Human error and not a lack of understanding or knowledge was behind most mistakes, the study said.
Extending the average GP consultation from 13 minutes to 15 and better training in safety would help, lead author, Prof Tony Avery, of Nottingham University, said.
Pharmacists and GP receptionists can also help by carrying out medicine reviews and checking monitoring arrangements.
Errors classed as severe included, a 62-year-old woman with a documented allergy to penicillin who was prescribed flucloxacillin, a similar drug, and elderly patients prescribed blood thinner warfarin, who should have been closely monitored but who were not tested for two years.
Moderate errors included a four-year-old girl with a stomach upset who was prescribed a drug that should be used 'with caution' in children.
Minor errors found in the study included a one-year-old girl who was given two prescriptions for antibiotics in the same consultation but with different doses stipulated.
In the study, pharmacists trawled the records of 1,700 patients, in 15 practices, examining their medical records for a 12 month period looking for mistakes in prescribing.
It was found that one in five patients who were taking medicines had been given a prescription with an error in it.
This rose to four in ten of the over 75s and each extra medicine a person was on increased the risk of errors by 16 per cent.
Over 6,000 prescriptions were examined and one in 550 had a serious error.
Failing to request that the patient be monitored was the most common serious error followed by prescribing a drug the patient was allergic to.
Almost all of the serious errors related to one drug, warfarin, which has been used as rat poison. It is prescribed to thin the blood in people at risk of blood clots. It must be carefully monitored because it interacts with other drugs and some foods and patients with levels too high can suffer potentially life threatening stomach bleeds.
Although the study was not designed to find out if patients had been harmed by the error it was discovered that one elderly woman was admitted to hospital with a stomach bleed two weeks after being prescribed warfarin.
If the figures were extrapolated across England where there are 900m prescriptions issued annually, it would mean 45m prescriptions contain errors and 1.8m of them would considered severe.
Professor Sir Peter Rubin, chairman of the General Medical Council, said: "GPs are typically very busy, so we have to ensure they can give prescribing the priority it needs.
"Using effective computer systems to ensure potential errors are flagged and patients are monitored correctly is a very important way to minimise errors.
"Doctors and patients could also benefit from greater involvement from pharmacists in supporting prescribing and monitoring."
Prof Avery, who is also a GP in Nottingham said: "Few prescriptions were associated with significant risks to patients but it's important that we do everything we can to avoid all errors.
"Prescribing is a skill, and it is one that all doctors should take time to develop and keep up-to-date."
Martin Astbury, president of the Royal Pharmaceutical Society, said: "Prescribing errors are common but the number of mistakes could be reduced by up to 50 per cent if GPs introduced an in-house pharmacist-led support scheme.
"We are calling for every GP practice to have a pharmacist on the premises dedicated to patient safety."
Health Secretary Andrew Lansley said: "Patient safety is paramount. The vast majority of prescriptions are checked by community pharmacists, who spot and put right any errors when they are dispensed. Patients can be confident that the medicines they receive are safe and appropriate."
Dr Clare Gerada, chairman of council at the Royal College of GPs, said: "There are over one million patient consultations in general practice every day across the UK, and this report demonstrates that in 95 per cent of cases GPs prescribe safely and effectively in the best interests of their patients."
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