The use of new and existing drugs in individual practices is determined by
the prescribing culture among the prescribers, said Dr JIM SMITH (pharmaceutical
adviser, Northern and Yorkshire regional office, NHSE).
General practitioners who used many new drugs tended to be less critical than
others were and assessed the evidence about the drugs less.
Prescribing indicators raised questions about the culture and prescribing of
practices. They had been used for some time as a management tool and were not
ideal but were the best measure that there was at the moment.
Other things that would have an effect on prescribing were the national service
frameworks, the National Institute of Clinical Excellence, the national plan
and the development of primary care trusts. Effective prescribing was being
encouraged by these and by the National Prescribing Centre and unified drug
budgets.
The Government had indicated that it was desirable to obtain value for money
for the National Health Service, while keeping a strong and competitive pharmaceutical
industry. Local forums, such as drug and therapeutics committees, were also
important in making and implementing decisions about drugs.
In Northern and Yorkshire region, drug budgets were being controlled locally
by the production of guidelines, imaginative use of incentives, promotion of
generic prescribing and good use of prescribing indicators. Collaborations between
health authorities on policies relating to new drugs had begun, primary care
trusts were being set up and a regional performance management scheme was in
place.
Local prescribing patterns
Dr Smith then showed the audience the prescribing costs both for Northern and
Yorkshire region and for England as a whole over the period 1992-2000 and he
explained the fluctuations in the figures (see Figure 1).
Prescribing costs had fallen steadily in both Northern and Yorkshire region
and England until 1996. The rise in cost seen between 1996 and 1998 had been
caused by growth in the use of effective but expensive drugs, such as proton-pump
inhibitors, statins and selective serotonin reuptake inhibitors, Dr Smith said.
However, prescribing costs had decreased again and had reached an all-time low
by 1999.
A doubling of expenditure on generic products brought about by recent price
increases had resulted in prescribing costs for 2000 in both Northern and Yorkshire
region and England being even higher than those for 1992.
Dr Smith then showed the prescribing cost figures for individual practices in
Northern and Yorkshire region for the two periods 1998-99 and 1999-2000. During
the first period, the majority of practices were underspent. In contrast, between
1999 and 2000, all had overspent their budgets.
These figures also demonstrated the dramatic change in prescribing costs that
had taken place over the period 1998 to 2000.
This showed that, however carefully prescribing budgets were controlled, the
figures could be ruined by factors over which there was no control, he said.