Savings could come from cutting out over-prescribing and drugs that do not have much effect - for example antibiotics for colds and flu which do little except increase patients' resistance to the drugs. Further savings would come from using cheaper branded drugs, and by replacing branded drugs with suitable non-brand name substitutes.
But doctors should also spend more on some expensive drugs - an extra pounds 75m a year on inhaled steroids for asthma would improve treatment and save the NHS money by cutting hospital admissions. For some conditions, GPs should be writing longer, not shorter, prescriptions to save NHS cash.
The Audit Commission's report is probably the most comprehensive look at how GPs could prescribe better and cheaper - its aim being to achieve 'rational', not the cheapest, prescribing. British GPs already have a good record, the commission says, but they could do better, saving the equivalent of 80,000 hip replacements a year.
The commission chose 50 'good' practices, which had drawn up lists of what they prescribed, and compared them with national patterns.
About pounds 275m a year could be saved by reducing tranquillisers, sleeping pills, blood-fat lowering drugs, vitamins, laxatives, pain-killers and ulcer-healing drugs, which the report says are being prescribed too early without proper investigation. Many of these drugs are potentially bad for patients.
Another pounds 45m could be saved by prescribing fewer drugs which have little effect. A similar sum would come from using different drugs for ulcers, while pounds 50m could be saved by substituting generics for just 20 commonly used brand-name drugs.
The GPs who prescribe best, the commission says, tend to spend longer with patients. Many GPs, however, were 'demoralised in the face of new pressures and responsibilities'. They 'no longer have to time to think' about costs, and the commission recommends measures they could adopt to find more time.
It warns that health authorities must agree how expensive drugs such as growth hormones or drugs for fertility and cancer are to be prescribed. Hospitals must not be allowed to dump the costs on GPs, leaving GPs 'to make political decisions on an ad hoc basis'.
A Prescription for Improvement; HMSO; pounds 6.Reuse content