Scotland’s medicines bill can shrink further, says report
pharmafile | January 25, 2013 | News story | Sales and Marketing | PPRS, Scotland, VBP, prescribing
An official review of primary care prescribing in Scotland has welcomed savings made, but says further efficiencies are possible.
Audit Scotland has published Prescribing in general practice in Scotland, its third report on the subject.
The report says GPs in Scotland are getting more “support and guidance” on their prescribing, contributing to an 11% fall in spending in real terms between 2004 and 2011. This is despite the volume of prescriptions rising by a third during that time.
General Practice prescribing accounts for 70% of all National Health Service (NHS) spending on drugs in Scotland. This amounts to almost £1 billion a year.
But the report says there is scope for further improvements, with a potential £26 million more saved every year without affecting patient care. It says this could mostly be done through reducing waste and cutting the use of less suitable medicines.
Auditor General for Scotland, Caroline Gardner, said: “The NHS spends almost £1 billion a year on drugs prescribed in general practice. Since we last looked at GP prescribing, the volume of drugs prescribed has continued to rise but the NHS has significantly improved how it manages spending. This was during a period when there have been considerable pressures and constraints on the health service.
“It has achieved this through providing doctors with more support and guidance and using better information about what GPs are prescribing. Demand for prescriptions is likely to increase further and it’s important that the NHS continues to work with GPs to make sure patients get the drugs they need and spending is well managed.”
The health service now has better quality information on GPs’ prescribing than in the past. The report recommends NHS boards use this to target areas for further improvement, such as identifying where particular drugs are over- or under-prescribed and supporting GPs to review patients who take a number of different medicines.
The report concludes that a number of factors will affect prescribing in the next few years, and it is difficult to forecast and quantify their long-term impact. These factors include new medicines and cheaper versions of existing drugs becoming available, Scotland’s ageing population, and lifestyle issues such as obesity, smoking and alcohol misuse and associated illnesses. The unclear long-term picture means it is important the NHS continues supporting cost-effective prescribing to get the most from the significant investment.
While there is considerable divergence between Scotland and England’s NHS, Westminster is planning to maintain a UK-wide medicines pricing system, when it updates the current PPRS from 2014. The new system is expected to include elements of Value-Based Pricing (VBP) for new products.
The report advised that NHS boards should:
• continue to work with GPs to reduce unnecessary waste; reduce the use of drugs considered less suitable for prescribing; increase generic prescribing; and only prescribe more expensive versions of drugs to those patients with a clinical need for them
• consider the business case for employing additional prescribing support staff as part of an invest-to-save initiative, where a board has high levels of prescribing, high spending and below average numbers of prescribing support staff
• work with GPs to implement the national guidelines on prescribing multiple drugs (polypharmacy) and support GPs in reviewing the medication of patients taking multiple drugs.
Andrew McConaghie
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