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Massive expansion in PCT drug switching schemes

By Nigel Praities

A dramatic expansion of NHS drug-switching schemes is having a huge impact on GP prescribing, a Pulse investigation reveals.

PCTs have introduced a swathe of schemes over the last year, the survey of 131 trusts shows. The number targeting bisphosphonates, ARBs and ACE inhibitors has doubled in a year, while schemes for antiplatelets have leapt almost fivefold.

An accompanying survey of more than 400 GPs found 65% were placed under pressure from their PCT to co-operate with drug-switching schemes and a third thought their freedom to do the best for their patients was compromised.

Schemes to increase generic statin prescriptions remain the most common, with 97% of trusts having one in 2008/9, compared with 84% in 2007/8.

But PCTs have diversified substantially – the number of trusts with a switching scheme for bisphosphonates has increased from 23% to 58% in a year, and for ACE inhibitors and ARBs from 38% to 75%.

The largest rises were for the number of PCTs with schemes for antiplatelet drugs, rising from 10% to 49%, and antihistamines, rising from 11% to 51%.


Dr Alun Cooper, a GPSI in osteoporosis in Crawley, West Sussex, and chair of the National Osteoporosis Society's primary care forum, said he was concerned the focus on use of alendronate – in line with NICE guidance – would harm patient care. ‘The danger is patients are switched, come back and say they have indigestion and the GP then starts them on a PPI. But we have evidence PPIs are bad for bones,' he said.

Dr George Kassianos, a GP in Bracknell, Berkshire, and a fellow of the European Society of Cardiology, said he was in dispute with his PCT over drug-switching schemes for clopidogrel and generic PPIs.

‘Where is the evidence of safety for using omeprazole or lansoprazole and aspirin, or discontinuing clopidogrel after 12 months? If PCTs are going to press ahead they need to give us materials to clearly explain the risks to patients,' he said.

Recent evidence shows stopping clopidogrel after 12 months could pose a danger to high-risk patients, with a rebound in mortality or heart attacks.

The survey also revealed 56% of PCTs with schemes paid incentives to GPs and 20% had received complaints from patients. Nearly 5% admitted to adverse events associated with drug switching, with one PCT reporting about 20 adverse events in one scheme.

Dr Neal Maskrey, director of evidence-based therapeutics at the National Prescribing Centre, said: ‘There's evidence schemes can encourage clinically effective and cost-effective prescribing. But they shouldn't override GPs' responsibility.'

Pulse investigation shows huge increase in drug switching schemes Pulse investigation shows huge increase in drug switching schemes GP prescribing

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