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GPs have already cut back on prescriptions for ‘low-priority’ medicines, study finds

GPs are writing one million fewer prescriptions for low-priority treatments but price hikes have led to an increased overall spend, a study has found.

The cost of prescribing low-priority treatments has increased in the last year, although there has been a reduction in the number of treatments being prescribed.

The study used data from an interactive website that collates prescribing information for all general practices in England to determine prescribing trends for ‘low-priority’ treatments – treatments that are deemed to be unsafe, ineffective or of low-value by NHS England, including coproxamol, gluten-free foods and homeopathy.

The researchers found that GPs prescribed almost one million fewer low-priority treatments in 2016/17 compared with the previous year, but that the overall cost of these prescriptions has increased by around £4.5m.

They noted that the cost per item has remained stable for many of the low-priority treatments but that the costs of liothyronine, coproxamol and trimipramine have risen sharply in the past year.

The researchers attributed the increased overall spend to drugs being removed from the drug tariff and having to be sourced as more expensive ‘special orders’, and a lack of competition on the market driving up costs.

‘Co-proxamol, liothyronine and trimipramine illustrate a concerning phenomenon, where despite successful efforts to limit prescribing numbers, costs have risen sharply,’ the authors said in the paper.

They also found wide variations in spending across the country, with prescribing behaviour found to be strongly associated with the local CCG. The authors suggested that this could be due to individual CCG prescribing policies.

The authors concluded in the paper: ‘The detailed analysis of trends and variation in low-value prescribing presented here should be used to inform future debate about the use of such treatments. A certain proportion of current variation in many of the observed treatments is likely to be due to differences in policy between different CCGs and practices, rather than clinical need.’

Figures released by NHS Digital in March showed that the total cost of prescriptions dispensed by GP practices fell by £30m between 2016 and 2017, despite the number of prescriptions increasing. RCGP chair Professor Helen Stokes-Lampard said that the rise in total number of prescriptions was due to patients living longer. 

The figures followed guidance issued to CCGs by NHS England aimed at cutting down over-the-counter prescribing in a bid to save almost £100m that could be reinvested in to frontline services.

But a recent Pulse survey showed GPs are having to bear the brunt of patient complaints resulting from the shift in policy.

J R Soc Med 2018; available online 23rd May


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