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Analysis: GP prescriptions drop by almost one million

The number of GP prescriptions in England dropped for the first year on record last year, with 950,000 fewer prescriptions and savings of £73m, new data has revealed.

In 2017/18, £8.25bn was spent on 1.095bn primary care prescriptions in England, according to new quarterly CCG prescribing figures.

The reduction in spending and items dispensed replaces consistent annual climbs. In 2016/17, there were 23m more prescriptions compared with 2015/16.

Large drop in analgesic prescribing

Among the most-dispensed items were lipid-regulating drugs (73m), prescriptions for hypertension and heart failure (71.6m) and antidepressants (67.9m), all of which saw increases from the previous year.

The largest changes were seen in analgesics (-2.9m), antidepressants (+2.8m) and emollient and barrier preparations (-2.2m).

Prescribing bans

The reduction follows NHS England’s crackdown on GP prescribing of medicines that are available over the counter, or deemed to be of clinical ‘low value’. 

NHS Clinical Commissioners, which devised the list of items that should be banned under the new policy, said the new data was evidence of its success.

Co-chair Dr Graham Jackson said: ‘This prescribing data is the first piece of evidence that the new national commissioning guidance on items of low priority for NHS funding, introduced in November 2017, is having its intended effect which is good news.’

And he added that following the latest advice, published in March, there should be further reductions to come.

‘It is important that we carry on having honest, open conversations on what the NHS can and should provide with the funding it has, so that we can continue to deliver high-quality care,’ he added.

Regional variations

NHS Sandwell and West Birmingham CCG saw the largest drop in prescription items in 2017/18, with some 9.97 million prescriptions – 364,000 fewer than the previous year. A spokesperson for the CCG said it had been an early adopter of the NHS England over-the-counter guidance, and has been working on chronic pain pathways and malnutrition screening to reduce prescribing.

NHS Bradford Districts CCG recorded 244,000 fewer prescriptions. Dr Carsten Grimm, a GP and clinical board member, said the drops were down to new patient online ordering systems and an oral nutritional project with a limited formulary and template to manage malnutrition.

He said: ‘Enabling patients to be in charge of their medication and order only what they need ensures that healthcare professionals are aware what patients actually need is important. Ordering more medication than is actually used can give GPs the false impression that patients need more potent drugs earlier on, with an increase in associated risks and side effects.’

Dr Grimm explained the importance of general practice in reviewing medication and and ensuring patients ‘take the right drug at the right time’.

The number of prescriptions per patient population in the north far exceeded southern and urban spots.

In Blackpool there was an average of 34 prescriptions per patient, and in NHS Durham Dales, Easington and Sedgefield CCG there were 33 prescriptions per patient. This was over three times the level of London CCG areas of Camden (10), Islington (11) and City and Hackney (11).

A spokesperson for NHS Blackpool CCG said: ‘Blackpool is well known for having high levels of patients with multiple long term conditions many of which are connected to the levels of deprivation in the town. This is the main driver of our higher item numbers and the CCG is looking at how we can optimise patients’ medication to reduce the number of prescriptions issued.’

A spokesperson for NHS Durham Dales, Easington and Sedgefield CCG explained they had moved to shorter period prescriptions produced for monitored dose systems (MDS). This aims to reduce medicine use and wastage, however, prescriptions are more frequent.

The CCG said the reduction in costs (-£2.1m) reflected these efforts. It also said the region has a higher rate of respiratory diseases such as COPD, at 2.7% in Durham against a national average of 1.7%.

GP leaders encouraged by findings

Dr Andrew Green, BMA GP Committee prescribing and policy lead, said: ‘GPs have been working very hard to ensure that their prescribing is appropriate, and the reduction in overall numbers of prescriptions is on the whole encouraging. Some of this may represent work by our CCGs, as they try to ensure proper prescribing of such things as nutritional supplements.’

He added: ‘I am also heartened by the decrease in analgesic prescribing, which hopefully recognises the very limited role for analgesics in chronic pain. The relentless increase in antidepressant prescribing is, however, of real concern and I await the findings of the [Public Health England] review of drugs with potential for dependence and withdrawal with great interest.’

RCGP chair Professor Helen Stokes-Lampard said: ‘Prescription costs are a massive expenditure for the NHS, so we’re pleased to see that the consultation about new guidelines to limit the amount of over-the-counter medicines has apparently already started to have a positive effect on reducing prescriptions of certain products.’

‘GPs are trained to know when medication isn’t needed’

Professor Helen Stokes Lampard

She stressed, however, that the restrictions are not a ‘blanket ban’ and said GPs must be trusted to make decisions in the best interests of patients taking into account ‘physical, psychological and social factors’.

Professor Stokes-Lampard said: ‘Understanding how to prescribe drugs is a major part of a GP’s training and professional development – so too is knowing when medication isn’t needed or can be discontinued.

‘GPs will always try to consider other alternatives such as social prescribing or other therapies to reduce the amount of prescriptions being issued, but we must also remember that the safe prescribing of drugs such as statins and antidepressants improves the health of many people and saves many lives.’

A version of this article was first published by Pulse sister title The Pharmacist


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