Prescribing is one of the three areas of significant cost where expenditure decisions are in the hands of primary care.
It makes sense to reward GPs to make savings. The new prescribing indicators are an invitation to see what GPs offer patients as quality prescribers. Prescribing with five indicators attached to it is worth 28 points, a potential income of £3,654.
To achieve these points will require a practice review, an external peer review and the practice following pathways. These indicators are planned for one year, with a possibility to extend to two years if savings are seen by the next year.
In Oldham, GPs in locality commissioning have started working on this in earnest and agreeing pathways with the PCTs. In my view, each practice and each consortium can make a significant contribution by prescribing appropriately.
This involves prescribing generically, adhering to national guidelines and local formularies, being clear about the reasons for prescribing, prescribing within your limitations and experience, saying no to unlicensed prescribing (even if the consultant says otherwise), and stopping specials.
Below are 10 tips to reduce prescribing costs. Remember that high-quality prescribing is more cost-effective than average quality.
1. Lead GP
Appoint a lead GP in your practice to take responsibility for providing regular feedback on prescribing, keeping up-to-date with local formularies, developing a protocol for locums and staying in touch with the medicines management team.
2. Assess benefits
It is important to balance the potential benefit and harm of medications. There are some patients we cannot help; there is none we cannot harm.
Medications are far from being the only intervention available in primary care.
Before clicking on to the prescribing screen, ask yourself if the prescription is really necessary. Could there be other non-drug interventions, such as lifestyle modifications, rather than prescribing? Could we offer physiotherapy or OTC medications? Are the wax softeners really necessary when we do not know about their safety or efficacy?
3. Involve a pharmacist
Ask for targeted medicines use reviews (MURs) by a community pharmacist. An MUR is a structured review of patients' use of their medication, ensuring they understand why they have to take it, how their medicines should be used, identifying any problems and providing feedback to the GP.
An MUR reduces medicines wastage, improves compliance and enhances patients' understanding of their medications. However, nothing can be achieved unless this is undertaken in a structured way.
4. 28-day prescribing
Introduce 28-day prescribing as the norm, because this helps to reduce wastage. Most of our patients do not pay for their prescriptions, so the 28-day interval is not a financial burden to them.
Those patients who pay for their prescriptions can be advised to buy a prepayment certificate. Patients going on holiday could be allowed two months, but not six months. We all see patients who might be living abroad and visiting us every six months just for repeats. Be bold and say no.
5. Check medications
Ensure the medication is needed. Check discharge medications when new junior doctors arrive at the hospital. Wrong prescriptions and inappropriate drugs and amounts are common when new doctors start work. Check that these drugs are not entered in the repeats. Regularly review repeats for elderly care homes.
6. Local formularies
Make use of your local formularies – in Oldham, we have one for antibiotic prescribing. If there is no formulary in your area, develop your own, for example, for pain control, NSAIDs or PPIs. Make sure the formulary is cost-effective and follows NICE/WHO guidelines.
7. Generic prescribing
There is no excuse for not prescribing generically, except in some cases, such as anti-epileptics. You could ask your pharmacist to return the non-generic written prescription.
8. Say no
We have all seen patients who are planning exotic holidays and who ask for sun cream, travel sickness tablets, antidiarrhoeals and paracetamol on prescription because they do not pay. Do not be afraid to say no.
9. Involve patients
Involve the patient when starting a new drug. Patients do not always take medication as prescribed and we need to improve the support we give patients.
Between 30 and 50 per cent of patients have prescriptions dispensed and then do not take the drugs. Millions of pounds' worth of medicines are wasted every year.
We must involve patients in decision-making about their treatment and ensure every patient knows what each drug is for.
If patients do not receive enough information when their medication is prescribed, they are unlikely to complete their treatment.
10. Join your local group
Join the commissioning group if you have been in hibernation – you have no choice now.
- Dr Sharma is a GP in Oldham, Greater Manchester
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