Can hospitals equal GP drug savings?

As GPs face ever-greater pressure to contain prescribing costs, a stark contrast is emerging with the lack of spending control in hospitals.

Over the past decade, the cost of prescribing in hospitals has risen twice as fast as in primary care, a trend that looks set to continue (Photograph: SPL)
Over the past decade, the cost of prescribing in hospitals has risen twice as fast as in primary care, a trend that looks set to continue (Photograph: SPL)

Over the past decade, the cost of prescribing in hospitals has risen twice as fast as in primary care, a trend that looks set to continue.

GPs have faced up to the challenge of rising drug costs and prescribing volumes by reviewing prescriptions, increasing generic prescribing and benchmarking.

The success of such measures has meant that the annual rise in primary care drug costs fell from 11% in 2000 to 3.4% in 2010.

In addition, the DH has published comprehensive data on prescribing by every GP practice in England.

Reducing the cost of primary care prescribing remains such a key focus that the 2011/12 QOF included 28 points, 3% of the whole framework, for prescribing 'improvement'.

But hospital trusts have yet to make the same inroads into rising drug spending.

Rising drug costs
The Office of Health Economics (OHE) estimates that UK medicines spending will increase by around 1.5% annually in primary care over the coming years, and by around 7% a year in secondary care.

In 2001, hospital prescribing represented less than 20% of drug costs in England.

If the rates estimated by the OHE continue in coming years, the amount spent on hospital prescribing will have outstripped primary care drug spending within 12 years.

But hospital prescribing costs are not often considered a priority area for making savings.

Last month's 92-page Nuffield Trust report Can NHS hospitals do more with less? mentioned 'prescribing' once, and 'medicines' three times.

GPC prescribing subcommittee chairman Dr Bill Beeby says the gap between the lack of cost-control on hospital prescribers and the zealous scrutiny of GP prescribing 'has been a long-standing issue'.

'GPs have their house in order in terms of cost-effective prescribing and hospital prescribers should now follow suit,' he says.

Despite the clear need to control rises in prescribing spending, a DH report in December showed that savings being made across England are falling short of the target set by the Quality, Innovation, Productivity and Prevention (QIPP) programme.

In the first half of 2011/12, the NHS achieved less than 46% of the £358m required under the QIPP programme. Reporting the figures, deputy NHS chief executive David Flory said the NHS faces 'substantial challenges' in maintaining this level of savings. 'The potential to continue to reduce costs through standard approaches to efficiency will decrease in value over time,' he said.

Incomplete data costs
The rising cost of hospital prescribing has been somewhat concealed by the fact that the data available on hospital prescribing costs is far less complete than that on GPs.

Hospital prescribing data is not collected centrally, but collated on a commercial basis and released to the NHS Information Centre as part of a contractual arrangement.

In addition, no information on costs or item numbers is collected and so the centre estimates these.

Although practice-level data for every drug prescribed in primary care is available to the public within three months, the NHS Information Centre issues national hospital data nine months after the event.

Regional difference
Despite such obstacles, some regions have managed better than others to keep rising prescribing costs under control.

In London, there was a 6.2% rise in hospital prescribing expenditure in 2010, despite far higher volumes of work as a result of referrals to specialist units in the capital.

In other areas, rises were almost 70% larger than this: in the West Midlands, costs rose by 10.5% and in the east of England costs rose by 10.6%.

Such discrepancies suggest that rises in hospital prescribing costs can to some extent be controlled.

Dr Beeby says hospital doctors must now look to take the same measures as GPs have to control prescribing costs.

'It is imperative that hospital prescribing, as its costs are rising, should be subject to the same level of scrutiny to ensure that prescribing is in line with best practice.'

* Exclusive: Hospitals fail to match GP drug savings

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