Branded medicines are overprescribed, according to a damning new report from the Committee of Public Accounts, which says the pharmaceutical industry spends more than £850 million annually on marketing its products to GPs.

Edward Leigh MP, Chairman of the CPA, commented: “One fifth of all GPs surveyed by the National Audit Office say their behaviour in prescribing drugs is more influenced by pharmaceutical company marketing than by official NHS advice. And the NHS spends each year at least £200 million more than it should as a result of GPs prescribing too great a proportion of higher cost, branded medicines, rather than generic versions which are cheaper, but no less effective in clinical outcomes.”

He continued: “It’s hard to doubt that the blandishments of the pharmaceutical industry are having an effect. But GPs must concentrate more on following official guidelines – increasing the prescribing of generic drugs where clinically appropriate. The fact that primary care trusts vary hugely in the extent to which their GPs prescribe generic drugs for common conditions shows what can be achieved.”

Prescribing costs growing
Of the entire NHS budget, one quarter of all primary care expenditure is for medicines, with both the volume and cost having increased exponentially over previous years. In 1996, 485 million prescriptions were dispensed in England but by 2006 this had increased by 55% to 752 million. Over the same period, the primary care drugs bill increased from £4.0 billion to £8.2 billion: a 60% increase in real terms. This growth, says the report, has been driven by new treatments being approved, more opportunities to treat disease using existing medicines, plus earlier treatment of some conditions.

And, while progress has been made in prescribing lower-cost generic medications, there is still scope for further savings to be made. Indeed, the report points to the variation in spend on lower-cost medicines by the PCTs: between 28% and 86% for statins, for example. An earlier National Audit Office report estimated that £200 million a year could be saved without affecting clinical outcomes, and this is backed by the CPA report.

Industry rebuttal
But the news sparked a rebuttal from the industry, which says innovative medicines are under-used rather than overprescribed by the NHS. “The assertion that NHS doctors prescribe too many branded medicines is contradicted by the fact that 82% of all prescriptions are written generically and the UK is bottom of the league compared with other, similar, countries in prescribing modern medicines,” points out the Association of the British Pharmaceutical Industry. It also notes that the £850 million spend on marketing should be seen within the context of overall NHS expenditure on medicines of around £11 billion and the pharmaceutical industry’s not-insignificant £3.3 billion a year investment in R&D for new medicines.

“Would any other industry be expected to spend an average of £500 million on developing a new product and then be criticised for telling people about it?” notes the ABPI’s Director General Richard Barker.

But it wasn't just the pharmaceutical industry that felt more than a little affronted by the report: the British Medical Association also noted: "GPs in the UK are among the highest prescribers of generic medication in Europe and the level of generic prescribing in the UK is close to the maximum achievable. Yet there are times when it is not always appropriate to prescribe generic drugs - GPs have to decide what is in the best interests of an individual patient and prescribe accordingly."

“Citing how much pharmaceutical companies spend is not evidence of GPs being swayed by their advertising. In a free and open market GPs sift the masses of data they receive from journals, PCT prescribing advisers, experts, postgraduate education and pharmaceutical companies." And the BMA made the important point that, while one in five of the 1000 doctors surveyed by the NAO felt more swayed by industry marketing, it also highlighted that four out of five GPs rely on official NHS sources for their prescribing information.

“The PAC report acknowledges that there has been a substantial increase in prescribing generic drugs in recent years and with just over 2% of the overall drugs bill identified as potential savings it shows that the official advice is already being heeded," it stressed.

David Stout, Director of the PCT Network which represents the majority of Primary Care Trusts, commented on the variation in prescribing of low cost medicines across the country pointed out that these may reflect the needs of the local population. But, in principle, the NHS Confederation would like patients to be made more aware of how much their medicines and services cost. "Every pound wasted on a drug where an equally effective and cheaper alternative is available and clinically appropriate, is a pound that could be spent on another patient. If the public were made more aware of the cost of drugs to the NHS, this could result in less waste and make prescribed treatments more effective.”