We’ve added a suite of new CQC Safety Alert indicators to help practices identify patients who may be at risk due to high-risk medicines, drug interactions, or missing monitoring.
These indicators help practices identify patients who may need safety advice, medication reviews, or checks at the right time, supporting safer prescribing in line with CQC and MHRA guidance.
🔍 What’s new
These indicators highlight:
Patients on higher-risk medicines
Patients with important drug interactions
Patients who need safety education
Patients who require urgent medication reviews
Patients who may be on contraindicated combinations
Each indicator follows the same structure:
Denominator = patients at risk
Numerator / complete = patients who’ve had the required review or safety advice
Not complete = patients needing action
Below is a breakdown of each safety alert.
1️⃣ CQCSAFETYALERT001 — Hydrochlorothiazide & Skin Cancer Risk
Identifies patients who need skin cancer risk information after starting hydrochlorothiazide.
What it checks
Prescribed hydrochlorothiazide in the last 6 months
Whether the patient has received written skin cancer risk information
What counts as complete
Patient has been given written advice about skin cancer risk since starting hydrochlorothiazide
Why this matters
Hydrochlorothiazide increases photosensitivity and is linked to higher rates of non-melanoma skin cancer. Patients should be informed about sun protection and monitoring for skin changes.
2️⃣ CQCSAFETYALERT002 — High-Dose SSRIs in Patients Aged 65+
Identifies elderly patients on high-dose SSRIs who need a medication review.
What it checks
Patients aged 65+
Taking citalopram 40mg or escitalopram 20mg
Whether a medication review has occurred in the last 3 months
What counts as complete
Medication review completed in the last 3 months
Why this matters
Higher SSRI doses increase risks of QT prolongation, falls, hyponatraemia, and bleeding in older adults. A dose adjustment may need to be considered.
3️⃣ CQCSAFETYALERT003 — Clopidogrel with Omeprazole / Esomeprazole
Identifies patients at risk due to reduced clopidogrel effectiveness.
What it checks
Patients taking clopidogrel
AND taking omeprazole or esomeprazole
Medication review completed in the last 3 months
What counts as complete
A medication review that documents consideration of the drug interaction
Why this matters
Omeprazole and esomeprazole reduce clopidogrel activation, risking treatment failure and cardiovascular events. Switching to an alternative PPI may be considered.
4️⃣ CQCSAFETYALERT004 — Febuxostat in Patients with Cardiovascular Disease
Identifies patients with cardiovascular disease who are prescribed febuxostat and need a risk–benefit review.
What it checks
Patients with CHD, stroke, TIA, or PVD
Currently prescribed febuxostat
Medication review in the last 3 months
What counts as complete
Medication review completed within the last 3 months
Why this matters
Febuxostat is associated with increased cardiovascular mortality in patients with pre-existing cardiovascular disease. Reviews help ensure safe gout management.
5️⃣ CQCSAFETYALERT005 — Fentanyl Patches Started Without Prior Opioid Use
Identifies patients who may be at risk of respiratory depression.
What it checks
Fentanyl patch started within the last year
No opioid prescriptions in the 3 months before initiation
Medication review completed
What counts as complete
Medication review completed since starting the fentanyl patch
Why this matters
Fentanyl patches are only appropriate for opioid-tolerant patients. Starting them without prior opioid exposure is a serious safety risk.
6️⃣ CQCSAFETYALERT006 — Mirabegron & Blood Pressure Monitoring
Identifies patients on mirabegron who need up-to-date blood pressure readings.
What it checks
Patients prescribed mirabegron
Blood pressure recorded in the last 12 months
What counts as complete
Blood pressure reading within the last 12 months
Why this matters
Mirabegron can raise blood pressure and requires regular monitoring, particularly in patients with cardiovascular disease.
7️⃣ CQCSAFETYALERT007 — Dual RAS Blockade (Not Yet Implemented)
Identifies patients on two or more RAS blockers who need urgent medication review.
What it checks
Concurrent use of multiple RAS blockers (ACE inhibitors, ARBs, aliskiren)
Medication review in the last 3 months
What counts as complete
Medication review completed in the last 3 months
Why this matters
Dual RAS blockade significantly increases the risk of hyperkalaemia, renal impairment, and hypotension. This is a high-risk, contraindicated combination.
8️⃣ CQCSAFETYALERT008 — SGLT-2 Inhibitors: Safety Education
Identifies patients who need safety information after starting SGLT-2 inhibitors.
What it checks
Prescribed SGLT-2 inhibitors in the last 6 months
Whether both types of education were provided:
Ketoacidosis symptoms
Fournier’s gangrene symptoms
What counts as complete
Both ketoacidosis education
AND Fournier’s gangrene education
Recorded after SGLT-2 inhibitor initiation
Why this matters
SGLT-2 inhibitors carry rare but serious risks that require early patient recognition and prompt action.
9️⃣ CQCSAFETYALERT009 — High-Dose Simvastatin with CYP3A4 Inhibitors
Identifies patients at risk of myopathy due to drug interactions.
What it checks
Patients on simvastatin 40mg or 80mg
Also prescribed amlodipine, diltiazem, or verapamil
Medication review in the last 3 months
What counts as complete
Medication review completed within the last 3 months
Why this matters
These combinations increase simvastatin levels and the risk of serious muscle toxicity. Dose adjustment may be required.
🔟 CQCSAFETYALERT010 — Teratogenic Medications in Women of Childbearing Age
Identifies women who need pregnancy-prevention counselling and review.
What it checks
Women aged 8–55
Prescribed valproate, carbimazole, modafinil, topiramate, or pregabalin
No pregnancy-preventing procedures recorded
Medication review in the last 3 months
What counts as complete
Medication review including contraception or pregnancy-prevention discussion
Why this matters
Teratogenic drugs carry significant fetal risk. MHRA requires pregnancy-prevention measures, particularly for valproate.
💡 Why this matters
These safety alerts help practices:
Identify high-risk prescribing quickly
Prevent medication-related harm
Provide timely safety advice
Ensure drug interactions are addressed
Align with MHRA safety updates and CQC expectations
✅ These indicators are now live
You can add them to your Recall Campaigns to support safer prescribing and timely medication reviews.