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James Stewart

4 Dec 2014 · Coroner Thomas Osborne · Bedfordshire & Luton
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The coroner's concerns

  1. 1. medication not checked with previous practice

    “There did not appear to be any system whereby when a new GP Practice is requested to prescribe medication from a patient's Nursing Home the details are not checked with the previous Practice. Such a system would have highlighted the fact that Mr. [name redacted] medication had not been included.”

Responses

2014-0526-Response-by-Bedfordshire-Clinical-Commissioning-Group.pdf ↗

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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

A link shows that a similar concern was raised again, not why. It is not a finding about any organisation or person. Methodology and responsible use · Report an error