GPs told to cut 'specials' use in DoH crackdown

GPs will be told to cut inappropriate prescribing of costly made-to-order drugs as part of DoH-commissioned guidance, GP can reveal.

Specials: spending to be curbed (Photograph: Istock)
Specials: spending to be curbed (Photograph: Istock)

Guidelines published by the National Prescribing Centre (NPC) next month aim to curb spending on bespoke 'specials', made for patients who cannot tolerate licensed products.

Prescription of expensive specials can sometimes be avoided by modifying licensed preparations, for instance by crushing tablets.

However, the implications for clinical liability of advising others to undertake such actions are not clear and last week the GPC called for clarity on the issue.

Jane Brown, director of policy and implementation at the NPC, said the guidance would give practical advice on prescribing cheaper alternatives, while ensuring patient safety. It would also encourage clinicians to make use of community pharmacists' knowledge of alternative preparations, she said.

GPC prescribing subcommittee chairman Dr Bill Beeby welcomed the guidance, but said more must be done to raise awareness of the high cost of specials. Price lists on practice IT systems give GPs the chance to consider a different treatment approach, he said. But even though specials can cost hundreds of times more than licensed products, a lack of data means IT systems often list specials as zero-cost.

Dr Beeby said: 'If something is prescribable, we should have an accurate price. If the system can't include specials prices, it needs to be squeezed to make sure it does.'

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