Prescribing costs and the burden that it is placing on NHS budgets cannot be overlooked. Lyndsey Stanley, director and clinical pharmacist and Tina Nightingale of the Practice Managers Association (PMA), ask how can practices keep up with national recommendations on prescriptions as well as the prescribing incentives set by their own CCGs
The cost of prescribing in the NHS has been an issue for a long time now. There have been countless incentives over the years to reduce NHS spend whilst maintaining quality of care for patients. This year is no different as two new sets of recommendations are launched.
But how can practices keep up? More importantly, how can they ensure implementation of new guidance on top of the prescribing incentives set by their own CCGs?
Counting the cost: GP vs over the counter
NHS England, in a bid to save £100m per year, has produced national guidance on conditions for which over the counter medicines should not be routinely prescribed in primary care after May 31, 2018. The guidance includes medicines that are for:
- A self-limiting condition, which does not require any medical advice or treatment as it will clear up on its own, such as sore throats, coughs and colds.
- A condition that is suitable for self-care, which can be treated with items that can easily be purchased over the counter from a pharmacy, such as indigestion, mouth ulcers and warts and verruca
Some of the products are considerably cheaper when purchased over the counter as opposed to being prescribed on the NHS. For example, a box of 32 paracetamol can be bought for under £1 in a pharmacy, but the same box of paracetamol will cost the NHS £34 on prescription, when you consider dispensing and GP consultation fees.
So, it comes as no surprise, then, that prescribing is the second highest area of spending in the NHS, after staffing. Statistics from NHS Digital show that in 2017 there were 1.11 billion prescription items dispensed, an increase of 0.15% from 1.1o billion in 2016. This was at a cost to the NHS of £9.17bn (down from £9.2bn in 2016).
Medicines Value Programme
In a further piece of recently published national guidance, NHS England, in conjunction with NHS Clinical Commissioners (NHSCC) have produced a list of 18 medicines which should no longer be routinely prescribed in primary care as part of the Medicines Value Programme. The aim of the programme is to promote greater value from medicines by improving health outcomes, reducing waste, targeting over prescribing and overtreatment and addressing excessive price inflation by drugs companies.
The 18 medicines that appear on the list have been selected because they are:
- Of low clinical effectiveness, with a lack of robust evidence of clinical effectiveness or have significant safety concerns.
- Clinically effective but more cost-effective products are available and includes products that have been subject to excessive price inflation.
- Clinically effective but due to the nature of the product are deemed a low priority for NHS funding.
Examples include co-proxamol, prolonged release doxazosin, glucosamine and chondroitin, herbal medicines, homeopathy, omega 3 fatty acids and paracetamol in combination with tramadol.
The aim of the guidance is to save £141m per year, that can be reinvested back into frontline services.
Optimising available resources
In times of finite NHS resources coupled with increasing numbers of prescriptions, it is imperative that prescribing is cost effective. By looking at the current prescribing levels of the drugs concerned, savings can be calculated based on a percentage of patients having the drug stopped or changed to a specified alternative. Auditing a practice in this way and in line with these two new pieces of guidance will ensure that best value for money from the drugs budget.
The fact that NHS England is investing in pharmacists in GP practices demonstrates the value they believe can be achieved and the fact that in the longer-term savings will be made whilst reducing GP workload. This may not be feasible for all practices, but shared pharmacist resource could be the solution. Any savings released are retained by the CCG who can then reinvest them in retaining or developing other services. Surely, this is an excellent incentive for CCGs to provide audit for practices in the locality?