The National Health Service could garner savings of as much as £300 million through more efficient prescribing, a report by the National Audit Office has found.

The report highlighted stark differences in prescribing between primary care trusts across the country. An analysis of prescribing habits for four groups of drugs, including statins, that account for 19% of the total primary care medicines' bill revealed that more than £200 million could be saved if PCTs prescribed as effectively as the top 25% of their peers.

Last year, the UK drugs' bill hit £8 billion, representing a 60% rise (in real terms) over the last 10 years. At least £100 million of this could also be clawed back through clamping down on wastage as a result of over-prescribing, according to the NAO.

The findings lend further support to the growing belief that doctors could, in many cases, swap more expensive branded medicines for cheaper copycat versions, without any detrimental effects to care.

The ‘right incentives’

Dr Gill Morgan, chief executive of the NHS Confederation, welcomed the report, saying: “Individual GPs need to consider what medicines they prescribe when more than one alternative is available. PCTs need to challenge GP practices and design the right incentives in the system to help this happen.”

“This is important morally and ethically as every pound that is spent on a more expensive drug, where there is a cheaper alternative, is a pound that cannot be spent to the benefit of other patients,” she added.

The Association of the British Pharmaceutical Industry said it supported the NHS’ need to get best value for money from medicines, but David Fisher, Commercial Director of the agency, warned that patient needs “must not be sidelined in the search to save money. While cheaper versions of some medicines may well be appropriate for many patients, they are not always so – and doctors must be supported in looking at the true ‘value’ an individual medicine can bring, and not simply its cost.”

He went on to stress the importance of doctors not being “constrained” from prescribing drugs approved by the National Institute for Health and Clinical Excellence due to cost pressures. A recent survey by OnMedica for PharmaTimes Magazine of 530 GPs representing over 200 PCTs found that a quarter of GPs felt their prescribing of medicines endorsed by NICE was inhibited in some way.

Edward Leigh MP, chairman of the Committee for Public Accounts said the report "clearly demonstrates that GPs are often not providing value for money for the NHS in the way they prescribe drugs and medicines."

’Unstable’ pricing situation

But Professor Mayur Lakhani, Chair of the Royal College of General Practitioners, rejects “the impression...that GPs are complacent in their choice of prescriptions. GPs consider their prescribing decisions very carefully but are often hampered by the lack of clear information on best choices in what is a rapidly changing and unstable pricing situation.”

He went on to point out that many prescriptions are “started by hospitals who use a different list of approved drugs which may not represent the best value for money,” and said that patients are not keen on “frequent switches of drugs and many are suspicious of reasons for change, seeing it as cost cutting.”

Prof Lakhani did, however, concede that “more steps should be taken to tackle the situation,” and urged PCTs to “provide more face to face prescribing support from credible advisers, as recommended by the NAO report.”