One tenth of the NHS's budget (pounds sterling 3.6 billion in England and Wales in 1992-3) goes on drugs prescribed by general practitioners. This drug bill grew by 14% last year, making it a target for Treasury efforts to find politically acceptable ways of limiting NHS spending. Despite recent headlines of “GPs' wasteful drug habits” British general practitioners prescribe fewer drugs than their counterparts in many developed countries and are usually described as “conservative prescribers.”1 But, according to the Audit Commission's recent report A Prescription for Improvement: Towards More Rational Prescribing in General Practice, they should become even more conservative.^2,3

Based on studies of 10 family health services authorities and interviews with 54 practices, the report details examples of “best practice.” The authors insist that what they want is rational prescribing - that is, prescribing that takes account of efficiency, safety, appropriateness, and economy - not cheaper prescribing. In some cases, rational prescribing could even increase the drug bill - for example, if all general practitioners prescribed half as many inhaled steroids as they do bronchodilators then drug costs would rise by pounds sterling 75m. But deaths would fall, and the total cost to the NHS of patients with asthma would fall because of fewer hospital admissions.4

The report claims that substantial savings would result from less overprescribing (which would save pounds sterling 275m), …