Editorial - Hospitals should face same scrutiny as GPs

Monitoring of GP prescribing has been part of general practice for many years.

The DH publishes detailed data on prescribing by every practice in England, which has been used to ensure GPs prescribe cost-effectively.

GPs have risen to the challenge. The annual rise in primary care drug costs fell from 11% in 2000 to 3.4% in 2010.

Keeping the drugs bill in check has been seen as key to containing spiralling costs as the NHS tries to deal with an ageing population and the emergence of new, expensive therapies.

So it is anomalous that hospital prescribing is not subject to similar scrutiny. As GP reveals this week, less than half of hospital trusts have benchmarked prescribing across individual clinical teams and many rely on the trust formulary as the only way to control spending. Trusts also push prescribing onto primary care, referring patients back to GPs to get a prescription for a drug recommended in a hospital consultation.

Many hospital doctors would readily admit that cost issues rarely come into play when choosing which medicine to prescribe. Most GPs will have seen discharged patients who are not on the most cost-effective drugs.

But if primary care is under pressure to prescribe cost-effectively, then secondary care should be also. This is not about denying patients access to medicines, or to newer, more expensive treatments, but about prescribers being mindful of the costs of their actions and the limits of NHS resources.

In recent years, GPs have improved their practices' organisational systems and invested in training for administrative staff and IT to help support prescribing that is both cost-effective and safe. Hospitals should be doing the same.

The NHS faces a difficult task to meet the £20bn efficiency savings target; it can only succeed if all parts of the system are making equal effort and pulling together.

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