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Prescribing costs in primary care

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.

“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.”

Sir John Bourn

Notes for Editors

  1. 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
  2. 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.
  3. Press notices and reports are available from the date of publication on the NAO website, which is at Hard copies can be obtained from The Stationery Office on 0845 702 3474.
  4. 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

PN: 26/07