New report highlights postcode lottery for medicines
pharmafile | December 12, 2011 | News story | | DoH, NHS, UK
A new report by the Department of Health illustrates a stark postcode lottery in drug spend for patients with chronic conditions.
The NHS Atlas of Variation 2.0, shows that there is a 25-fold variation in the prescription of anti-dementia drugs across England.
It also shows that patients with type II diabetes are twice as likely to receive the highest standard of care in some areas of England in comparison to others.
This second Atlas – the first was issued in November last year – was published by the Department of Health to highlight the amount each English primary care trust spends on clinical services over the past year, and aims to link this with the health outcomes patients see.
It comprises 71 key indicators, including: hospital admission rates, what treatments health trusts choose to fund and how children are managed in NHS, and attempts to map the “utilisation of healthcare services that cannot be explained by variation in patient illness or patient preferences”.
Postcode lottery for dementia drugs
For anti-dementia drugs, which include Pfizer and Eisai’s Alzheimer’s drug Aricept, and Janssen and Shire’s Reminyl, there was a large variation in prescriptions.
The report shows that patients in some parts of the country – such as North Lancashire – were prescribed 25 times as many treatments and drugs to help temporarily improve or stabilise symptoms, compared to dementia patients in Kent.
The authors say the data shows that there is an “unwarranted variation in this aspect of care for people with dementia”.
One possible reason for this variation is the inconsistency in the diagnosis of dementia across England.
This could be because dementia has been stigmatised, the authors say, with some doctors assuming that nothing can be done, meaning that GPs may not refer them for specialist assessment.
To remedy this, the report says that commissioners, GPs and hospital workers should “review the training available for healthcare professionals to improve early identification and diagnosis of dementia”.
Variation in diabetes drugs spend
Spend on non-insulin diabetes drugs – such as metformin, Merck’s Januvia and Takeda’s Actos – for the NHS was £259 million last year, with the average spend per adult with diabetes reaching £110.79.
But across PCTs there was a large variation, with spending from GPs ranging from £65 to £180, according to the report.
It was a similar story with insulin as well; with the average spend per patient hitting £131.40.
But there was a comparable variation as with the non-insulin drugs, with the lowest being paid out per patient at just £79 and the highest at £176.
The report suggests that to remedy these disparities, all commissioners “should investigate whether local prescribing practice is in line with NICE guidance”.
The Atlas will be a key message for PCTs, and highlights the tension between health secretary Andrew Lansley’s vision of a localised health service, and the need to impose minimum standards of care across the NHS as a whole.
It also serves as a warning for the emerging clinical commissioning groups that, from 2013, will take over from PCTs as the ones responsible for the NHS budget.
As this is a key part of the government’s reform of the NHS, it will put these new groups under pressure to ensure that this inequality of care is ironed out.
Health minister Lord Howe said: “The Atlas of Variation lets us look at how the local NHS is meeting the clinical needs of their local population.
“This will help commissioners to identify unjustified variations and drive up standards so patients are receiving consistently high quality care throughout the NHS.
“Commissioners will be able to apply contractual penalties if any organisation is failing to deliver improvements for patients.”
Ben Adams
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