Expert advice

Medicines management: What can I do to help reduce overprescribing in the NHS?

Shrewd and informed prescribing can contribute to the survival of the health service

Shrewd and informed prescribing can contribute to the survival of the health service

Patients are more likely to not waste their medicines if they know how much they cost the NHS. Picture: iStock

The exact amount spent on medication in the NHS can be difficult to pin down, but a report from the King’s Fund shows that funding levels are not keeping pace with NHS spending on medicines.

The report, published in April 2018, reveals that the estimated total NHS spending on medicines in England has risen from £13 billion in 2010-11 to £17.4 billion in 2016-17 – an average growth of about 5% per year.

Considering the NHS budget growth has been about 1% per year in recent years, the obvious deficit will be having an effect on other areas of the health service.

Budget pressures

The bill includes all medicines – generic and branded – in both primary and secondary care, but the biggest pressure on the budget is in secondary care. This now accounts for almost half of the NHS drugs bill in England, despite only about a fifth of medicines being prescribed in secondary care.

Likely contributors to the increase in spending in secondary care are new medicines and innovations in specialities such as cancer and other complex conditions.

Generic medicines

The medicines budget in primary care is also under pressure, with increased prescribing of medicines such as statins and anti-hypertensives. But the encouraged use of generic medicines, along with excellent negotiations with pharmaceutical pricing tariffs, have led to almost a 25% reduction in the price of the average cost per prescription item.

‘The NHS is never going to be a bottomless money pit and we all have a duty to deal responsibly with the finite amount of taxpayers' money available’

Other initiatives, such as encouraging certain medicines to be bought over the counter, have also started to make an impact on the primary care drugs bill.

Further debate is also needed about how data is shared with pharmaceutical companies when developing medicines. If the NHS saves pharmaceutical companies money on development costs, surely savings can be made when products come to market?

Incentivising the pharmaceutical industry is vital, especially in the development of antimicrobials which we will need as a reserve for when our current antimicrobials become less effective.

10 things you can do to help reduce the NHS medicines bill

  1. Educate your patients – about 50% of patients with long-term conditions do not take their medicines as prescribed
  2. Check your stock – anything nearing its expiry date can be used elsewhere if needed
  3. Try not to over order medicines
  4. Consider making the cost to the NHS visible on products – if people realise how expensive things are, they are less likely to waste them
  5. Explain to patients why buying some medicines over the counter helps save the NHS money
  6. Reflect on your prescribing practices – this will help encourage responsible prescribing
  7. Review prescribing data for your area or practice
  8. Encourage regular medication reviews with patients
  9. Use the skills of your pharmacy colleagues – they can help you address both overprescribing and medicines wastage
  10. Highlight the issues to the public – realising the extent of the overspend could empower people to help as participants in their own health economy


Paid to prescribe

We also need to open up the debate about GP practices which dispense medicines making deals with pharmaceutical companies who don’t have their products on formularies, and the profits made by the practices when prescribing these medicines.

Software companies developing decision support tools for prescribers can play their part by including the costs of medicines and introducing alerts that suggest cheaper alternatives when they are available.

When we train as nurses we are not taught to be commercially aware and this needs to be reviewed. Although some nurses work in more commercially aware environments, such as newer private healthcare providers or GP practices, the vast majority of us still work in the NHS. We need to look at how others in healthcare manage medicines budgets and learn from them.

Duty to prescribe responsibly

Increasing demands will always be upon us as new medicines are discovered. But the NHS is never going to be a bottomless money pit and we all have a duty to deal responsibly with the finite amount of taxpayers' money available.

Saving money on medicines now will help prolong the survival of the NHS. It could also make more treatments available to a greater number of people in the future.

Matt Griffiths is visiting professor of prescribing and medicines management at Birmingham City University

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