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Doctors must help NHS save money, says report

Published on 07/11/14 at 10:56am
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A report has suggested the National Health Service could make nearly £2 billion in cost savings if doctors ‘provided more appropriate care’.

The Academy of Medical Royal Colleges (AOMRC) guidance says that level of cost reduction could be achieved "in just 16 areas of clinical practice" through simple measures – such as increasing the frequency of ward rounds, making more efficient use of operating theatres and being more mindful of the side effects of drugs.

"One doctor's waste is another patient's delay," writes professor Terence Stephenson, the AOMRC's chair, in a foreword to the report, adding: "Potentially, it could be that other patient's lack of treatment." 

The new document has been published just ahead of the release of new figures showing that the number of hospitals being bailed out by government has almost doubled in fiscal 2013/2014 to 31 from 16 in the prior year, with the amount of money given also rising from £263m to around £500m. 

The AOMRC - which represents the 20 medical Royal Colleges and Faculties across the UK and Ireland - suggests around 20% of mainstream clinical practice brings no benefit to the patient thanks to overuse of tests and interventions, which saps scarce NHS resources. 

Making doctors more aware of the possibility of adverse drug reactions - particularly among frail or elderly patients - could save the NHS £466 million a year, according to the report, which suggests ADRs account for 4% of all hospital bed days. One analysis showed that over half of the patients being treated could safely have their medication reduced or stopped altogether, it adds.

Increasing the frequency of ward rounds could allow patients to be discharged from hospital sooner, says the AOMRC, citing the case of the Royal Liverpool University which reduced bed occupancy by nearly 8% by upping rounds from two a week to twice-daily. 

Meanwhile, improving the use of operating theatres and schedules better saved the University Hospital Bristol Trust £2 million a year which - if replicated across all 160 acute trusts in England - would generate a significant saving.

One of the main recommendations in the report is to make use of tools such as the National Institute for Health and Care Excellence 'do not do' database, which helps doctors avoid clinical practices that have limited value. 

Examples in the database include not offering systemic antibiotics to adults based only on positive wound cultures without clinical evidence of infection, not routinely offering ultrasound of the urinary tract when the cause of acute kidney injury has been identified – and not prescribing drugs to aid sleep unless sleep problems persist despite following a sleep plan.

"This is not simply about costs," insists Stephenson. "It is about supporting doctors and other clinicians to ensure that the resources of the NHS are used in the most effective way possible to provide the best possible quality and quantity of care for patients." 

Earlier this month, research from the Royal Pharmaceutical Society suggested that pharmacists could also save the NHS some £1.1 billion a year if they took over the treatment of minor ailments such as coughs and sore throats. 

Re-purposing old drugs 

Meanwhile, UK medical charities - including the Breast Cancer Campaign, the MS Society and the Alzheimer's Society - have called on the government to seek licenses for drugs that are no longer patented in order to re-purpose them for use in other indications.

Citing examples such as the potential value of cholesterol drug simvastatin in MS, they claim that there is no incentive to seek licenses for new uses and the government should step in to ensure this happens. 

A bill - which is being tabled by Conservative MP Jonathan Edwards - is scheduled to be presented to Parliament for a second reading today. The Department of Health is not backing the bill, however, saying the underlying problem is not one of licensing but encouraging appropriate off-label prescribing of drugs." 

Phil Taylor

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