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Update: GPs face renewed crackdown on prescribing costs

GPs face closer scrutiny of their prescribing after CCGs warned they were overspending drug budgets – in some cases by millions of pounds.

Information obtained by Pulse shows that several CCGs expect to report large overspends on their prescribing budgets for 2013/14, despite the ongoing QIPP challenge to reduce NHS costs.

CCG leaders blame the overspend on unexpected hikes in the prices of ‘high volume’ generic drugs and general growth in demand, and say they will be stepping up schemes to ‘optimise’ GP prescribing as a result this year.

But GP leaders warn the scope for major savings will be limited unless CCGs tackle the shunting of secondary care prescribing costs onto primary care.

Pulse found eight CCGs have issued warnings about their prescribing budgets at the end of 2013/14.

These include NHS Warrington CCG, which predicts a £2.3m overspend in 2013/14 due to higher demand and unforeseen price rises for drugs, such as phenytoin. Chair Dr Andrew Davies, a GP in the town, says the CCG is offering money to practices to train a ‘practice-based medicines co-ordinator’ – usually a receptionist – to help remind GPs to stick to local prescribing lists.

He says: ‘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 their own medicines management co-ordinators.’

NHS Lambeth CCG, in south London, says rising care home prescribing costs have led to many practices going over their prescribing budget in 2013/14.

Board papers say the CCG will be visiting practices with high drug bills. ‘Overspent practices are being visited by the prescribing adviser and NHS Lambeth CCG board medicines lead. Action plans will be produced and implemented.’

A spokesperson from NHS South Reading CCG and NHS Newbury and District CCG – which collectively predict an overspend of £0.7m on prescribing in 2013/14 – says they will also be looking closely at GPs. She says: ‘The medicines management team is proactively working with practices to ensure appropriate prescribing and has introduced a protocol on the use of the new anticoagulant drugs to support GPs in their prescribing practices.’

But GP leaders warn prescribing budgets are driven largely by the ageing population. Dr Tim Morton, chair of Norfolk and Waveney LMC, says: ‘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.’

CCG prescribing overspends

  • NHS Warrington CCG – £2.3m predicted overspend in 2013/14 due to rising demand and drugs costs
  • NHS Vale of York CCG – forecasting an overspend on primary care due to the ‘£1.4m forecast outturn in prescribing’
  • NHS South Reading CCG and NHS Newbury and District CCG – forecasting respective overspends of £0.3m and £0.4m on prescribing in 2013/14 due to rises in cost of ‘high-volume’ generics and new anticoagulant drugs
  • NHS Lambeth CCG – says rising care home prescribing has led to many practices going over budget
  • NHS Haringey CCG, NHS Tameside and Glossop CCG and NHS West Norfolk CCG – warning of problems keeping within their budgets in 2013/14



Dr Andrew Green: ‘Hospitals have blown GPs’ prescribing budgets’

Dr Andrew Green

GPs are used to balancing two huge responsibilities, that to the individual patient in front of them and that to patients as a whole, and therefore have a duty to prescribe cost effectively.

Working with medicines management teams is an important part of this. But I believe that the significant gains from medicines’ optimisation have already happened, either because projects have been done in earlier years or because drugs which previously were the target for changes are now off patent.

This has led to some changes being suggested that are inappropriate. Although prescribing budgets are being squeezed, we need to recognise that any change is disruptive for the patient, can reduce concordance, or expose patients who are settled on one medication to a new set of side effects, so changes must be significant in value, be sustainable, be infrequent, and must always be to a drug of similar effectiveness.

GPs can do a lot of this kind of work with many patients in order to save relatively small amounts of money, then find any saving blown out of the water by a single request from secondary care for a high cost medication that previously would have been prescribed from the hospital directly, with ‘specials’ particularly problematic in this regard.

Dr Andrew Green is chair of the GPC’s clinical and prescribing subcommittee and a GP in Hedon, East Yorkshire.


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