The four UK Chief Medical Officers (CMOs) asked the Academy to provide further information on concerns regarding the prescription and administration of cytotoxic agents by foundation doctors.
Concerns regarding the potential risk to patients from prescription of chemotherapy by foundation doctors were raised at the Academy Foundation Programme Committee and reported to the CMOs who acknowledged that this was an important issue and asked the Academy to undertake further work on the issue.
The Academy therefore established a cross-specialty working group and, in conjunction with the UK Foundation Programme Office, subsequently carried out a survey to seek further information. The findings and a series of recommendations were then set out in the attached report.
The results of the survey suggest that:
- Prescribing cytotoxic and immunosuppressant agents by foundation doctors and core medical trainees is not uncommon and occurs in the context of oncology and several other specialties
- There is a perceived lack of understanding of the risks of these agents and the requirements for monitoring and supportive therapy which accompany their use
- Adverse incidents related to prescribing these agents are not uncommon and at least one death was reported
- There is a perceived lack of specific training and guidance for doctors involved in the prescription of these agents.
We believe that the survey has identified that there is a real patient safety issue and risk to patients in current practice.
The report recommends that:
- Training in the use of agents with a narrow therapeutic index is included in undergraduate curricula and is formally assessed.
- Realistic and proportionate standards of training and assessment should be developed for healthcare professionals prescribing these agents. The relevant medical Royal Colleges should adopt these standards into their core and specialty training curricula.
- Specialty specific educational and assessment resources are developed by medical Royal Colleges and the Royal Pharmaceutical Society relevant to the prescribing and monitoring of these agents.
- All healthcare providers should ensure that systems and safeguards are in place to prevent harm to patients from incorrect prescribing / monitoring of agents with a narrow therapeutic index.
- Induction sessions should specifically state that prescribing of chemotherapy and immunosuppressive agents is prohibited without satisfactory demonstration of appropriate competence e.g. by completion of a designated and approved training programme.
The Academy will now be setting up a small Task and Finish Group to develop appropriate guidelines and educational materials.
Read the report here