CCG costs are soaring as GP practices struggle to stick within prescribing budgets, with shortages of common drugs forcing them to prescribe expensive alternatives.
Sheffield CCG is facing a £3.8m overspend on its primary care prescribing budget in the current financial year, figures obtained by GPonline under the Freedom of Information Act reveal. The CCG said that drug shortages have affected costs not just in its area, but nationally.
Rising prices for category M drugs alone are set to add £1.2m to 2019/20 prescribing costs in Sheffield CCG - while figures obtained by this website for a large CCG in south-east England suggest it faces a £1.6m additional cost for these medicines and more than £1m in further drug cost pressures.
GP funding cuts
Practice funding could be further affected as GPs miss out on prescribing incentive payments because spending targets have slipped, accountants have warned.
A total of 123 medicines prescribed in primary care are currently out of stock according to the drug shortage tracker produced by GPonline's sister website MIMS. Meanwhile, 22 drugs are currently listed on the Pharmaceutical Services Negotiating Committee (PSNC) price concessions list, which shows drugs for which the NHS has agreed to pay a temporarily higher price to prevent shortages.
Price concessions on drugs have cost the NHS an extra £150.2m over the past year, according to data collected by the Open Prescribing website, including £44.8m so far in the current financial year.
BMA GP committee executive team member Dr Farah Jameel said: 'Drug shortages can happen for all sorts of reasons, but they are a daily frustration for GPs and are gradually getting worse.
Generic prescriptions
'In some cases, this means sourcing an alternative drug, and GPs will issue a generic prescription for a pharmacist to then see what they have in stock, but this can be expensive and lead to mounting costs across the health service, depleting essential funds for other areas of patient care. Another risk is that alternative medications might not have the same desired effect, further delaying a patient’s treatment journey.
'If this situation carries on, it will be incredibly hard for GPs to stay within their already limited budgets, which is why urgent action must be taken to address drug shortages and ensure patients can continue to access the treatment they need, when they need it.'
Specialist medical accountant Andy Pow of Mazars LLP said: 'Short-term prescribing costs will go up as people are having to switch to more expensive options. This could have a longer impact as patients don’t like switching drugs and therefore will be less likely to want to switch back once (and if) supplies return to normal. So short-term problems may become medium-term ones.
'Overspending on budgets has to be paid for – so will come out of primary care funding unless the government compensates the NHS for this.'
Prescribing budget
He added: 'Many GP payment schemes have some reference to prescribing budgets and keeping within them. The ability for GP practices to keep within budget will undoubtedly be harder now.'
Mr Pow said some local commissioners may 'cut GPs some slack' if practices argue that they should not be penalised for factors outside of their control. But he warned: 'CCGs will have less money due to the increased costs so may be unwilling to be flexible in the need to balance their books.'
GPonline reported earlier this year on the major impact of drug shortages on GP workload, as practices were forced to issue alternative prescriptions for products that were out of stock.
Mr Pow said increased workload for practices remained the biggest issue for practices, highlighting a comment from a GP in a recent meeting about having to spend an hour sourcing alternative HRT products for a single patient.
Dr Jameel added: 'GPs will often only know about a shortage when a patient returns to clinic, having been told by a pharmacist that their prescription is unavailable, and this can dramatically add to their already crippling workload – as well as distressing patients by delaying their treatment.'
The continued lack of clarity over the terms on which the UK will leave the EU if Brexit goes ahead have added to concerns for GPs. An online pharmacy published a list earlier this year of around 60 products that pharmaceutical suppliers have predicted could become more expensive or difficult to obtain in the event of a no-deal Brexit.
An NHS England spokesperson said: 'The NHS medicines policy team monitor the financial position, including CCG medicine expenditure and the impact of price concessions, on a monthly basis and will keep the situation under review.'
