Improving Patient Safety Through Smarter Folic Acid Co-Prescribing

Methotrexate is used to treat many inflammatory and autoimmune conditions, including rheumatoid arthritis and psoriasis. Widely prescribed in primary care, it plays a critical role in managing long-term disease but is associated with well-recognised risks, such as gastrointestinal side effects and liver toxicity.

National guidance, supported by the Royal College of General Practitioners (RCGP) safety indicators, states folic acid should be routinely co-prescribed alongside methotrexate to help mitigate these risks. Yet we understand that co-prescribing does not always happen in practice.

When a widely prescribed medicine like methotrexate is involved, even small gaps in adherence to guidance can have population-level consequences. Medicines-related harms, can place a significant burden on healthcare services, with some analyses suggesting that related admissions could exceed £2 billion annually across England. Improving consistency in folic acid co-prescribing is therefore not just a clinical issue – it’s a patient safety and system efficiency priority.

Preventing harm at scale therefore requires a proactive, population-level approach – this is where AnalyseRx comes in. It enables NHS organisations to identify patients across their population who may not be receiving folic acid alongside methotrexate.

These opportunities for co-prescribing are automatically flagged as ‘High Priority’, allowing teams to act quickly and action relevant next steps rather than waiting for the next prescribing event.

Beyond Folic Acid: Identifying High-Risk Prescribing at Scale

Folic acid co-prescribing is just one example of how AnalyseRx supports safer medicines use. The platform currently includes 96 High Priority opportunities covering a range of high-risk medicines, including DRMARDs, anticoagulants, lithium and ACE inhibitors.

Using High Priority filters, teams can quickly identify patients on high-risk drugs with out-of-range of range or abnormal test results. Patients can then be prioritised based on factors such as the time since their last test or the severity of abnormal results, helping practices manage review capacity more effectively. Once identified, tasks can be coordinated and delegated within AnalyseRx itself, removing the need for manual exports or paper-based processes.

To support continuous improvement, AnalyseRx also includes a reporting suite that helps organisations understand the scale of monitoring opportunities available, making it easier to spot variation across their locality and support targeted quality improvement initiatives.

This visibility not only allows clinical and management teams to implement system-wide interventions, but also clearly evidences improvements and reductions in risk exposure to the CQC.

Turning Guidance Into Action

Folic acid co-prescribing alongside methotrexate is well established in national guidance, yet the real challenge lies in consistent implementation.

By providing proactive population analytics and opportunities for proactive review, AnalyseRx helps turn guidance into action, reduce avoidable harm, and support safer prescribing at scale.

Because improving patient safety isn’t just about knowing what to do – it’s about making it easier to do the right thing, every time.