Wide variation in repeat prescription lengths across England
There is a wide variation in repeat prescription lengths by GP practices across England, researchers have found.
Their report published in the British Journal of General Practice (BJGP) focused on prescriptions issued for five common routine medications – ramipril, atorvastatin, simvastatin, levothyroxine and amlodipine – between 2018 and 2019.
Doctors are asked to select ‘clinically appropriate’ prescription durations in the absence of national guidance, typically between 28 and 84 days – but regional variation in the proportion of 28-day prescriptions was stark, ranging from as low as 7% in some legacy CCGs, to 95% in others.
The proportion of a practice’s patients with chronic conditions was a significant predictor of repeat prescription lengths. The quintile of practices with the most patients with chronic conditions prescribed 28-day at a 27% higher rate than the lowest quintile.
Researchers found that practices with more chronically ill patients are more likely to have to do more frequent monitoring and adjustment of medications.
‘The percentage of patients with chronic conditions was also associated with prescription duration. Practices that have more patients with a chronic condition will likely have more patients with multiple chronic conditions, likely requiring multiple treatments and more frequent monitoring and/or medication adjustments,’ the report said.
The overall proportion of tablets or capsules issued according to repeat prescription lengths was roughly similar, with 48.5% 28-day prescriptions compared to 43.6% 56-day prescriptions.
Factors such as a practice’s dispensing status could also account for the huge variation in repeat prescription lengths, the researchers suggested.
The quantity of tablets issued as part of 28-day prescriptions, as opposed to 56- or 84-day items, was 64% higher for dispensing practices than non-dispensing.
The report suggested this could be the product of volume-based dispensing remuneration payments which incentivise more frequent prescribing.
It said: ‘Dispensers (both community pharmacies and dispensing doctors) are paid on a per-item basis, and if there was a substantial shift to longer prescriptions it would likely lead to reduced income with minimal workload reductions.’
Dr Helen Curtis, senior researcher at the Bennett Institute and senior author on the paper, said ‘This research shows that there is no consistent approach to how long repeat prescriptions last in England, even for the same medicines and conditions.
‘While some variation may be clinically appropriate, the scale of the differences suggests that local policy, payment structures, and system design are also playing a role.’
A 2021 report by the Department for Health and Social Care (DHSC) on reducing overprescribing had said national organisations should support practices to improve consistency of repeat prescribing.
The review, which prompted ministers to pledge to ‘take action’ on overprescribing, found 10% of medicines dispensed in primary care in England were not needed.
Last year, a repeat prescribing toolkit was published by the RCGP and Royal Pharmaceutical Society (RPS) in the form of a ‘self-assessment process’ to help practices and PCNs assess their local arrangements.
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