GPs: Anti-depressants and Alcohol

Lord Markham Excerpts

Wednesday 16th November 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask His Majesty’s Government whether they will review the purpose, effectiveness, and the cost, of GPs prescribing anti-depressants to patients who continue to consume alcohol.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

Decisions about what medicines to prescribe, and in what circumstances, are rightly made by the clinician caring for the patient. At the same time, NICE guidelines are clear that anti-depressants should not be used to treat alcohol dependency. Prescribers must be free to make their own decisions, based on their clinical judgment and discussion with their patients, with the appropriate care for the individual always being the primary consideration.

[Lord Brooke of Alverthorpe (Lab)]

I am grateful to the noble Lord for his reply. As we face public expenditure cuts and as the College of Medicine has estimated that 110 million items prescribed every year are wasted at a phenomenal cost, what steps are the Government going to take? Will they have discussions with GPs about the ways in which we can cut back on wasting money on useless prescriptions?

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[Lord Markham (Con)]

I agree with the premise of the question. Clearly we want the most efficient use of our resources. As I am sure the noble Lord is aware, there is a national review of overprescribing, which is looking at precisely these sorts of guidelines to make sure that medicine is used only when it is needed.

[Baroness Wheatcroft (CB)]

My Lords, there is clear evidence that the prescribing of activities, particularly cultural activities, is very effective in treating depression in many cases. What steps are being taken to encourage the prescribing of culture and other activities, as opposed to expensive drugs?

[Lord Markham (Con)]

I agree that the first step should normally be cognitive talking-type therapies. As the House will be aware, we have been investing quite considerably in the mental health space. We have had a 25% increase in referrals to talking therapies, to 1.8 million in the past year alone. I very much agree that there should always be action to see whether we can help with those cognitive behavioural-type therapies first before resorting to prescribing drugs.

[Baroness Blackwood of North Oxford (Con)]

For some patients talking therapies and CBT may be an appropriate treatment for depression, as discussed, but for others next-generation SSRIs may be quite literally life-saving, and I am sure that no one in this Chamber would want to shame or discourage any patient who has been appropriately prescribed such a therapy. The Minister, I know, would want to suggest that GPs should be spoken to before any such action would be taken.

[Lord Markham (Con)]

I thank my noble friend and agree. It should always be down to the GP, working closely with the patient, to decide the best form of treatment, whether talking therapies or drugs, and that is why we are quite clear in the guidance that first and foremost it has to be the local clinician who makes the decision.

[Baroness Brinton (LD)]

My Lords, the noble Baroness, Lady Blackwood, made the very important point that there are differing results with different anti-depressants and different reasons for depression. A 2007 study showed that the use of anti-depressants reduced alcohol intake in those who drank a lot while they were very depressed. However, a 2011 study showed that SSRIs and alcohol often produced disinhibition. The one thing those two studies both showed was that where the physician was able to talk to the patient and explain, the patient reduced their alcohol. When will more time be available for GPs to talk these things through properly with patients?

[Lord Markham (Con)]

We all agree that GPs are best placed to do this. I think the House is aware of our commitment to increase the number of GP appointments by 50 million, and we are well on course to meet that target. At the same time, we have the independent review of drugs by Dame Carol Black, which looks at mental health, drugs and drink and how they are closely related, to make sure we have the best advice. First and foremost, I totally agree that the best-placed person is a GP talking to their patient.

[Baroness Merron (Lab)]

My Lords, the Joseph Rowntree Foundation reports that the number of anti-depressant prescriptions is twice as high in the most-deprived areas compared to the least-deprived, with the differential even more marked when it comes to severe conditions. With the long-promised health inequalities White Paper now seemingly sunk without trace, where is the Government’s strategy to change the conditions that affect mental well-being in the most deprived areas?

[Lord Markham (Con)]

My Lords, as set out in the draft mental health Bill, mental health activities are very focused on where help can be given in areas of inequalities. As to the position in the White Paper, I am afraid that the answer is the same as in the previous case: I do not have any information at the moment on any date.

[Baroness Browning (Con)]

My Lords, the medication for mental health conditions, including addictions, can be vastly improved in outcome and the proper use of that medication if the doctor is able to test the DNA of the patient to marry up the correct medication. When is genetic testing going to become an integral part of the NHS?

[Lord Markham (Con)]

We all see the great promise in genetic testing, and I know that this is something very close to my noble friend Lady Blackwood’s heart. It is a progressive area, where we are seeing new treatments all the time that can be helped by the use of genetic testing. As they come down the stream, this is very much on the agenda of NICE as well to make sure that those are available as required.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, regardless of the misuse of alcohol with drugs, is there also not a danger of patients taking anti-depressants, painkillers and sleeping medication, such as codeine, becoming addicted over time? Is this carefully monitored?

[Lord Markham (Con)]

First and foremost, it is the role of the GP and the local clinician to monitor that. Again, the guidance given by NICE is that we very much back up and work with the NHS performance teams to make sure that things are integrated. Not only is there the meeting of the patient with the GP in the first place, but these are reviewed very frequently, on a six-monthly basis, to ensure that exactly the issues mentioned by the noble Lord are controlled.

[Lord Sikka (Lab)]

My Lords, the Government can help to reduce the use of anti-depressant drugs by tackling the root causes, which are anxiety, insecurity and poverty inflicted by the Government’s own policies. Will the Minister tell us when the Government will be in a position to reduce the NHS waiting lists back to the numbers they were at in 2010?

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[Lord Markham (Con)]

I believe that the House is very aware of our plan for patients. It is very much the focus of my activity. I was just talking to the NHS and the CFO this morning on where we are on the recovery of the elective treatments and the plan for that, so it is very much in the front of our minds.

[Lord Teverson (LD)]

My Lords, I very much welcome the Government’s initiative on environmental prescribing, particularly for depression and mental illness. Will the Minister say what assessments they have made of the success of that programme so far, and whether they will promote it further?

[Lord Markham (Con)]

On this occasion, that is probably a question about which I need to write back to the noble Lord to give him the detail on it.

[Lord Kamall (Con)]

My Lords, the noble Baroness, Lady Wheatcroft, alluded to the fact that sometimes patients would be more effectively treated through social prescribing, or cultural and arts prescribing. What advice is given to GPs to make them aware of cultural, art and music therapy in solving or tackling depression?

[Lord Markham (Con)]

I agree that we have to make sure that GPs are equipped with the full range of tools for the job and the full range of knowledge. We are probably all aware of some instances of GPs who are very aware and progressive in this space, and others where they do not have that same level of information. We are putting a £2.3 billion increase in 2023-24 into the mental health space to treat an extra 2 million people. We need to make sure that we have a range of help that we can put in place for these people.

[Baroness Altmann (Con)]

My Lords, I echo the words of my noble friend that GPs are absolutely critical to sorting out these issues, and the Dame Carol Black review on overprescribing presumably will look into that too. Does he agree that one of the problems that urgently needs to be sorted is the pension issues that are driving our GPs to retire early? Might we look forward to some early resolution of that problem?

[Lord Markham (Con)]

I am very aware of the issue. Funnily enough, just today I had a meeting on this with the noble Baroness, Lady Finlay. It is something on which we are working closely with Treasury and other officials.