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How I saved £360,000 on drug costs

Dr Mark Spencer tells Lilian Anekwe how his practice has ploughed huge savings made on prescribing back into his practice under a PBC scheme

Dr Mark Spencer tells Lilian Anekwe how his practice has ploughed huge savings made on prescribing back into his practice under a PBC scheme

As active participants in practice-based commissioning, our six-partner practice gets to keep most of the savings it makes on prescribing costs. In the 2008/9 financial year we have saved £360,000 on a total prescribing budget of £2.8m. How have we done this?

There are four main areas we concentrate on. One is to look at alternatives to prescriptions – what can we offer a patient that works equally as well, but isn't a script? For example, in pain management we commission treatments such as acupuncture, transcutaneous electrical nerve stimulation and physiotherapy through PBC. For patients with mental health problems, we offer counselling or CBT instead of automatically reaching for the antidepressants.

We also switch patients from one medicine to another in its class. We have done this with statins, PPIs, calcium channel blockers and ACE inhibitors. We ran advertisements in the local paper, telling patients what we are doing and why, what savings are being made and how we are reinvesting those savings in services.

The third area is drug-specific protocols for treatment of long-term conditions. All our GPs prescribe to a standardised protocol to make sure all the drugs are cost-effective. Before we did this, we would have eight or 10 ACE inhibitors prescribed for no great clinical reason. Now we prescribe two and it's far more cost-effective.

Finally we only prescribe small amounts of medicines when initiating a new drug. So instead of giving a month's worth of medicines, we try giving a patient a week's worth to make sure they can tolerate it – otherwise the extra drugs are just wasted.

You don't need any extra expertise or kit to do this in your own practice. It's very straightforward. The difficulty can be engaging patients, and practices can fail if patients see change negatively. But this is often because the practice hasn't communicated what it is doing and what the benefits will be. Tell patients what you're doing and involve your practice staff – both prescribers and the receptionists who will have to field questions. We have meetings every couple of months to keep them informed of how much we've saved and the plan for the next six months.

Year on year, we are saving more money. This past 12 months we have been looking at painkillers and anti-inflammatories and doing switches in those areas and standardising prescribing. We have also identified protein build-up drinks as an area where we're spending too much on prescribing. We have used some of the savings to employ a pharmacist who monitors prescribing costs and comes up with further suggestions of areas to look at.

Prescribing is often the first domino in making your practice more cost-efficient. Once you start looking at one area, others follow and the process becomes iterative.

Dr Mark Spencer is a GP in Fleetwood, Lancashire

Five top tips for prescribing savings

- Target areas of high spending - such as statins
- Standardise prescribing within the practice
- Switch patients not on cost-effective drugs
- Be open with your patients and explain the benefits of making savings to them
- Involve your practice staff, including receptionists

How savings are being reinvested

• Pharmacist practitioner – £45,000
• Three mental health workers – £100,000
• Commissioning pain management services through PBC, including physiotherapy, TENS machine and acupuncture – £65,000
• Enhanced community nursing for housebound patients – £45,000
• Falls team to cut fracture rates by half – £40,000

Dr Mark Spencer saved £360,000 on prescribing Dr Mark Spencer

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