DEPARTMENT OF HEALTH: PRESCRIBING COSTS IN PRIMARY CARE
Publication of 2nd Report, Session 2007-08
Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:
“The pharmaceutical industry spends £850 million each year on marketing its products to GPs. One fifth of all GPs surveyed by the National Audit Office say that their behaviour in prescribing drugs is more influenced by pharmaceutical company marketing than by official NHS advice. And the NHS spends each year at least £200 million more than it should as a result of GPs prescribing too high a proportion of higher cost, branded medicines - rather than generic versions which are cheaper, but no less effective in clinical outcomes.
“It’s hard to doubt that the blandishments of the pharmaceutical industry are having an effect. But GPs must concentrate more on following official guidelines, increasing the prescribing of generic drugs where clinically appropriate. The fact that Primary Care Trusts vary hugely in the extent to which their GPs prescribe generic drugs for common conditions shows what can be achieved.
“Unused and wasted drugs cost the NHS at least £100 million a year and almost certainly a lot more. The Department of Health must do more to find out why this is happening. Given that nearly 90% of prescription items are dispensed free and the rest for a standard charge, the Department should start by making it clear on the packaging just how much the medicines in question actually cost.”
Mr Leigh was speaking as the Committee published its 2nd Report of this Session which, on the basis of evidence from the Department of Health, examined the scope for better use of the £8 billion a year spent by the NHS on prescription drugs.
Around a quarter of all expenditure in primary care is on drugs, and both the volume of drugs prescribed and their total cost are increasing. In 1996, 485 million prescriptions were dispensed in England; by 2006 this had increased by 55% to 752 million. Over the same period the primary care drugs bill increased from £4.0 billion to £8.2 billion: a 60% increase in real terms. Growth has been driven by the licensing of new treatments, the discovery of new opportunities to treat disease through existing medications, and moves to earlier treatment of some diseases. Efficient management by the Department of Health (the Department) and NHS bodies can however make the drugs bill more affordable without affecting patient care.
In recent years there has been a substantial increase in prescribing lower cost, generic versions of drugs, rather than more expensive brand name drugs. There are a number of examples of good practice where progress has been made: for example by supporting GPs to switch patients’ medication to lower cost generic forms where appropriate, by working with local opinion-leaders to promote better prescribing, and by using benchmarking data to help GPs peer-review their prescribing practices.
There is however still scope for further savings to be made, through GPs more often following official guidelines and prescribing generic and other cheaper drugs where suitable. There is wide variation between Primary Care Trusts (PCTs) in the proportions of lower cost drugs being prescribed for some common conditions, for example between 28% and 86% for statins. The National Audit Office has estimated that £200 million a year could be saved without affecting clinical outcomes, money which could be used to treat patients. The Department does not know the extent to which drugs being prescribed are not taken and wasted, though the value of drugs returned to pharmacists alone is estimated to be at least £100 million a year.