Chris Lancelot: Controlling prescribing costs without interfering

Last week, I discussed what I see as a clumsy attempt by NHS Bedfordshire to reduce the costs of statin prescribing by using Annex 8 to surcharge practices which don't hit its arbitrary 74 per cent simvastatin target.

The GP Record, by Fran Orford www.francartoons.com
The GP Record, by Fran Orford www.francartoons.com

In case you thought this was merely a localised, provincial difficulty, think again. NHS bodies across the UK are likely to try to adopt surcharging in order to deliver the prescribing economies needed in the coming cash-strapped era. This approach risks affecting all of us, wherever we practise.

As it happens, I am fully in favour of prescribing targets - but not implemented like this. Nevertheless, this incident has highlighted the urgent need to develop ways of cutting prescribing costs, using sensitive and sensible methods rather than blunderbuss ones.

But how can NHS organisations keep control of prescribing costs without interfering with clinical freedom? It is quite feasible. The first rule is: never impose a target which, to allow for exceptions, aims on the low side. Instead, impose a high target - perhaps even 98 per cent - but allow extended exception reporting. Reasons include: intolerance to the preferred lower-cost medication; non-availability of that medication; or where different medication has been recommended by a consultant unit.

There should also be an exception 'on clinical grounds', which would need to be spelled out in full in the patient's notes.

This should include 'patient unsuitability' and 'patient insistence'.

Crucially, GPs should also be able to except patients because, in their opinion, either the suggested low-cost medication has deleterious side-effects, or the higher-cost alternative has significant benefits.

Clearly this exception is open to abuse and should be monitored by inspection teams: the requirement should not be to provide a cast-iron argument in an area which is obviously a matter of medical debate, but instead to produce clear evidence that the clinician has thought carefully before prescribing.

A high target with extensive exception reporting would force clinicians both to prescribe thoughtfully, and to toe the line over using cheaper drugs wherever possible: equally, it would accommodate patients with a clear medical need and, crucially, protect GPs' clinical freedom.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Babylon signs 10-year 'integrated digital health' deal with NHS trust that runs 10 GP practices

Babylon signs 10-year 'integrated digital health' deal with NHS trust that runs 10 GP practices

The company behind controversial video service GP at Hand has partnered with an NHS...

10 tips for greener general practice

10 tips for greener general practice

Taking steps to tackle climate change can help improve people's health both now and...

Public health officials issue coronavirus guidance for primary care

Public health officials issue coronavirus guidance for primary care

Public Health England (PHE) has issued guidance for primary care clinicians on what...

HPV infections drop sharply but experts warn vaccination may not stop cervical cancer

HPV infections drop sharply but experts warn vaccination may not stop cervical cancer

HPV infection has dropped sharply among sexually active young women in England since...

Flawed DES could scupper NHS long-term plan, warns network pioneer

Flawed DES could scupper NHS long-term plan, warns network pioneer

The five-year programme of reform set out in the NHS long-term plan could fail because...

New standards for nurses working in advanced roles in primary care

New standards for nurses working in advanced roles in primary care

A new framework, which is backed by NHS England, has set standards for the academic...