This site is intended for health professionals only

Blanket 28-day prescribing policies ‘cost more than they save’

Policies promoting 28-day prescribing by GPs are likely to be a false economy as they cost at least as much as they are projected to save, pharmacy researchers have suggested.

Their study said the Department of Health-endorsed policy to promote shorter prescribing durations costs at least an additional £150m a year due to increased dispensing fees from pharmacies.

It found the policy had been effective in prompting a ‘generalised change in prescribing behaviour’, with GPs prescribing five fewer doses per prescription compared with a decade ago.

But the analysis led by Professor David Taylor, professor of pharmaceutical and public health policy at University College London School of pharmacy, concluded the policies had been applied too ‘rigidly’ in some areas, and said GPs should be allowed to use their discretion in determining prescription duration.

Published in the journal Primary Care Research and Development this month, the study looked at trends in prescribing data from 1998-2009 in England for 11 medicines, including simvastatin, aspirin and ramipril.

The medicines represented a fifth of all prescription items supplied and apart from amoxicillin, which was included as an acute comparator, all the medicines showed a significant drop in doses per prescription. This drop in prescription length meant an extra 35 million items were dispensed during 2009 compared with 1998.

The researchers calculated this would equate to an additional £150m a year in dispensing fees and, when taking into account other costs such as patient/GP time, loss of disease control and so on, the benefits were unlikely to outweigh the expense.

They cited a University of York analysis showing that in England policies to reduce the cost of unused medicines in the NHS were likely to only generate savings of up to £150m at best.

‘A cost of £150m, the available evidence suggests, is considerably in excess of any possible savings that a blanket rather than selective use of 28-day prescribing periods is likely to generate,’ the researchers concluded.

Dr Bill Beeby, chair of the GPC clinical and prescribing subcommittee and a GP in Middlesbrough, said the study showed rigid 28-day policies were based on flawed figures.

He said: ‘The problem is most people do take their medicines and so it is inconvenient, insulting and demotivating to have to get their medicines every 28 days.’

Dr Peter Swinyard, chair of the Family Doctor Association, told Pulse that GPs should be allowed to decide prescribing lengths on a case-by-case basis ‘depending on the drug and on the patient’.

He said: ‘There are some areas of the country where PCTs have been extremely heavy handed with practices and have performance-managed them to make sure they only prescribe in 28-day cycles.’

But Dr Agnelo Fernades, assistant clinical chair at Croydon CCG, said guidelines for practices in his area had helped to dramatically reduce the quantity of drugs wasted.

He said: ‘In south-west London alone, three metric tonnes of wasted drugs were returned last year from patients who didn’t take them.

‘Yes, 28-day prescribing creates extra work for GPs because they have to generate the prescriptions, but you have to balance the inconvenience with the fact that patients will be more compliant in taking their medication. I think 28-day prescribing is the right thing to do.’

Changes in average number of doses per prescription
Source: Prim Health Care Res Dev 2012, online 3 October
Ramipril 5mg5439
Amlodipine 5mg4337
Atenolol 50mg4639
Simvastatin 10mg4336
Levothyroxine 50µg7443


Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.