Deal to boost GP prescribing freedom

Plans to overhaul drug reimbursement could ease prescribing pressure on GPs by slashing more than £100 million a year from PCT costs.

PCT spending on 'special' medicine has tripled in two years (Photograph: Getty Images)
PCT spending on 'special' medicine has tripled in two years (Photograph: Getty Images)

PCT spending on 'specials', the unlicensed medicines manufactured for individual patients with specific needs, has tripled in two years.

Slashing the cost of specials could bring double the £49 million saving the DoH hopes will come from its controversial generic substitution plans, which would allow pharmacists in England to switch branded drugs prescribed by GPs for generic alternatives.

Costs increased from £3.8 million a month in England in December 2007 to £11.2 million a month in December 2009, equivalent to £162 million a year across the UK.

The rise has occurred because the fee that manufacturers charge per special has risen 60 per cent in this period, and because pharmacies are increasingly reluctant to mix drugs themselves due to safety fears.

In an attempt to control costs, the DoH is now working with the Pharmaceutical Services Negotiating Committee (PSNC) to amend national reimbursement arrangements for pharmacists. A PSNC spokesman said the committee expected the new arrangements would begin 'within the next few months'.

If the deal brings the cost of each special down to 2007 levels, it would save the NHS £107 million a year.

PCTs are also attempting to control spending by reducing prescribing of specials. Data obtained by GP show trusts estimate that savings of at least 50 per cent could be achieved, worth £81 million UK-wide.

PCTs are asking pharmacists to query specials prescribing with GPs and arranging to visit GPs to discuss individual practices' prescribing patterns.

GPs backed plans to overhaul reimbursement of specials. Deputy GPC chairman Dr Richard Vautrey said: 'Many GPs are unaware of the significant extra costs of special drugs and usually welcome advice about suitable alternatives that would meet the need of their patients.'

GPC negotiator Dr Chaand Nagpaul said GPs would welcome any measure to reduce the unit cost of drugs and free funds for other services.

Dr Nagpaul said controlling spending on special drugs would be preferable to PCTs placing undue pressure on GPs to cut prescribing.

'There should not be inappropriate pressure on GPs to deny patients the product they need,' he said.

Dr Vautrey warned that in some circumstances a special drug was the only option for an individual patient.

'It is always better for PCT prescribing advisers to work with prescribers with professional understanding rather than imposing blanket bans,' he said.

The Royal Pharmaceutical Society of Great Britain would like to see negotiation on specials 'treated as a priority', a spokesman said.

Spiralling cost of 'specials'
  • Rises in requests for liquid formulations for children and elderly patients have fuelled increases in the number of specials prescribed.
  • Costs have risen because pharmacies now tend to order products from specialist manufacturers, rather than making up preparations themselves.
  • Moves away from in-house manufacture of specials followed the death in 1998 of a three-week-old baby given a product made up in a pharmacy.
  • Concerns have been raised about a lack of price controls in the specials market.

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