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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. 

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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


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