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The benefits of this project
Benefits for Your Patients
- Less medication to take
- Fewer side effects which may improve adherence
Benefits for Your Practice
- £1729/year per 100 patients switched BD to OD dosing (based on ferrous fumarate 210mg tablet price, May 2025)
- Fewer side effects may decrease demand for GP appointments
Benefits for The Planet
- Reduced prescribing means lower environmental impact
Opportunity for improvement
- The British Society of Gastroenterology guidelines recommend once daily dosing with oral iron but current practice is often to prescribe multiple doses in a day. The once daily regimen is associated with better iron absorption and fewer side effects. Alternate day dosing is also an option.
- Iron absorption can be reduced if iron is taken with other medications especially proton pump inhibitors (PPIs) or food including tea or coffee. Improving dietary intake of iron can also boost levels.
- Medications are responsible for the majority of the carbon footprint of general practice so reducing prescribing can decrease healthcare’s environmental impact.
- Prescribing iron once daily and informing patients on how to best take the tablets, will therefore benefit patients (boosting iron absorption and minimising side effects), save money (by reducing tablets prescribed) and improve environmental impact.
- This project outlines how to put these changes into practice (see disclaimers).
- You might like to create a SMART goal for this project e.g. to reduce the number of patients prescribed >1x daily iron supplements by at least 80% within 1 month.
How to carry out this project
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Switch to once daily dosing
Review the notes of all patients prescribed iron and switch to once daily dosing if they require long-term iron replacement (after confirming long-term treatment is indicated). Send them a text message/letter explaining why:
Resource: Example text message
We have changed your iron prescription to once a day as this is associated with better iron absorption and lower side effects compared to multiple doses per day with no reduction in effectiveness. You can find out more about your iron tablets here: https://www.nhs.uk/medicines/ferrous-fumarate/. Please only order more iron tablets when needed.
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Record data
Record how many patients were found to be on 2x, 3x and 4x daily dosing and record if any of these were not changed to 1x daily dosing.
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Automate
Make once-daily iron prescribing the default pick in your GP practice IT system.
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Training
Educate prescribers on the change in iron prescribing guidance to once daily dosing. This could be via an online training session and email communications. Provide prescribers with a text message which can be sent to patients when they are prescribed iron tablets:
Resource: Iron tablets
Your test showed low iron levels. We would recommend increasing iron in your diet. Foods high in iron include lentils, dark green vegetables, apricots, prunes & iron-fortified bread. We have prescribed iron tablets. Please take these separately to other medications and ideally 30-60 mins before eating including tea + coffee. If you develop side effects e.g., nausea or constipation, try taking the tablets every other day or with food. You can find out more about your iron tablets here: https://www.nhs.uk/medicines/ferrous-fumarate/
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Community Pharmacy
Liaise with your local community pharmacists so they are aware of the change and can support with consistent messaging to patients about how best to take their medications. Your practice pharmacist will likely know how best to get in touch with them.
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Study
Review the results, summarise learning, share with practice team + decide if any changes are needed to improve the process.
Decide when to re-audit again to ensure the change has lasted e.g. 2-3 months and use the Project Monitoring form to keep track.
Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches.
Top tip
You might need to repeat the advice to prescribe once daily iron quite a few times before everyone adopts this change.
We found it helpful to chat directly to the clinicians who kept prescribing multiple doses to change prescribing practice across the board.
How to scale this project up or down
| Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members. |
You could upscale this project by working with your local ICB (England), Health Board (Scotland & Wales) or SPPG Pharmacy Advisor (Northern Ireland) to ensure once daily or alternate day dosing is the default pick in local formularies.
You could take it to your Primary Care Network or Cluster to implement across all practices in your area.
Case study
This was a straightforward project completed by one of our trainee doctors.
She audited iron prescribing over 1 month to understand how many patients were prescribed once daily, twice daily or thrice daily iron. She reviewed the notes for patients prescribed multiple daily doses and switched any on long-term iron to once daily, sending them a message to let them know why. She then presented to our GPs and sent an email recommending a change to once daily prescribing. We created a text message to send to any patients prescribed iron, advising how to take the tablets and how to get more iron in their diet. After 1 month, we re-audited and found big improvements.
This project helped to educate our patients on improved diet and reduced their risk of medication side effects. Switching to once daily iron prescribing will save our practice >£2500 per year. A win for all.
Charlotte Keel Medical Practice, Bristol
Have you completed this QIP?
Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost savings and other benefits. This project may help with CQC evidence submission (see disclaimers).
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