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Clozapine: national review of postcode prescribing

Senior House Officer, South London and Maudsley Mental Health Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, email: johnny.downs{at}iop.kcl.ac.uk

Martin Zinkler

Consultant Psychiatrist, East London and City Mental Health Trust, Newham Centre for Mental Health, London

Declaration of interest

None.

AIMS AND METHOD

We review the prescribing rates for clozapine among all mental health trusts in England and explore whether it has changed with the introduction of NICE guidelines, generic clozapine and the Healthcare Commission ratings. Data were collected from mental health trusts in 2005–2006 and compared with a previous study from 2000. Mental health star ratings of 2004–2005 were taken from the Healthcare Commission.

RESULTS

We found a reduced inter-trust variability from 34-fold variation in 2000 to 5-fold variation in 2005–2006. There was a significant inverse relationship between star rating and clozapine prescribing.

CLINICAL IMPLICATIONS

NICE guidelines and generic clozapine seem to have improved access to gold standard therapy for treatment-resistant schizophrenia. Star ratings have little bearing on the implementation of NICE guidelines.