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Around a quarter of all expenditure in primary care is on drugs, and both the volume of drugs prescribed and their total cost are increasing. In 1996, 485 million prescriptions were dispensed in England; by 2006 this had increased by 55% to 752 million. Over the same period the primary care drugs bill increased from £4.0 billion to £8.2 billion: a 60% increase in real terms. Growth has been driven by the licensing of new treatments, the discovery of new opportunities to treat disease through existing medications and moves to earlier treatment of some diseases. Efficient management by the Department of Health (the Department) and NHS bodies can however make the drugs bill more affordable without affecting patient care.
In recent years there has been a substantial increase in prescribing lower cost, generic versions of drugs, rather than more expensive brand name drugs. There are a number of examples of good practice where progress has been made: for example by supporting GPs to switch patients' medication to lower cost generic forms where appropriate, by working with local opinion-leaders to promote better prescribing, and by using benchmarking data to help GPs peer-review their prescribing practices.
There is however still scope for further savings to be made, through GPs following official guidelines more often and prescribing generic and other cheaper drugs where suitable. There is wide variation between Primary Care Trusts (PCTs) in the proportions of lower cost drugs being prescribed for some common conditions, for example between 28% and 86% for statins. The National Audit Office has estimated that £200 million a year could be saved without affecting clinical outcomes, money which could be used to treat patients. The Department does not know the extent to which drugs being prescribed are not taken and wasted, though the value of drugs returned to pharmacists alone is estimated to be at least £100 million a year.
On the basis of a report from the Comptroller and Auditor General,[1] we took evidence from the Department on prescribing costs in primary care, and the scope for better use of the £8 billion a year spent by the NHS on prescription drugs.
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