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Independents' Day

GPs face crackdown on prescribing costs after million-pound overspends

Exclusive GPs face closer scrutiny of their prescribing after CCGs warned they were overspending their drug budgets by thousands of pounds, with some commissioners planning to train receptionists to drive prescription costs down.

Information obtained by Pulse shows that several CCGs reported large overspends on their prescribing budgets at the end of 2013/14, despite the ongoing QIPP challenge to reduce NHS costs.

CCG leaders cited unexpected hikes in the prices of ‘high volume’ generic drugs and general growth in demand for the overspend, and said they would be stepping up schemes to ‘optimise’ GP prescribing as a result this year.

One CCG told Pulse it would be funding an initiative for practices to train receptionists to check prescriptions to remind GPs to stick to local prescribing lists.

But GP leaders warned that any scope to make major savings was limited unless CCGs tackle the shunting of secondary care prescribing costs on to primary care.

Pulse has found examples of eight CCGs who have issued warnings about their prescribing budgets at the end of 2013/14:

  • NHS Warrington CCG told Pulse it has had a predicted £2.3m overspend due to more people taking medicines and drugs - such as phenytoin - becoming more expensive
  • NHS Vale of York CCG, which has said it was forecasting an overspend on primary care ‘owing to the £1.4m forecast outturn in prescribing’
  • At NHS South Reading CCG and NHS Newbury and District CCG, managers forecast respective overspends of £0.3m and £0.4m on prescribing due to expected rises in cost of ‘high-volume’ generics such as sertraline, temazepam and new anticoagulant drugs
  • In NHS Lambeth CCG, a spokesman said care home prescribing led to many practices going over their prescribing budget
  • Other CCGs warning of problems keeping within their prescribing budgets include NHS Haringey CCG, NHS Tameside and Glossop CCG and NHS West Norfolk CCG.

NHS Warrington CCG chair Dr Andrew Davies said it would be offering money to practices to train up a ‘practice-based medicines co-ordinator’ – usually a receptionist – to help remind GPs to stick to local prescribing lists.

He said: ‘There is some prescribing optimisation still to do – there are still some high-cost drugs being started in the community that perhaps are not the optimal use of resources.’

‘We’ve got the medicines management team here but we have also given practices resources to train up their own medicines management co-ordinators. So one of the reception staff is trained up to do some of the more systematic switches and just correct prescribing at source.’

A spokesperson for NHS Lambeth CCG told Pulse that they would be looking closely at care home prescribing and minutes from the CCG said they would also be visiting practices with high drug bills.

The minutes said: ‘Overspent practices are being visited by the prescribing advisor and Lambeth CCG board medicines lead. Action plans will be produced and implemented to address overspend.’

A spokesperson from NHS South Reading CCG and NHS Newbury and District CCG said that they would also be looking closely at GP prescribing.

She said: ‘The medicines management team are proactively working with practices to ensure appropriate prescribing and have introduced a protocol on the use of the new anticoagulant drugs to support GPs in their prescribing practices.’

But GP leaders warned that prescribing budgets were being driven largely by the ageing population and increased demand, with little room left for making further cost savings through performance management of GPs’ prescribing.

Dr Tim Morton, chair of Norfolk and Waveney LMC, said: ‘I think from what I can see, practices are trying very hard with sensible prescribing. Despite all that, the pressure is on – because of the morbidities, access and more secondary care work. They’re the main determinants of our cost pressures.’

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee and a GP in Hedon, East Yorkshire, said that primary care has saved all it can from prescribing budgets but these are ‘blown out of the water’ by requests from secondary care.

He said: ‘Many secondary care clinicians appear unaware of the cost of these preparations. Clearly any resource allocation formula needs to be sophisticated enough to allow for this happening, as it would be unethical for a GP to decline to prescribe for a patient a necessary prescription wholly on the basis of cost.’

Readers' comments (26)

  • All non urgent outpatient prescribing is now GP prescribed in Reading. Generic costs, manufacturing issues are all adding to the issue and of course it's the GP's job to sort this out! Most prescribing is for a reason and if you start 'cost' cutting you end up shifting costs to another area. More appointments, less efficacy, wasted medicines.
    And really? My receptionist is going to be in the queue behind the prescribing advisor, chemist, prescribing nurse, CCG and patient to all have a different view on why I've precribed generic rhubarb caps tds!

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  • This is nonsense of course. Especially, at the moment, because there are supply shortages of so many common medications. Even simple links like co-codamol and bendroflumethiazide have short through the roof.

    Our local pharmacist makes a substantial chunk of his income by predicting what the next common price rise medication will be and buying in bulk (10,000 packets+).

    Trying to stop this from the GP end is like peeing in the wind. And asking receptionists to be involved is ridiculous (and dangerous).

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  • we can solve this by prescribing more statins...................

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  • Perhaps paying for a professional to manage the in-house prescribing costs would be a good plan.... i.e. a pharmacist. Most pharmacists could save their salary several times over and improve the quality of prescribing without breaking a sweat. They could also follow up any high cost secondary care prescribing on a patient by patient basis - as issue which primary care complains about but rarely actually challenges robustly.

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  • So how are the CCG going to manage the withdrawal of Glucophage sachets for those who cannot swallow tablets when the alternative is the liquid metformin @ £50.75 for 500mgm od. How are practices expected to manage costs which are beyond their control. Do the CCG's think that a receptionist has some sort of magic wand!!

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  • Anon @10.50 - we already have hands-on CCG meds management pharmacists, computer software and our own professional approach to prescribing and effective cost management

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  • CCGs can start by giving us support for refusing to change a private prescription into an NHS one.

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  • THERE is no such term as "overspent" for demand which has no limit. budgets are set on waited list size.not on actual list size, no idea who came up with this idea.that 5 or 6 hundred patients don't matter.
    if patient complains than not many helpers for you.. save your skin.
    have a common formulary for hospital and primary care.

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  • My practice employs a full time pharmacist. She is worth her weight in gold. she was originally part funded by the PCT/CCG who over the years have paid less and less of her time (out of their MMT budget - they seem to be getting rid of pharmacists and having techs instead!)
    We picked up her hours from our pockets. She saves a fortune and helps us hit targets but more importantly she helps us deliver quality, she supervises our repeat meds system, has just helped us implement ETP, She has sorted out an in house formulary based on sensible clinical guidance and we have trained her up to be a prescriber and she runs a hypertension clinic for us.
    Pharmacists have a huge role to help primary care - alas i dont believe this is community pharmacists - they have different concerns and pressures - they need to be embedded in a GP practice to work.

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  • My pharmacist has stuck with branded Ventolin inhalers for years. Last year he switched to generics. While being much smaller they claim to contain the same amount of medication - they do not. They are also far less effective, needing a much higher dose. The valve mechanism is also defective and frequently fails.

    Overall I use at least triple the amount of generic Salbutamol for far less benefit than Ventolin.

    I can also buy my hydrocortisone (I have primary Addison's), on the open market for a mere fraction of the cost to my GP's budget. And that's paying retail prices.

    Perhaps addressing the questions of quality and pricing should be priorities, NOT putting patients at risk by having them fobbed off by receptionists?

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