Scottish general practice drug spending fell 11% in real terms between 2004 and 2011, despite the volume of prescriptions rising 33% over the period, Audit Scotland has reported.

GP prescribing accounts for 70% of all NHS spending on drugs in Scotland and amounts to almost £1 billion year. In its third report on this issue, Audit Scotland says that the NHS has improved its management of GP prescribing, and that family doctors are getting more support and guidance. In the seven years prior to 2004-5, Scottish GP prescribing costs had risen 50%.

However, the report also finds that there is scope for further improvements and potential to save as much as £26 million a year without affecting patient care. This could mostly be done through reducing waste and cutting the use of less suitable medicines, it suggests.

"The NHS has taken a range of actions since our last report in 2003 to improve the quality and cost-effectiveness of prescribing. These have had an impact on quality and spending," says the report, which goes on to note that overall spending on drugs is lower in Scotland - and in the UK - than in other European Union (EU) countries. "Spending in Scotland is falling in real terms, but increasing in most EU countries," it says.

The measures it recommends to save a further £26 million annually without affecting patient care are: - reducing drug wastage, producing an annual saving of £12 million; - reducing the use of drugs considered less suitable for prescribing (£8 million); - increasing generic prescribing (£12 million); - only prescribing more expensive versions of drugs to those patients with a clinical need (£2 million); and - achieving the targets in the national therapeutic indicators (£2 million).

"In addition, we estimate the potential annual savings in primary care from drug patents that expire in 2012 and 2013 to be at least £86 million. These savings are likely to outweigh the cost of introducing new drugs in the short term," it says.

The report's authors say they have found little evidence that the abolition of prescription charges in Scotland has led to a significant increase in the quantity of drugs prescribed by GPs. 

In 2011-12, NHS Scotland spent an estimated £10.5 million on prescribing support staff, who are using "good quality data" to support prescribers.  All GPs get regular feedback on their prescribing and most general practices have in-house support from pharmacists, which is funded by their NHS board, they note.

The report makes a number of key recommendations for NHS boards, calling on them to:
- continue to work with GPs to reduce unnecessary waste, reduce the use of drugs considered less suitable for prescribing, increase generic prescribing and only prescribe more expensive versions of drugs to those patients with a clinical need for them;
- consider the business case for employing additional prescribing support staff as part of an invest-to-save initiative, if a board has high levels of prescribing, high spending and below-average numbers of prescribing support staff; and
- work with GPs to implement the national guidelines on prescribing multiple drugs (polypharmacy) and support them in reviewing the medication of patients taking multiple drugs.

- Total spending by NHS Scotland in 2011-12 reached £11.7 billion, of which £974 million was accounted for by drugs prescribed in general practice, with GPs issuing 91 million prescriptions during the period, says Audit Scotland. It also notes that, between January and March 2012, 1.25 million people in Scotland, or around 24% of the population, were being prescribed four or more different drugs. The majority - about 900,000 people - were aged over 50.

Also, GP practices serving the most deprived areas of the country prescribed an average of 46% more drugs per patient than those in the least deprived areas, it notes.