GPs face tough new drug switch targets

28 Nov 07

The powerful NHS Institute of Innovation and Technology is to increase the target for the proportion of statins prescribed generically from 70% to 77%, Pulse has learned.

It also plans a brand new ‘Better Care, Better Value’ indicator for PCTs, setting a target for use of ACE inhibitors and the proportion of PPIs and antiplatelets prescribed as generics.

The precise percentage of cheaper drug use within these classes is yet to be decided, but trailblazer SHAs are already setting targets of 90% generics for PPIs and up to 80% for ACE inhibitors as opposed to ARBs.

The new targets – set to be introduced early next year – look likely to place GPs under strong pressure from PCTs to initiate patients on cheap drugs and switch patients from branded to generic products.

PCTs have enthusiastically implemented the current 70% indicator for use of statins, with new figures showing that by earlier this year, half of trusts had hit the target.

The new indicators follow a consultation among SHAs and the implementation of tough targets in some areas.

NHS East of England, NHS West Midlands and NHS South West have all set a 90% target for generic PPIs. For ACE inhibitors as a proportion of all drugs affecting the renin-angiotensin system, the target is 80% at NHS East of England and 79% at NHS South West.

Mark Jennings, NHS priority programme director for the Better Care, Better Value indicators, said there was still ‘room for improvement’.

‘If you commit NHS resources to prescribing a more expensive drug, you’ve spent something you can’t spend on someone else. We’re trying to get PCTs and their GPs to look at what they are doing, to try to get more consistency.’

He said the institute planned a composite indicator for PCTs on use of ACE inhibitors, generic PPIs, aspirin and perhaps one other drug class.

Dr Bill Beeby, chair of the GPC prescribing subcommittee, said it was ‘inevitable’ GPs would be under pressure to modify prescribing in an era of tightening NHS budgets.

But he warned: ‘Pushing statins beyond 77% is probably going to be very difficult for many complex reasons. You’re never going to get to 100%, although I’m sure some people would like it.’

Dr Peter Swinyard, former member of the committee and a GP in Swindon, said a scheme in his area transferring patients to omeprazole left many patients struggling with their new treatment. ‘I have reservations about these mass switches, where PCTs persuade, cajole, and almost tell doctors to change everyone from one drug to another,’ he said.

Professor Mike Kirby, a GP in Radlett and professor of health and human sciences at the University of Hertfordshire, said it was essential to assess patients individually to ensure switching was done safely – and that there were medicolegal implications for GPs if procedures were not followed.