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PCTs 'overspending' on prescribing

Published on 24/05/07 at 11:22am

PCTs could save the NHS more than £200 million if they can persuade more GPs to prescribe generically, according to Parliament's spending watchdog.

The National Audit Office found large variations in prescribing for the same conditions between PCTs in its report and said patient care wouldn't be affected if fewer branded drugs were used.

Its report looked at how the NHS can help make future growth in prescribing more affordable without affecting clinical outcomes.

Head of the National Audit Office (NAO) Sir John Bourn said: "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."

Small changes in prescribing behaviour can lead to substantial savings and PCTs should learn from their high performing peers, he added.

The ABPI said the report was constructive but that cheaper versions of drugs were not always appropriate and that doctors must be supported in looking at a medicine's true value.

Commercial director David Fisher said: "We support the NHS need to get best value for money from medicines and its other services, but the needs of patients must not be sidelined in the search to save money.

The NAO's report identified four drug groups - statins, rennin-angiotensin drugs, proton prump inhibitors and clopidogrel - as offering the biggest savings opportunities.

In particular, statins were singled out as an area for savings. In the second quarter of 2006-07, the proportion of statins prescribed generically varied from 28% to 86% across England's PCTs.

The NAO also found it was difficult for GPs to assimilate all the information they received on prescribing and that both official NHS prescribing advisers and the pharma industry influence GPs prescribing decisions.

Doctors leaders said that GPs must look at the effectiveness of medicines and cost should be secondary.

Dr Brian Dunn, from the BMA's General Practitioners Committee clinical and prescribing subcommittee, said: "UK general practice is one of the most efficient in the world. The registered list allows GPs to build a life-long relationship with patients, which in turn allows long-term conditions to be more efficiently managed."

He added that the committee would welcome increased prescribing support for GPs, appropriate incentives to prescribe efficiently, measures to decrease medicine wastage and better co-ordination of prescribing between primary and secondary care.

Alongside the new report, the NAO also launched a communication aid - available online at - to help NHS prescribing advisers communicate more effectively with GPs in order to improve their prescribing information.

The toolkit was partly based on communication methods used by pharma's own sales reps to influence GPs' behaviour so that it might help PCTs support high-quality and cost-effective prescribing.

Dr Gill Morgan, chief executive of the NHS Confederation which represents more than 90% of NHS organisations, said: "Individual GPs need to consider what medicines they prescribe when more than one alternative is available. PCTs need to challenge GP practices and design the right incentives in the system to help this happen.There are implications for the drug industry in their relationships with prescribers."

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% in real terms.

The NAO report also pointed out that the NHS bill for unused or wasted drugs could be as much as £100 million each year.

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