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Prescription-GP-WritingMarch 11 2015

GP prescribing practices in Northern Ireland are costing tens of millions of pounds more than would be the case elsewhere in the UK. In addition, more effective prescribing could have saved the NHS in Northern Ireland £14 million over the two years from 2012.

The figures are claimed in a report on primary care prescribing from the Public Accounts Committee of the Northern Ireland Assembly. The report says: “A comparison of prescribing costs per head of population across the UK suggests that if Northern Ireland prescribing costs had been in line with those in Wales in 2013, overall costs could have been reduced by £73 million.

“If local GPs reduced their prescribing of pregabalin, which is used to treat epilepsy, neuropathic pain, and generalised anxiety disorder to the level prescribed in other jurisdictions, the health service would have saved over £8.5 million in 2012 and £9.7 million in 2013.”

Overall, prescribing costs in primary care are £460m each year, around 10% of all health and social care expenditure in Northern Ireland, says the report. It notes that prescription item volumes have been increasing across the UK and almost 39 million items were dispensed in Northern Ireland in 2013.

“Despite the rise in volume, prescribing costs per head of population fell in England, Scotland and Wales over the seven year period to 31 March 2014. By contrast the prescribing costs per head of population in NI were slightly higher in 2013 than in 2007,” says the report.

PAC Chairperson Michaela Boyle MLA said: “The Committee acknowledges that the health service has made savings as it has encouraged the prescribing of lower cost generic drugs. However, we believe that significant further saving could be made if the lowest cost versions of generic drugs were prescribed.

“My Committee was surprised to learn that, for a number of common diseases, GPs here tend to prescribe more expensive generic versions of drugs compared to their counterparts in England, Scotland and Wales. If the most effective and least costly drugs had been prescribed, it would have saved £8.9 million in 2012 and £5.1 million in 2013.”

Data used to compile the report found a wide variation in prescribing costs, with over a 100% difference between the lowest and highest cost GP practices.

The PAC is recommending that the Department of Health, Social Services and Public Safety work with the Health and Social Care Board to assess the level of potential savings which more effective generic prescribing could generate.

“This could then be used to set a target prescribing cost for individual GP practices against which to benchmark prescribing performance and to identify areas where further improvement is necessary,” it says. In addition, it notes that GPs’ prescribing choices have only recently been bound by an agreed ‘formulary’ of cost effective drugs.

“In the Committee’s view, GPs have little incentive to consider the cost of their prescribing decisions since the cost falls to the HSC Board,” says the report.

“The challenge for the HSC Board is to continue to: develop close working relationships with GPs in order to promote better prescribing; use benchmarking data to help GPs peer-review their prescribing practices; and encourage GPs to more fully explain their decision to prescribe a particular medication to patients.

Ms Boyle has also called on the Department to work towards agreeing a community pharmacy contract with a revised reimbursement structure. It is critical of community pharmacists for not supplying the Department with information in 2006 which would have allowed it to set the terms of a revised contract in line with reimbursement models seen in England and Wales.

However, it points out that the Department’s failure to reach a new pharmacy contract agreement means £46m has had to be repaid to pharmacy contractors. This follows on from a Judicial Review of the use of the Scottish Drug Tariff as a model of reimbursement in 2010 without a contractual agreement in place.

Links:

Northern Island Assembly Public Accounts Committee announcement    

NIA PAC ‘Report on Primary Care Prescribing’ Executive Summary and recommendations    

Full report    

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