Prescribing guidance and practice
: exploring the factors that have an impact on prescribing in a mental health environment

  • Andrew Campbell

Student thesis: Doctoral Thesis


The study used in-depth interviews to explore how prescribing practice, and hence patient outcomes, could be improved by a range of stakeholders; namely GPs, pharmacists,psychiatrists, representatives from the pharmaceutical industry and service users.

The author, as Chief Pharmacist for Dudley and Walsall Mental Health Partnership Trust (DWMHT), is responsible for the strategic leadership in medicines optimisation across the organisation. In the role of Chief Pharmacist, the author has identified that there are disparate prescribing patterns across the trust, in addition to a distinct lack of clarity on prescribing responsibility with the local health economy.

There is a paucity of research which incorporates the views of a variety of healthcare professionals and service users on prescribing practice in a mental health setting; furthermore, the author is unaware of any study that has incorporated the views of the pharmaceutical industry on joint working with the NHS in a mental health context.

Fifteen healthcare professional interviews were conducted, which included pharmacists, psychiatrists and GPs. In addition, 5 expert by experience service users were interviewed about their experiences of shared decision-making whilst managed under the care of mental health services. The study also explored with representatives from the pharmaceutical industry, the scope for collaborative working with the NHS to optimise the use of medicines. Semi-structured interviews were conducted and the data was analysed using Framework analysis.

This study revealed that four core tensions exist in the delivery of prescribing in mental health. These are:

1. The notion of guideline driven care versus the individual needs of patients

2. The need for holistic, patient-centred care versus the constraints on healthcare professional to deliver this

3. The rhetoric about patient choices versus the realities of shared decision-making in a resource-limited system

4. The acknowledgement of the need for joint working with the pharmaceutical industry, which is based on the current NHS financial climate, versus the inherent mistrust by healthcare professionals of the industries’ motives.

Further to the identified tensions the study also identified three areas of concord across the stakeholder groups which are:

1. The importance of communication with service users

2. The role of prescribing guidelines

3. The meaning of wellbeing for the recipients of care

The complexity of decision-making in prescribing practice was highlighted by the study. The success of patient centred care is reliant on healthcare professional attitudes, patient empowerment, and resources such as electronic prescribing to support evidenced-based prescribing practice. Scarcity of resources impacts heavily upon the decisions that are made which can have a substantial impact upon variability in treatment decisions and on the ability to facilitate patient choice in a meaningful way.
Date of AwardMay 2016
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorDavid Brown (Supervisor)

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