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, outlinesthe 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.
Sometimes switching people to cheaper unbranded drugs is not always a safe or cost efficient option. Many patients complain to us that they have had their statin or blood pressure drug changed and have had new side affects and they have stopped taking them, often without their doctors knowledge.
Also patients on warfarin sometimes find that the unbranded tablets have different colourings and coatings which upset them. It has also been reported, although not extensively researched, that by having unbranded warfarin or a mixture of unbranded and branded in the same prescription causes variations to their INR levels when their blood is tested.
This once again treats drugs/prescribing in isolation from all other interventions. How many other, more expensive interventions do 'repeat' prescriptions prevent? How would tighter prescribing controls affect this? Are all other interventions 'optimal'? Until a comprehensive, system-wide approach is taken, analyses such as these misleading, at best.
You are absolutely right. Furthermore, many drugs do more harm than good with side-effects. Recent research published in the last few months shows that statins cause heart attacks and stokes (rather than prevent them) and the cocktails given to old people cause 30-40 more cognitive impairment, and earlier deaths than the control group. A million hospital admissions are caused by adverse drug reactions. Details on wddty.co.uk and mercola.com.
Reducing the drug bill is win win - better public health at less cost to taxpayers. See sectco.org for how to fill the vaccuum with NICE-recommended complementary therapies.
NHS Trusts need to be more informed of where they spend their drug money within their Directorate or service...this is a huge step on being empowered to show the outliers. Just to understand the spend and why it is happening needs to be continually challeged by the CE, MD, DoO, DoF. They need to get lost in detail, to data mine what is actually happening with spendis the First Step! you dont know what you dont know...
We are trying very hard to save any drug wastage in our surgery and generally across the local area. We have regular meetings and the health authority give us feedback on where they think we can make savings. last year out of a budget of over £1 million they identified savings of about £3000 or 0.3% which shows that we are very close to the minimum. As drugs come off patent we are managaing most of the standard iilnesses at very cheap rates with most generic drugs costing less than £4 a month. At the risk of being controversial i would suggest we could save a lot of money on drugs with very little benefit such as a lot of the chemotherapy we give patients dying of cancer. Its known they hardly have any effect in some conditions and they make the poor patients last year of life a misery of nausea and hospital visits..... However this tends to be a 'sacred cow' and not much sense is reported in the media on this particular subject.
I know that we used to be given financial incentives to prescribe generically. We were keen to prescribe as cheaply as possible while maintaining quality. The problem is that there is an ageing population and the evidence has been that treating cholesterol, blood pressure etc reduced the risks to health. I was a practising GP long enough to see evidence turned on its head on numerous occasions, not to mention the number of times drug companies with-held evidence that did not support a drug. We certainly need an ongoing debate about drug treatments, as we do about all treatment. The best available evidence needs to be considered and reviewed at regular intervals as it will undoubtedly change over time. I do not think we should keep bashing GPs who on the whole do the best they can with the evidence and guidelines available.I do agree that we should give consideration to the misery that can be caused by extending peoples lives, often very briefly with nasty chemotherapy. I feel that people should be given more information and choice about the drugs they are offered.
Comments
Also patients on warfarin sometimes find that the unbranded tablets have different colourings and coatings which upset them. It has also been reported, although not extensively researched, that by having unbranded warfarin or a mixture of unbranded and branded in the same prescription causes variations to their INR levels when their blood is tested.
Reducing the drug bill is win win - better public health at less cost to taxpayers. See sectco.org for how to fill the vaccuum with NICE-recommended complementary therapies.
Add your comment