Letter: How pharmacists can bring down the NHS drugs bill

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The Independent Online
Sir: Nicholas Timmins (8 March) reports that the Audit Commission is suggesting, among cost-cutting measures, that 'for some conditions, GPs should be writing longer, not shorter, prescriptions to save NHS cash'.

Which conditions does it mean? Conditions such as hypothyroidism require long-term therapies and it is already widespread practice to prescribe three months' supply or longer. Contraceptive pills are almost always supplied in three-, six- or 12- month quantities. Most conditions require monitoring; updating diagnoses, medication or doses is imperative for the well- being of the patient. An exception might be young adult asthma sufferers, able to judge the severity of their condition, and hence suitable candidates for long-term prescriptions. But since they are not, by virtue of the illness, exempted from prescription charges, monthly prescriptions, rather than three- or six-monthly ones, would actually increase revenue.

The only saving to be made by prescribing large quantities is a reduction in the dispensing fees paid out to pharmacies. Against this, there would inevitably be an increased level of waste. It is inconceivable that a GP would insist that a patient complete the remainder of a course of medication, even if they returned because of a change in the condition. Wrong diagnoses, wrongly written prescriptions, the introduction of new drugs, improvement or worsening of the condition, all cause the GP to re-evaluate and re-prescribe. Doing so inevitably causes waste, but to prescribe larger quantities will result in yet more waste.

Since the average dispensing fee per item is between one-sixth and one-eighth of the average prescription item value, the increased wastage would easily outstrip the saving in dispensing fees. As the cost of drugs prescribed is taken into account with fund-holding GP budgets, but the costs of dispensing are not, this can only lead to less cash being available at surgeries, therefore less ability to buy medical services at hospitals, etc.

The likely introduction of graduated fees for pharmacy contractors will mean payments for numbers of patients, rather than numbers of items dispensed: such a system is laudable, and is the final argument that to encourage the prescribing of larger quantities of medicines, rather than smaller amounts, is absolute folly.

Yours faithfully,

SELWYN LEARNER

London, N2

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