The safer management of controlled drugs: Annual update 2023

Register of controlled drugs accountable officers

We maintain and publish an online register of controlled drugs accountable officers (CDAOs) across England for those organisations that are registered with us and are required under the 2013 Regulations as amended to have one. These organisations are defined as ‘designated bodies’ under the regulations and are required to notify CQC of their CDAO appointment. We update this register monthly. At the end of 2023, there were approximately 1,000 CDAOs listed. We approved 13 requests to be exempt from the requirement during 2023.

We remind all designated bodies that it is a legal requirement to tell us about any changes to the contact details for your CDAO so they are up-to-date on our published register. Designated bodies also need to notify us where a temporary CDAO is going to be in post for longer than 6 weeks. See more information for CDAOs.

NHS England regional teams and controlled drug local intelligence networks

The Senior Responsible Officer in NHS England for the controlled drugs accountable officer function is the National Medical Director. NHS England controlled drugs accountable officers (CDAOs) worked effectively and collaboratively during 2023. They held regular meetings for members of local intelligence networks (LINs) – both nationally and regionally. Local intelligence network meetings are an effective way to deliver consistent messaging, raise concerns, and share intelligence and learning. They also provide valuable networking opportunities for members.

NHS England CDAOs led local intelligence network meetings across England with each network meeting held online at least twice in the year. Several regions also held in-person or hybrid meetings. As well as sharing the details of controlled drugs incidents, most LIN meetings also include how the learning from these, and from other aspects, can help to improve local management of controlled drugs.

Participants in local intelligence network meetings can be unsure about what they are able to share relating to concerns over individual people or services. NHS England CDAOs provide a regular reminder about what information can be shared appropriately, and within the law.

NHS England CDAOs hosted 2 national controlled drugs learning events for all local intelligence network members across the country, which received good feedback from attendees. Regional CDAO teams also produced newsletters to share information and maintain contact with LIN members between the network meetings.

Given the helpful work from CDAOs across the regions, it may be useful for NHS England to consider how this valuable learning might be shared more widely, particularly to organisations that are not part of the LIN, across both health and social care settings.

Key concerns discussed at local intelligence network meetings

• Poor governance processes, although more organisations reported that they are now carrying out regular audit and monitoring checks.
• Controlled drugs governance in relation to paramedics and independent ambulance services.
• Home Office controlled drugs licences.
• Prescribing of cannabis-based products for medicinal use (CBPMs); how services support people if they have been prescribed, and consideration of what governance arrangements need to be in place.
• Closures of community pharmacies or a reduced service, specifically for people who receive support from substance misuse services.
• The diversion of controlled drugs in lower schedules. It is particularly challenging to identify diversion for organisations that use these in larger volumes.
• Diversion of controlled drugs by health and care professionals.
• Ongoing fraud with private prescriptions, often for controlled drugs in lower schedules.
• Arrangements for using oral liquids safely – including balance checking.
• Controlled drug patches, such as those containing fentanyl and buprenorphine. This includes inappropriate prescribing, where people don’t need constant pain relief, as well as problems with administration.

Controlled drugs reporting tool

NHS England updated its CD reporting tool in December 2022. This update has helped to further standardise processes across all regions through 2023. Users have welcomed the more streamlined process to report concerns and incidents. The reporting tool now also includes links to relevant guidance and short training videos, and resources to carry out other controlled drug functions such as requests for authorised persons to witness the destruction of obsolete Schedule 2 controlled drugs.

Information requests from NHS England CDAOs

When NHS England CDAOs request information, organisations need to respond and submit this as soon as possible. This could include quarterly performance reports, improvement frameworks, details of incidents or investigations and self-declarations.

Controlled Drugs National Group

CQC leads the Controlled Drugs National Group, which met in March, June and November 2023. Membership comprises government departments, key regulators and agencies with a controlled drug remit in England, Scotland, Wales, Northern Ireland, Ireland and the Channel Islands.

Key discussion topics and issues of shared interest between our cross-border members included:

• controlled drugs governance
• Home Office controlled drugs licences
• controlled drug destruction
• cross-border and remote prescribing
• the rise in the use of nitazenes, including treatment of exposure to these
• non-medical prescribing
• cannabis-based products for medicinal use (CBPMs)
• controlled drugs and medication safety.

A separate summary of activity from the past year shows how member organisations contributed to the overall safer management of controlled drugs. If you would like a copy of this summary, email medicines.enquiries@cqc.org.uk.

Operational Sub-group

The operational sub-group to the National Group also met regularly in 2023. Membership comprised:

• NHS England lead CDAOs
• specialist pharmacists and medication safety officers
• NHS Business Services Authority
• chief pharmacists
• integrated care system (ICS) prescribing leads
• other government bodies.

Where appropriate, we also invited other healthcare professionals with relevant expertise to contribute.