The National Prescribing Centre (NPC) has published an initial list of 15 common drugs where prescribing savings can be made or quality improved in primary care. A fuller report will follow but this list, says the NPC, is of “therapeutic topics for early consideration, which offer real opportunities for maintaining or improving quality and enhancing value for money”. Director of Evidence-based Therapeutics at the NPC, Neal Maskrey, introduces the report by stressing that although this is all about increasing the efficiency of primary care prescribing, “the evidence base for all the topics identified has been carefully examined to ensure that safety and clinical effectiveness would be maintained, or in some cases even improved, if they were incorporated into prescribing practice with less variation than at present.”
The topics are: renin-angiotensin system drugs; statins; newer hypoglycaemics; proton pump inhibitors; non-steroidal anti-inflammatory drugs (NSAIDs); low-dose antipsychotics in people with dementia; long-acting insulin analogues; self-monitoring of blood glucose in type 2 diabetes; clopidogrel; ezetimibe; antibiotic prescribing – especially quinolones and cephlasporins; hypnotics; orlistat; high-dose inhaled corticosteroids; and alendronate. Much of the advice refers to NICE or other existing guidance, highlighting common areas of over-treatment, and instances where higher doses than needed are often prescribed, or where the evidence does not support the use of more expensive drugs.
Some will not save costs but will improve quality, says the document, whereas in other cases small local savings can contribute to large national ones. It cites analysis showing savings of Â£443 million in 2009 (compared with 2005) from more cost-effective prescribing across four drug categories.
The National Pharmacy Association has said that the NHS should, “look through the other end of the telescope for the big wins”, highlighting problems with what patients actually do with their medicines, and pointing out that up to half of all medicines may not be taken as the prescriber intended. It is calling for a national medicines concordance scheme to be rolled out in pharmacies in England.