Press Release - Prescribing costs in primary care
18 May 2007
GPs could prescribe lower cost clinically effective medicines
without affecting patient care, according to Parliament’s spending
watchdog. And this could save primary care trusts (PCTs) more than
£200 million a year. Today’s report by the National Audit Office
also points out that unused or wasted drugs could cost the NHS at
least £100 million a year.
In 2006 the NHS spent more than £8 billion on medicines in
primary care and more than 750 million prescriptions were
dispensed. Over the last decade the primary care drugs bill has
increased by 60 per cent in real terms. Today’s report looked at
how the Department of Health and NHS organisations can help make
future growth in prescribing more affordable without affecting
clinical outcomes. It also looked at the extent of medicines being
wasted through, for example, GPs over prescribing or medicines
being dispensed to patients but not being used.
Today’s report to Parliament by the head of the National Audit
Office, Sir John Bourn, identified large variations between PCTs in
the extent to which local GPs prescribed lower cost drugs for the
same conditions, such as statins used to treat high cholesterol. In
the second quarter of 2006-07 the proportion of statin
prescriptions that were lower cost varied from 28 per cent to 86
per cent across PCTs in England.
Analysis of the prescribing of four common types of medicines,
representing 19 per cent of the drugs bill, showed that more than
£200 million could be saved if all PCTs prescribed as efficiently
as the top performing 25 per cent of PCTs. The report also found
that if all PCTs prescribed as efficiently as the top ten per cent
of PCTs, then more than £300 million could be saved. The four drug
groups examined for this review offer the NHS the biggest savings
opportunities, but the report says that further savings may be
possible in other areas of primary care drugs expenditure.
The report found that it was difficult for GPs to assimilate all
the information they received on prescribing. Both official NHS
prescribing advisers and the pharamceutical industry influence GPs’
prescribing decisions. The report examined how value for money in
prescribing could be improved, and makes recommendations to the
Department of Health and to PCTs on supporting GPs to improve
prescribing.
The report also found that there is a significant cost to the NHS
from medicines being wasted, for example, by being dispensed to
patients but not used. The full cost of wastage is difficult to
quantify because of a lack of robust data and a wide range of
reasons for waste. But the NAO found that an estimated £100 million
worth of drugs are returned unused to the NHS, and destroyed, each
year, to say nothing of other forms of waste. The report says that
the Department of Health needs to do more work to establish a
robust estimate of the scale of medicines wastage in England and
why patients don’t take their drugs.
The Department recognises that wastage is a serious problem and
in 2005 introduced initiatives to address it. But so far, uptake of
these initiatives has been low.
Sir John Bourn said today:
“There is significant scope for the NHS to improve the value for
money of prescribing in primary care. If GPs more often followed
official guidelines and prescribed generic and other cheaper drugs
where suitable, then there would be more money to treat patients
and pay for expensive or innovative treatments.
“We have found that some small changes in prescribing
behaviour can lead to substantial savings for the NHS. All primary
care trusts should learn from the best performing PCTs and strive
to be as efficient in their own prescribing, making the £200
million in savings realistically achievable.”
Notes for Editors:
- Achieving efficiency savings and enhancing value for money in
prescribing requires prescribers - mainly GPs, since GPs write 98
per cent of primary care prescriptions - to change prescribing
behaviour. Today the NAO has also launched a communication aid to
help NHS prescribing advisers communicate more effectively with GPs
in order to improve their prescribing information. The
communication aid is informed by methods used by drug company
representatives to influence GPs’ behaviour, and draws on the
evidence of ‘what works’ in the NAO report to help PCTs support
high quality and cost effective prescribing. The toolkit is
downloadable at http://www.nao.org.uk/.
- The 19 per cent of the drugs bill looked at by the National
Audit Office covers the four largest therapeutic areas: statins
used for high cholesterol, renin-angiotensin drugs used for high
blood pressure, proton pump inhibitors used for gastric conditions
such as dyspepsia, and clopidogrel used to reduce blood clotting.
There is official guidance from bodies such as the National
Institute for Health and Clinical Excellence (NICE) recommending
the use of lower cost drugs in appropriate cases.
- Press notices and reports are available from the date of
publication on the NAO website, which is at www.nao.org.uk. Hard
copies can be obtained from The Stationery Office on 0845 702
3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 850 staff. He
and the NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
Key facts about the primary care drugs bill
In 2006:
- 752 million prescriptions items were dispensed in primary care.
Seventy-seven per cent of these were for six therapeutic areas: the
cardiovascular system, the central nervous system, the endocrine
system, the respiratory system, the gastro-intestinal system, and
infections.
- £1.9 billion (a quarter of the total bill) was spent on
cardiovascular prescriptions.
- Ninety-eight per cent of prescriptions dispensed in the
community were written by GPs, the remainder by nurses, pharmacists
and dentists.
- The average cost to the NHS of a prescription item was about
£11.
In 2005 (latest figures available)
- There were on average 14 prescription items dispensed per head
of population over the course of the year. Patients under the age
of 16 received 4 items per head on average, whereas those over 60
received 38 per head.
- 88 percent of all prescription items dispensed were free to
patients
Source: NHS Information Centre
Press Notice 26/07
All enquiries to Donna Watson, NAO Press Office: Tel: 020 7798
7038
Mobile: 07917 555 388