimicrobial stewardship. This study carried out in GP surgeries in Cornwall examined whether clarithromycin was being prescribed in accordance with NICE guidance, and whether allergy status and symptoms were correctly recorded in the case of patients who had penicillin allergy noted. [ABSTRACT FROM AUTHOR]

Many newer primary care professionals have limited experience of psychiatry, yet need to manage patients on multiple medications including antidepressants. This article outlines common prescribing dilemmas and solutions for novice primary care prescribers managing patients who require antidepressant therapy. [ABSTRACT FROM AUTHOR]

Pharmacogenetic (PGx) testing to personalise prescribing of certain medicines can improve patient outcomes and reduce adverse drug reactions. This article summarises the key findings of the PGx Impact study, designed to estimate the impact of pre‐emptive genetic testing on prescribing, and discusses potential ways in which pharmacogenetic testing may optimise primary care prescribing in the near future. [ABSTRACT FROM AUTHOR]

In the second of this two‐part series on the non‐medical use of prescription‐only medicines (POM) and over‐the‐counter (OTC) medicines, Graham Parsons discusses how to identify and reduce the risk of non‐medical use of medicines, and provides an overview of the treatment options for managing dependence. [ABSTRACT FROM AUTHOR]

In the first of a two‐part series on the non‐medical use of prescription‐only and over‐the‐counter (OTC) medicines, Graham Parsons discusses the prevalence of the problem, the medicines most likely to be misused and the patient groups at highest risk. [ABSTRACT FROM AUTHOR]

Although knowledge of paediatric prescribing is particularly important for medical students, most undergraduate medical training is spent in adult settings. In this article, two medical students provide their perspectives on the teaching of paediatric prescribing in an undergraduate curriculum and provide suggestions for how this could be improved. [ABSTRACT FROM AUTHOR]

Optimising antibiotic prescribing in the primary care setting is a key component of the UK antimicrobial resistance (AMR) strategy. In this project, the authors worked with eight GP practices in Cornwall that had high levels of antibiotic prescribing to help them find ways to improve their prescribing and reduce antibiotic consumption, using defined daily doses (DDDs) as a measure of consumption. [ABSTRACT FROM AUTHOR]

It is important that opioids are not prescribed long‐term for chronic primary pain, owing to their adverse effects, risk of dependence and limited evidence of benefit. This article discusses strategies for tapering opioids in patients with chronic non‐cancer pain in primary care, emphasising the need for a multifaceted approach, incorporating both patient and prescriber behaviour change. [ABSTRACT FROM AUTHOR]

The use of direct oral anticoagulants (DOACs) is becoming increasingly common in primary care. While this group of drugs requires less intensive monitoring than warfarin, safe prescribing is still necessary to achieve optimum therapeutic effect and minimise adverse effects. This article discusses the key principles of safe DOAC prescribing for non‐valvular atrial fibrillation (NVAF), and the systems that general practices can put in place to achieve this. [ABSTRACT FROM AUTHOR]

This article provides an overview of the antimicrobial stewardship measures and prescribing trends in primary care in Northern Ireland (NI) over recent years. It discusses the impact of the COVID‐19 pandemic on antibacterial prescribing in primary care (including by dentists), and the measures being taken to improve antimicrobial stewardship and reduce antimicrobial resistance in the future. [ABSTRACT FROM AUTHOR]

Anticholinergic medicines are routinely prescribed to manage a variety of clinical conditions, but are potentially inappropriate in the treatment of older people, especially those living with frailty. Here, the authors describe how their AC‐FRAIL tool can assist practices to identify frail older people within a practice population who are at greatest risk from anticholinergic burden. [ABSTRACT FROM AUTHOR]

Supporting cancer patients receiving systemic cancer therapies requires a multidisciplinary approach, and primary care plays a key role in identifying and managing the physical effects of treatment, providing psychosocial support and arranging specialist review. This article discusses the management of patients receiving systemic cancer therapies from a primary care perspective. [ABSTRACT FROM AUTHOR]

Deprescribing preventative medications such as antihypertensives may reduce adverse events in some older adults, leading to improved quality of life. The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE) trial examined the safety and efficacy of antihypertensive deprescribing in older patients taking more than one treatment for hypertension. This article discusses the findings of the study and their implications for clinical practice. [ABSTRACT FROM AUTHOR]

NICE's antimicrobial prescribing guidelines offer evidence‐based advice to help health professionals and patients manage common infections and reduce antimicrobial resistance. This article summarises the antimicrobial guideline on managing leg ulcer infection (NG152). [ABSTRACT FROM AUTHOR]

