Healthy Skepticism Library item: 12434

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Publication type: report

House of Commons Committee of Public Accounts
Department of Health: Prescribing costs in primary care
London: House of Commons 2008 Jan 17
http://www.publications.parliament.uk/pa/cm200708/cmselect/cmpubacc/173/173.pdf

Abstract:

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 following official
guidelines more often 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.

On the basis of a report from the Comptroller and Auditor General,1 we took evidence
from the Department on prescribing costs in primary care, and the scope for better use of
the £8 billion a year spent by the NHS on prescription drugs.