The National Health Service could save around £200 million a year through more efficient prescribing by GPs, a report by the think-tank The King's Fund has found. 

While its extensive inquiry into general practice in England praised the majority of care, it found significant variation in prescribing across the country, and that substantial savings could be made if family doctors were more efficient in prescribing certain drugs, particularly statins.

The extensive review also other widespread variations in the quality of care and performance throughout primary care.

For example, one-third of patients with stomach or oesophageal cancer who needed an urgent referral to hospital were actually given a non-urgent referral by GPs.

In fact, overall, an eight-fold variation at which practices urgently refer patients with suspected symptoms of cancer on to specialists in secondary care was found.

Continuity of care continues to be an issue, as only just over a quarter of patients are able to see the doctor of their choice in the lowest performing practices.

Variations in effective management

Crucially, there were also wide variations in admission rates for patients that could actually be treated outside hospital, which is particularly important as the effective management of patients within the community could also save the NHS hundreds of millions of pounds a year, The King's Fund said.

On a more general note, the inquiry's report strongly backs the position of GPs as generalists rather than specialists, but also notes that the profession must embrace the radical changes laid out in the government's reform of the health system - particularly new commissioning powers -  in order to "maintain its international reputation for excellence".

In addition, in order to help meet the growing challenges in healthcare, such as the ageing population and increasing demand on service, by building on the changes already taking place within the system.

It calls on GPs to accelerate the trend for multi-professional teams that work closely alongside specialists outside the practice, move away from being ‘gatekeepers’ to ‘navigators’ who essentially co-ordinate care for people with complex needs, and place a greater emphasis on prevention of ill health.

There must also be a much stronger focus on improving the quality of care, the report notes, and also calls on GPs to take responsibility for driving forward progress through a stronger commitment to transparency, particularly on performance data, peer review and benchmarking, and better data capture and use of information.

"Although general practice in this country remains the envy of the world, there is no room for complacency," warned The King's Fund's chief executive Chris Ham. 

"While many practices have been at the vanguard of innovation and quality improvement, too many GPs remain unaware of significant variations in performance and do not give priority to improving quality," he noted.

Big challenge

NHS Confederation acting chief executive Nigel Edwards said improving primary care and GP services is one of the biggest challenges facing the NHS, and that the report "highlights the need to address the major variations in the standards of care patients are receiving".

He calls for the introduction of a national process to compare general practice standards which, he claims, would not only empower patients to compare the standard of care, but would also help "drive down variation in diagnosis, referrals and prescriptions, all of which are central to saving lives".

According to the British Medical Association a "culture of self-scrutiny has existed for many years but now more than ever, given the increased intensity and complexity of general practice work nowadays, GPs need time off the treadmill so they can look critically at what they do and make improvements". 

"A reduction in bureaucracy would help them to do this, as would stopping the constant reorganisations within the NHS", it stressed.