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Why it’s time to re-think guidance on 28-day prescriptions

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In England, the NHS spends over £9 billion each year on prescription medicines dispensed through hospitals and GPs, which is equivalent to 7% of its total budget.

Long-term treatments with medication often play a fundamental role in the clinical management of patients with stable long-term non-communicable conditions, such as diabetes, asthma and hypertension. In many cases, patients are provided with so-called ‘repeat’ prescriptions that are usually issued without the need for further consultations with the GP.

Guidance issued by the Department of Health recommends prescription lengths balance patient needs and good medical practice, while also considering NHS resources. To try to control the costs of unused or partially used medications – estimated to cost around £400m a year – local commissioning groups have encouraged GPs to shorten prescription length, typically to 28 days.

However, our study commissioned by the National Institute for Health Research shows that increasing the length of prescriptions for people with long-term conditions could result in substantial savings for the NHS.

Evidence does not support policies promoting shorter over longer prescription lengths

Despite the link between longer prescription lengths and increased waste, the study found that switching to longer prescriptions could result in cost savings, as the biggest impact on cost was the time administrating repeat prescriptions. Identifying patients with particular long-term conditions and characteristics that could benefit from longer prescriptions would be a good start toward realising these savings.

A good example is antidepressant prescriptions. Ninety five per cent of these prescriptions are less than 60 days, but a previous study showed longer-term prescriptions could potentially save as much as £305 million. This means that providing longer prescriptions for just one long-term medical condition would negate a large proportion of the costs of ‘wastage’.

The latest study also suggests that longer prescriptions could be associated with improved medication adherence. Therefore, there could be clinical benefits to increasing the length of repeat prescriptions for patients with chronic conditions. This could result in further long-term cost savings due to reductions in the use of health services by patients.

Another factor that could impact the cost savings are the personal costs incurred by patients through the shorter prescription lengths. The current evidence does not include the time and travel costs of patients that have to travel to hospitals, pharmacies or GPs to pick up their prescriptions. If these personal costs were considered then there is likely to be further savings associated with issuing longer prescription lengths.

Furthermore, 28-day prescription lengths have been described as disempowering and a hassle that can cause anxiety for patients when they are running low, particularly when their ability to travel is constrained.

We still need to do more research on these potential associations, but the evidence available suggests that the policy on 28-day prescriptions does at least require a re-think. The argument that it saves on ‘waste’ has been shown to be questionable, with the costs associated with dispensing fees and prescriber time outweighing wastage costs.

The current evidence base does not support policies and guidance promoting shorter prescription lengths over longer prescription lengths. If anything, the significant cost savings to the NHS warrants a look at whether more patients with long-term conditions should be issued longer prescriptions.

Josephine Exley is a Centre for Evaluation fellow at the London School of Hygiene & Tropical Medicine and a former senior analyst at RAND Europe