Cost drive gathers pace

28 Nov 07

It’s a dramatic, barely believable turnaround that owes more than a little to ever-tightening constraints on prescribing costs – led by the totemic drive to switch patients to cheaper statins.

But the NHS apparently has no intention of resting on its laurels. Pulse this week reveals a further raising of the bar on generic statin use – from 70% to 77% – and a new indicator on cheap prescribing of PPIs, antiplatelets and ACE inhibitors.

Questions over safety

As policy drives go, it’s impressively, perhaps ruthlessly, ambitious – but questions remain about safety.

As experts told Pulse in a special debate on drug switching last week, there is plenty of evidence to support initiating patients on generic drugs like simvastatin – but very little for the safety or effectiveness of switching to them.

To which GPs might reasonably ask, why not? With drug switching set to save millions, is it unreasonable to set aside just a little cash to evaluate its safety?

GPs are of course used to working in an imperfectly evidence-based world, and recognise the need for cost-effective prescribing. But that should not be an overbearing need, and there must be a limit to the pressures applied to achieve it.

When some switching incentives pay GPs to ignore QOF points, it is legitimate to ask if the policy drive has gone too far.