PCTs apply 28-day prescribing policy without patient impact assessment

Over 40% of PCTs have introduced 28-day prescribing policies without any assessment of their impact on patient care.

Photograph: J H Lancy/HML
Photograph: J H Lancy/HML

Patient groups have raised concerns over the effect of such polices - designed to save money by reducing medicine wastage - on access to treatment, increased costs and inconvenience for patients.

Guidance on 28-day prescribing is in widespread use. Of 46 PCTs who responded to a Freedom of Information request, 45% had introduced guidance for GPs to limit prescriptions to 28 days' supply at a time.

However, only one of the PCTs had carried out any assessment on whether the guidance had affected the number of prescriptions patients were collecting from pharmacies or the number of prescriptions doctors were issuing.

In addition, only two PCTs carried out any assessment of the extra administrative burden the guidance had placed on GP practices.

Reducing medicine wastage
The picture is similar for other measures introduced by trusts to tackle medicine wastage. For instance, 87% have run initiatives designed to reduce medicine wastage in the past five years, but only 11% collected information on the impact of the initiative on patient care, cost to patients or the inconvenience to patients introduced by the scheme.

Edwina Wooler, clinical lead at Asthma UK, warned that people with long-term conditions such as asthma, could be particularly affected by policies restricting medicines to a 28-day supply. ‘This limit may result in patients paying more for the same amount of medicine, as they would have to pay a charge every time they renew their prescription,' she said. ‘Add to this the inconvenience of having to return to their doctors so frequently and this may act as a deterrent to people taking their medicines as prescribed.'

She added: ‘The DoH has not assessed the impact of this new initiative on patients and it is important that they do so, to ensure that cost cutting strategies do not affect patient care.'

Roger Goss, co-director of Patient Concern, also believes that such policies will have a negative impact on patient care. ‘The problem with going down the 28-day prescription route is that, inevitably, some people will decide not to take the medicines they need,' he said. ‘The reason PCTs would be favouring this is to save money. That is not the object of prescribing.'

No evidence of impact on patients
He also pointed out the potential problems for patients with long-term conditions. ‘Many people on medicines have mobility problems, many are living alone and many don't have family or friends,' he said. ‘How are they supposed to get out and collect their prescriptions every four weeks?'

When his PCT introduced a 28-day prescribing policy, Buckinghamshire GP Andrew Webber asked what evidence there was that it would save money. ‘The only evidence was one poorly researched paper on the issue,' he said. ‘It might all blow up in our faces if PCTs across the country are pushing for 28-day prescribing and there is no evidence behind it. If there is evidence, we should be able to find it and take a look at it.'


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