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Focus on… prescribing

Catherine Picton and Cathy Quinn outline the challenges ahead for GP commissioners in keeping prescribing budgets under control.

The NHS spends over £11bn on medicines each year. As the most common therapeutic intervention used in the NHS, about 14% of a consortium's budget is likely to be spent on them. This includes medicines prescribed by both GPs and other prescribers in the community, and many of the medicines used in hospitals.

As the expert prescribing panel on pages 16-18 mentions, we have come a long way in ensuring that we get the best from medicines and keeping expenditure under control. At an operational level, medicines management teams work closely with practices (pages 24-7).

However, there is still more to do, and the quality of prescribing is as important as keeping costs under control. Of the 4-5% of hospital admissions that are due to preventable problems with medicines, between 11 and 30% result from patients not using their medicines as recommended.

Consortia will need leadership and a strategic overview of medicines management.

In hospitals, about 60% of medicines expenditure is on high-cost drugs excluded from the national Payment by Results tariff. These medicines need active management and monitoring. Through horizon scanning and working with hospital clinicians, growth can be managed and potential problems prevented.

The NHS Constitution gives patients a right to know how decisions are taken about the availability of medicines locally. So if a consortium decides not to routinely fund a medicine, the process used to make that decision needs to stand up to legal scrutiny if subjected to judicial review.

Looking ahead to 2014 and value-based pricing, the way medicines are reimbursed in the NHS will change radically. Consortia need to be able to manage any risks and challenges value-based pricing brings.

How will your consortium manage these challenges? How best should you configure to get maximum value for money from your medicine management teams? The case study from Dr Steve Pike's team describes how they are tackling these challenges. The National Prescribing Centre organisational competency framework will help consortia define and establish their medicines management support. Consortia must also take into account systems that are currently working well, and may often go unnoticed. Like governance systems that prevent serious patient safety incidents, these systems may be at risk of being destabilised through disinvestment and an overemphasis on cost over quality.

In facing these challenges, the importance of consortia having access to strategic senior-level medicine management expertise should not be underestimated.

Catherine Picton is author of the National Prescribing Centre organisational competency framework for commissioning consortia

Cathy Quinn is chief pharmacist, NHS Nottinghamshire County and former pharmacy lead, NHS East Midlands