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Milking the NHS

Have you ever met the pharmaceutical advisor for the Pharmacy and Medicines Optimisation Team of your local Commissioning Support Unit?  I have. Her job descriptions may be long-winded, but her point was punchy: cut your drugs spend by 2% this financial year. Period. 

Drug costings intrigue and frustrate me in equal measure.  Why is naproxen £6.50 for 56 tablets, but only £3 if you give the patient 2 packs of 28? A slip of the mouse and you’ll spend twenty quid on nystatin suspension whilst the branded Nystan is £1.80.  I know, its pharmaceutical giants being clever and canny, but it’s really quite sad.  Lesson number one then: be aware of industry tricks, and turn on ScriptSwitch. 

That wasn’t all.  The bright little chemist from the CSU had other ideas:

Tip 2. Prescribe generic finasteride instead of dutasteride (Avodart) – fine, a quick report and a bulk mail to affected patients can sort that. £2 a month per item rather than £28.  Certainly worth an hour of admin time. 

Tip 3. Increase generic prescribing.  Sounds simple, but try prising entitled GORD sufferers from their Nexium and you’ll regret it pretty sharpish.  One hyperlipidaemic lashed out with her bingo wing when I tried to take her off Crestor. 

Tip 4. Consider self-care items.  These are those Oilatum shower gels and Doublebase body washes that the sensitive skinned lather up with.  Aveeno’s a personal favourite of mine.  With its natural oatmeal ingredient, a surefire alternative when they’ve reacted badly to aqueous cream.  Practices can blow up to £19,000 a month on these scripts.  That’s certainly eye-watering enough for me to deny little Jonny his FP10 for Cetraben.

Tip 5. Reduce glucosamine, omega-3, quinine for night cramps, and anything else without a smidge of an evidence base.  See 3 above: patients don’t like change.  They’ve had it for years, they can’t get an appointment, and they bloody well want their Maxepa. 

There it is then, a quick guide to cutting prescribing costs.  Common sense really, but it can make for a challenging consultation.  Patients become attached to their repeats.

Of course, despite best intentions, there are always those patients that’ll slip through the medication review sieve.  A GP colleague in Scunthopre recently received a script query.  A two-year-old’s Mum wants 6400g of Nutramigen 1 Lipil, can she have?  Hold on, he thought: that’s 16 tins of baby formula… for a 2 year old?  He delved deeper: she’d had 16 tins, every month, for 16 months.  That was 256 tins in just over a year.  Market value being £14 a tin, her ravenous pup appeared to have guzzled £3,500’s worth of NHS sponsored milk. 

I wanted to find out more about Nutramigen 1 Lipil so I Googled it. Now I’m not here to cast aspersions on the young Mums of Scunny, but there’s literally gallons of the stuff for auction on eBay.

Tom Gillham is a GP in Hertfordshire and Specialty Doctor in A&E. You can follow him @tjgillham.