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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)

  • I am heartened that so many of the posts here see value in using a pharmacist to help them manage their prescribing costs. I also appreciate some comments which reflect less well on pharmacy relating to over-ordering - can I ask that reader if they have challenged the pharmacy directly? And if not, why not?
    Additionally, it is true, patients need to take responsibility for the cost of their medicine - not by paying for it directly but by not over-ordering and GPs need to support this by not rolling over and reaching for their prescription pad every time. Yes, there is a huge amount of waste in medicines but until you sort out potential liabilities, reuse is not an option - and even if it was, surely it would still be better to reduce the requests/authorizations for prescriptions in the first place? In short, there is no single simple solution to this problem. It requires a concerted effort from prescribers, pharmacists & patients all working to make sure we don't pour millions of pounds of unwanted medicines in to incinerators when that money could be put to better use

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  • Sorry to come late to this but I love that a Dr Graves has Dr Addisons disease. Nominative determinism at it's best

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  • we are conflating two seperate items and putting the usual NHS management "anti GP Spin" on them.
    Firstly- prescribing quality
    - pharmacy support, decision support software and so forth- all of which optimise the GP's own professional practice and choices and I recommend strongly.

    Secondly- "pass thorough" medicines costs.

    With the strategy being for "out of hospital care" more secondary care prescribing and dispensing is moving to primary care.
    I have been unable to find any evidence of hospital pharmacy budget and staff admin costs being added on to the "pass through" primary care budget increase.
    We have been given a "financial cap" and wifully had extra costs put into it.
    The third and inevitable consequence will be to lambast the profession for failure when the impossible task is impossible.
    Astro-pu and all other tools weight against a historical "GP only prescribing" model. The increased unremunerated secondary care costs practices are now scripting will ensure we all fail, the only difference is how long you can hang on.
    Call on your CCG to delibver a costed rationale for your presctibing budget clearly demonstrating the additionality for the pass through costs.

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  • my observation is that its not just prescribing which is causing overspends [as most prescribing leads think] its NICE recommendations--shift from secondary care to primary care and above all not tackling medicines optimization--we need to have the community pharmacists working with GPS and CCGs-Nationally we are loosing £300 million through the wastage--lets wake up and work in the 21st century

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  • Easy option, which will save millions.

    Stop giving patients medicines.

    On a serious note - The NNT for statins and many other NICE approved medications is ridiculously high, and then the QOF requires you to start unnecessary medication which they refuse to eat anyway.

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  • Now that GPs are forming networks is it not time to consider purchasing some local retail pharmacies. That way we could gradually develop one portal for ordering and delivering medication for our patients. We can then manage the whole process involving medication reviews, concordance, appropriate ordering and stopping wastage

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