Do we spend too much money on drugs?

The cost and quality of prescribing have come under the media spotlight in recent weeks, with a recent report arguing that the UK had turned into a nation of 'pill poppers' as the amount spent on prescriptions has risen from £113 per head in 2000 to £169 per head in 2010. At a time when there is increasing evidence of explicit rationing elsewhere in the NHS, the question must be – are we spending too much money on drugs?

Due to conflicting evidence, getting to the truth on this subject is difficult. The UK spends much less per head on prescriptions than the likes of France or the USA, in part due to the UK's high level of use of cheaper, non-branded drugs. Moreover, much of the growth in prescriptions can be explained by naturally rising levels of demand and the concerted effort to prevent heart disease and stroke through prescribing cholesterol-busting statins.

Nonetheless, new evidence, published this week on the quality of GP prescribing, outlines the scale of the issue. The research reveals that, in 2009, there were 886 million items prescribed, costing £8,529 million (some 15 per cent of NHS costs). The number of items dispensed has doubled in ten years, with an average of 40.8 items prescribed annually for each individual over 60 years of age. Around two-thirds of GP consultations lead to the issue of a prescription, with 70-80 per cent of all prescriptions issued 'on repeat'.

In line with the wide variations in the quality of care highlighted in the Fund's recent inquiry into general practice, the research gives examples of significant cost-saving opportunities as a result of unwarranted variations in prescribing practice. For example, across PCTs it described a six-fold variation in the costs of prescribing ezitimibe – used to lower cholesterol – and a 16-fold variation in the prescription of the antibiotic cephalosporin. The research also estimated that some £150 million every year (or about £1 in every £50 spent) of drug wastage is preventable.

More cost-effective prescribing and improved medicines management has the potential to have a substantial impact on costs without compromising on quality. This is why we made it one of our ten priorities for commissioners in transforming the NHS. With the cost of prescribing increasing at a relentless rate – about 7 per cent year-on-year – ensuring that medications are prescribed optimally is essential. As GPs come closer to holding the purse-strings, getting a handle on the costs of prescribing will be a key task. As a result, GPs may come under greater suspicion that they are rationing care to save money. Uncomfortable times lie ahead.