Oxygen switch 'could be costing NHS millions'

11 Sep 07

Following the chaotic transfer from pharmacist to private provision last year, clinicians have lost control of oxygen supply and pricing has become unclear, the Drugs and Therapeutics Bulletin found.

Patients now receive an initial prescription for short-burst home oxygen from a GP or hospital specialist and are then given responsibility for reordering supplies.

Given the lack of evidence for short-burst oxygen in many cases, and its high cost, patients should be regularly reviewed to ensure they still need oxygen, the DTB said.

In 2005, over 710,000 prescriptions for oxygen cylinders were dispensed in England at a total cost of £17.7 million.

No comparable figures were publicly available for 2006 following the change in supply arrangements, researchers found.

Dr Ike Iheanacho, DTB editor, said: ‘It is an expensive treatment, the costs are less transparent and patients could be taking it without any evidence that it is doing them any good: that has big cost implications for primary care.’

Respiratory experts said that because much short-burst oxygen therapy was of ‘dubious efficacy’ and could be difficult to withdraw from patients, it was essential patients were properly assessed initially and regularly reviewed.

They said GPs did not want to write a prescription each time a patient needed more oxygen, but should be kept informed how much oxygen each patient was using.

Dr Mike Thomas, a GP in Minchinhampton, Gloucestershire, and a hospital practitioner in respiratory medicine, said short-burst oxygen therapy had been ‘over-used and inappropriately used’ in the past.

‘Anyone being contemplated for it should be properly assessed by a GPSI in respiratory medicine or a hospital specialist and all patients should be reviewed by an appropriately trained clinician at least annually,’ he said.

Dr Ian Millington, secretary of Morgannwg LMC, said initial problems with the new service, including a lack of specialist respiratory assessment teams, had been ironed out.

He said: ‘The main issue is that lots of short-burst oxygen therapy is of dubious efficacy but we are moving towards more appropriate ordering of oxygen.

‘They have now put more money into the service so we will hopefully get proper assessment of patients and appropriate prescriptions of oxygen.’

Dr Millington said some hospitals in Wales had got 30% of patients off short-burst oxygen after reviewing all patients receiving the therapy.

Dr Iheanacho said: ‘You would have to go to quite a lot of effort to find out how much oxygen is costing due to individual patients in your practice. I would be surprised if GPs could find that out easily.’