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prescrptionsDecember 3 2014

Primary care prescribing data for Northern Ireland shows annual efficiency savings of £132 million have been made over the past four years.

The cost of prescribing has fallen 18% in real terms since 2006, while prescription volume has risen from 23 million items in 2000 to almost 39 million in 2013, says the Northern Ireland Audit Office. The figures also show that in 2013 pharmacy contractors received almost £460 million which included dispensing reimbursement of £381 million.

Prescribing costs per head of population for 2013 were £223.54, down from £243.94 in 2010, and almost back to the 20067 level of £221.09. Comparative figures for 2013 from the rest of the UK are £183.73 in Scotland, £182.96 in Wales and £160.12 in England.

The figures have prompted Kieran Donnelly, the head of the NIAO, to conclude that if GPs prescribed more lower-cost, clinically effective medicines then significant economies in drug expenditure could be achieved without affecting patient care.

However, there is scope for further improvements, says the NIAO. “In particular, [the report] draws attention to variations in the prescribing patterns of local GPs and estimated that, in 2013, potential savings of £19 million could have been realized if all GPs had prescribed as efficiently as those in the average performing practice.

“Moreover, reducing the average by 10%over a three year period could yield savings of £54 million.” In addition, “if the prescribing costs of local GPs had been in line with those in Wales in 2013 there was potential to save up to £73 million.”

The NIAO announcement also draws attention to drug classes for hyperacidity, cholesterol and depression, and pregabalin. “This analysis showed that had drugs in these categories been prescribed at cost levels experienced in the rest of the UK, £17 million would have been available for other health services in 2012 and £15 million in 2013.

“Pregabalin has cost the prescribing budget more than any other single medicine prescribed by GPs. During 2013, a total of £17 million was spent on the drug, reflecting the fact that GPs here have prescribed it more frequently than other parts of the UK: £9.43 per head of population here compared to approximately £4 per head in the rest of the UK.”

The Health and Social Care Board has set a target to reduce the prescribing of pregabalin by £1 million during 2014. “However, the report’s view is that with the assistance of the HSC Board’s medicine management advisers, GP practices could move much more quickly to prescribing levels elsewhere in the UK.”

Commenting on the data Mr Donnelly said: “The findings in this report demonstrate the extent to which GPs choosing to prescribe cheaper but just as clinically effective generic medicines can lead to real savings. This is all the more important with demand for prescriptions rising year on year as the population ages and more and better treatments become available. It is important, therefore, that the Department and the HSC Board continue to support cost-effective prescribing to get the most from the significant investment involved.”

Derry GP Dr Tom Black, Chairman of the BMA’s GP committee in Northern Ireland has praised the work family doctors have done in reducing the costs of prescription drugs.

“Family doctors have saved £132 million in the past four years through changes in prescribing,” he said. “This is despite the fact that the number of prescriptions issued has leapt almost 15% from 34 million to 39 million scripts since 2010. This success in saving money is unequalled in the health service.”

He has contested the report’s suggestion that further savings in prescribing should include greater use of generic medicines and reducing the amount of specific expensive drugs.

“We are at the limit of generic prescribing,” said Dr Black. “There also needs to be a look at hospital prescribing and how savings could be made there. There is an issue with wasted medications and the fact that all drugs, even low cost over the counter medications, are available on prescription.

“GPs across Northern Ireland will continue to prescribe with the wellbeing of their patients at the heart of everything we do. If we are to be required to make further savings, then that will require close working with pharmacists. Family doctors are happy to do this, but this approach will need to be fully resourced in order to work.”

Other data in the report includes:

•    In 2014 there were 224 community pharmacy contractors providing community pharmacy services from 535 pharmacies - the figures for twelve years ago were 320 CPCs and 509 pharmacies.
•    The average number of prescriptions per service provider in 2013 was 70,750, or an average of 21.5 prescriptions per head of population
•    About 70% of reimbursement in 2012-13 related to the supply of branded drugs, they accounted for approximately 30% of the volume of items dispensed.
•    Category M medicines cover about 55% of all items reimbursed and about 86% of all generic items reimbursed

Links:

Northern Ireland Audit Office announcement

NIAO ‘Primary Care Prescribing’ report

BMA comment

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