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Dispensing doctors do try to keep prices down

Dr Richard West 

pharmacy advice pharmacist  ppl


Dr Goldacre’s study is an interesting read and the Dispensing Doctors’ Association (DDA), of which I am Chairman, neither encourages, nor condones, the prescribing of costlier medicines.  Indeed, the GP contract has provisions which permit the NHS to take action against those who do so.

The study uses one month’s data from January 2015. Due to the continually changing reimbursement prices for medicines it is impossible, and disingenuous, to forecast one month’s estimated savings into a full year. There are also a number of one-off occurrences that can occur. For instance, in January 2015 there was a shortage of the valsartan generic.

Unlike community pharmacies, dispensing practices cannot use NCSO (no cheaper stock obtainable), and hence will always write a prescription for the brand if a generic medicine is in shortage. This puts a rather different complexion on the month snapshot that was taken in the study. In November 2018 alone, the price concessions for medicines for which there are shortages cost the NHS £23.3 million.

The cost of the medicines in the chosen four therapeutic areas of the study have decreased significantly, in addition to the prescribing of the brand originators, hence the paper really should have chosen more up-to-date data, which would show significantly decreased costs. Dispensing practices, like all practices, look to make efficiencies through increasing generic prescribing. For example, Olmetec prescriptions in 2015 cost £8.6 million, but in 2017 it was £0.78 million. That would have been rather less of a headline for your readers. 

The DDA has been concerned for some time that the system of reimbursement for drugs is not fit for purpose. For the last seven years, we have tried to interest the Department of Health and NHS England to develop a better one. To date, nothing has happened. 

We encourage our members to regularly audit their prescribing so that they ensure that they are acting in the best interests of the patient and the NHS. 

Dr Richard West is chairman at Dispensing Doctors’ Association and a GP in Stowmarket

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Readers' comments (2)

  • Old news. First of all it’s 4 year old data. Then the price differences are tiny, under 2percent for ACEIs, and less for PPIs. The Sartan data is skewed by the poor availability of Valsartan.

    And of course there are a small number of dispensing doctors who do let their financial interest bias their prescribing, but to smear 1in 8 GPs on the basis of aggregated data is unfair just as it is unfair to accuse pharmacists in general of being biased in advising patients to buy useless and expensive remedies for coughs etc because some of them do that.

    Could Dr Goldacre and colleagues also do a comparison of patient satisfaction scores, continuity of care, and unnecessary admission rates between dispensing and non dispensing doctors. No prizes for guessing the results.

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  • One of my patients has requested and received monthly doses of Decapeptyl injections over the last 14 months.
    When questioned where she was being administered these, she was surprised that she had these as the 'packets are unopened in the cupboard- do I have injections also?' But you ordered them !
    Now 14 injections is only what - 14 x £69, a measly 1000 pounds or so?
    If the patient had to pay 10p per script, I am certain she would have known what she was ordering and why. She would not have agreed to pay £1.40 from her pocket and wasted a thousand pounds of NHS resources. Freebies to people cost millions and also need to be dealt out wisely.
    However, we live in Eden don't we? Politicians are scared of putting a 10p charge on scripts which would talk more sense to people - they're just plain scared of losing votes with unpopular moves!

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