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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 May 26; 334(7603): 1076.
PMCID: PMC1877914

Cost of some types of prescribed drug can vary fourfold across England, audit shows

Up to £300m (€440m; $590m) could be saved every year in England through smarter prescribing by GPs, the government's spending watchdog said last week.week.

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The National Audit Office (NAO) has published a report saying that smarter prescribing—and particularly the prescribing of generic drugs—could save primary care trusts more than £200m a year, and cutting back on unused drugs could save a further £100m.

For the report the NAO surveyed 1000 GPs, polled advisers on prescribing in primary care trusts, analysed prescriptions written between August 2005 and July 2006, and interviewed GPs, NHS trusts, academics, pharmacists, and the drug industry.

The report identifies wide variation among trusts in the extent to which local GPs prescribe cheaper drugs for the same conditions.

The authors analysed the way in which four common types of drug were prescribed. They looked at:

  • The percentage of statins prescribed as generic simvastatin
  • The percentage of drugs affecting the renin-angiotensin system prescribed as angiotensin converting enzyme (ACE) inhibitors
  • The percentage of proton pump inhibitors prescribed as generic drugs, and
  • The volume of clopidogrel prescribed (guidelines say that it should normally be prescribed for no more than a year after a cardiovascular event).

These four groups represent 19% of the overall drug bill, and the report claims that more than £200m could be saved if all primary care trusts prescribed as efficiently as the top performing 25% of trusts.

The NAO also found that the cost per dose of the first three of these drug groups varied almost fourfold across primary care trusts. The cost of a daily dose of a statin in North Eastern Derbyshire, for example, was only 10p, whereas in North Norfolk it was 37p.

GPs find it difficult to assimilate all the information they receive on prescribing, the report says. A fifth of those surveyed said that drug companies had more influence on their prescribing than prescribing advisers.

The report also said that as much as £800m worth of drugs may be being wasted every year by patients collecting their drugs but not taking them. It recommends that GPs take steps to counter this by limiting the time period of prescriptions for new patients and by giving repeat prescriptions for only 28 days at a time. Primary care trusts could also run public awareness campaigns.

Practice based commissioning could be a way to improve value for money in prescribing, says the report, because it allows GPs to reinvest a proportion of any efficiency savings they make into their practices. Its potential, however, has yet to be tested, and only 8% of GPs responding to the NAO survey said they thought it would encourage significant savings.

The head of the NAO, John Bourn, said, “If GPs more often followed official guidelines and prescribed generic and other cheaper drugs where suitable, then there would be more money to treat patients and pay for expensive or innovative treatments.”

Brian Dunn, from the BMA's clinical and prescribing subcommittee, said that GPs in the United Kingdom were among the most efficient primary care doctors in the world.

He said, “As professionals, GPs must look at the effectiveness of medicines, and cost should be secondary. Doctors, however, have a responsibility to use NHS resources responsibly—whether in prescribing or referral to hospital.

“We would welcome increased prescribing support for GPs, appropriate incentives to prescribe efficiently, measures to decrease medicine wastage, and better coordination of prescribing between primary and secondary care.”


Prescribing Costs in Primary Care is accessible at

Articles from The BMJ are provided here courtesy of BMJ Group