General practice is now responsible for prescribing more high‐risk medicines with regular monitoring requirements. This article discusses some of the medicines that require more intensive monitoring, and the systems Primary Care Networks can put in place to ensure safer prescribing of these medicines. [ABSTRACT FROM AUTHOR]

Although symptoms of autism often first appear before the age of three years, many children experience significant delays in identification, diagnosis and access to specialist services. This article discusses the signs and symptoms of autism in children, screening and referral, and the management options available. [ABSTRACT FROM AUTHOR]

Polypharmacy in the elderly, weaning patients off steroids, and reducing the use of antibiotics, antidepressants and opioids were among the topics discussed at the Royal College of Physicians' conference Avoiding Harm from Over‐prescribing held in London in November. Joy Ogden presents some of the highlights of the conference. [ABSTRACT FROM AUTHOR]

In light of the recent MHRA restrictions on the use of fluoroquinolone antibiotics, this article provides an overview of the adverse reactions associated with all classes of antibiotic ‐ from the most common side‐effects such as gastrointestinal disturbance to rare, idiosyncratic reactions. [ABSTRACT FROM AUTHOR]

Since 2012, NHS Scotland has published a series of polypharmacy guidelines to help clinicians address the many medication‐related problems arising from multimorbidity. Here, Alpana Mair, Chair of the guideline group, Martin Wilson and Tobias Dreischulte explain how the third and latest edition of the polypharmacy guidance has been updated to place a greater emphasis on what matters to the patient. [ABSTRACT FROM AUTHOR]

NICE recently updated its guideline on the diagnosis and management of chronic obstructive pulmonary disease (COPD) and at the same time published new antimicrobial prescribing guidance on managing acute exacerbations of COPD. This article provides a summary of these two documents. [ABSTRACT FROM AUTHOR]

Last November, the government moved cannabis‐based medicinal products out of Schedule 1 into Schedule 2 of the Misuse of Drugs Regulations, meaning they can now legally be prescribed. However, conflicting advice from different authorities, sourcing difficulties and a lack of guidelines have meant that few patients have so far been able to access these medicines. [ABSTRACT FROM AUTHOR]

In the second of our two‐part series on helping pharmacist independent prescribers set up and run a hypertension clinic in primary care, Briegeen Girvin discusses the factors to consider when prescribing and monitoring antihypertensive drugs and statins. [ABSTRACT FROM AUTHOR]

NICE has recently published a comprehensive set of guidelines on antimicrobial prescribing for urinary tract infections, covering lower urinary tract infection, acute prostatitis, acute pyelonephritis, recurrent infection and catheter‐associated infection. This article provides a summary of the recommendations. [ABSTRACT FROM AUTHOR]

All recently‐qualified medics will be familiar with the Prescribing Safety Assessment (PSA), an examination that must be passed before doctors can move on to their F2 foundation year. Now, the British Pharmacological Society, which co‐created the PSA, is championing wider use of its Prescribing Skills Assessment – the cloudbased learning platform that underpins the PSA – and is introducing a series of 'box sets' to test prescribers in various areas of prescribing. [ABSTRACT FROM AUTHOR]

The annual ESPAUR report provides a roundup of the achievements of the UK Five Year Antimicrobial Resistance Strategy 2013 to 2018 in terms of antimicrobial consumption, resistance, and stewardship in England. This article summarises the findings of the 2018 report. [ABSTRACT FROM AUTHOR]

Social prescribing has the potential to address unmet patient needs and ease pressure on GPs and other healthcare professionals. This article investigates the evidence behind social prescribing, the benefits and drawbacks, and how it is gaining a higher profile in the NHS. [ABSTRACT FROM AUTHOR]

Chronic fatigue syndrome, also known as myalgic encephalomyelitis, can be difficult to both diagnose and treat, but there are many prescribed medications that can help with specific symptoms and co‐morbidities. This article provides a guide to treatment in primary care. [ABSTRACT FROM AUTHOR]

The Goldilocks principle, ie not too much or too little, but just right, is important when prescribing thyroid hormone replacement, especially in the elderly or women of reproductive age. The authors present the results of their multi‐practice audit evaluating the monitoring of patients on thyroid hormone replacement in primary care. [ABSTRACT FROM AUTHOR]

OpenPrescribing is an online service launched in 2016 that facilitates the analysis of NHS primary care prescribing data in order to improve the quality and cost‐effectiveness of prescribing. In this article, Joy Ogden talks to its founders Dr Ben Goldacre and Dr Peter Brindle about what the service has achieved since its launch, and their plans for its future development. [ABSTRACT FROM AUTHOR]