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Investigation Triggers Diazepam Prescription Review

A review of prescriptions given to hundreds of people with drug and alcohol dependencies across England has been triggered after an investigation revealed that a charity breached national guidelines for prescribing diazepam.

The Local Government and Social Care Ombudsman found that Change Grow Live (CGL), on behalf of Cambridgeshire County Council, had been prescribing benzodiazepines to people long-term, against national guidance.

CGL is a national charity that provides drug and alcohol services for 50 other councils.

The NHS recommends that diazepam should not be used for longer than 4 weeks. People should have their prescriptions reviewed regularly, and those reviews should consider the benefits and risks of continuing with the current dose, reducing or stopping it, with a management plan put in place after each review.

Prescriptions Issued Contrary to Agreed Policy

However, in its investigation, the Local Government and Social Care Ombudsman found that CGL had been prescribing benzodiazepines to people long-term, "against national guidance and not in line with its own prescribing policy". 

During the course of an investigation relating to a client of CGL in Cambridgeshire, the Ombudsman discovered there were others receiving prescriptions for benzodiazepines long-term who were not part of any complaints procedure.

For the latest investigation, a CGL clinician audited the records of nine clients in its Cambridgeshire service who were prescribed long-term benzodiazepines. The audit uncovered that although six of the cases had a clear rationale for their long-term prescription, three cases did not.

The Ombudsman asked CGL to provide an anonymised breakdown of the number of clients on long-term benzodiazepines for each council area where it ran services. This identified that 343 clients were on long-term benzodiazepine prescriptions in the services commissioned by 50 other councils in England. Subsequently, CGL's medical director commenced a national clinical audit focussing on benzodiazepine prescribing across the organisation.

Patients to Receive Comprehensive Reviews

The ombudsman found CGL was either not reviewing people's prescriptions regularly enough or not keeping proper records of reviews, and concluded that there was "fault" by CGL which acted for the Council. This had caused "avoidable uncertainty" about the management of clients prescribed long-term benzodiazepines, the report emphasised. 

The ombudsman recommended that CGL and the Council provided a report of the national clinical audit currently being undertaken by CGL. The Council was also required to ensure CGL improved record keeping, updated its policy to include recent guidance from NHS England, and completed yearly audits of Cambridgeshire CGL clients who are on long-term prescriptions of benzodiazepines.

The Council must consider the report and confirm within 3 months the action it has taken or proposes to take, ordered the Ombudsman.

Nigel Ellis, Local Government and Social Care Ombudsman chief executive, said he was "pleased that patients in these vulnerable groups will now have their cases reviewed more regularly and comprehensively".

Mr Ellis stressed that both CGL and the council had "co-operated fully" with the investigation, and had provided "ready acceptance" of the recommendations.

Medscape News UK has asked CGL to comment.

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