Improvement in prescribing can be measured only over time

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7281.302/a (Published 03 February 2001) Cite this as: BMJ 2001;322:302
  1. David F Bird, general practitioner (dfbird{at}doctors.org.uk)
  1. French Weir Health Centre, Taunton, Somerset TAI INW

    EDITOR—Avery et al say that practices with lower prescribing costs prescribe less, use cheaper items, and avoid new and expensive drugs.1 A five year old managing their pocket money could have told us the same basic economic statement. Without some look at clinical outcomes such studies are of little value. If in 10 years Avery et al could tell us that the low prescribers have just the same rate of coronary events, bypass grafts, suicides, osteoporotic hip fractures, and so forth as the high prescribers then they might have made a useful point. Currently, with more and more pressure from our paymasters to raise standards and follow clinical guidelines, some expensive prescribing is inevitable, unless we opt for therapeutic nihilism. That may simply shift the cost of our prescribing budgets into secondary care management. It is cheaper for us to avoid prescribing inhaled steroids, for example, when the cost of hospital admissions for status asthmaticus is borne by someone else, but it is hardly in our patients' best interests or ethical.

    Like many general practitioners, I have over the years since prescribing analysis and cost (PACT) data came in tried to keep prescribing costs down by following good practice guidelines. Until the past 12 months my figures have always been below national and local averages, and during the past 20 years the average age at death for my male patients has risen from 70 years to 75 years and for women from 77 years to 83 years—perhaps an indication that I have done something right. But now, after the fiasco concerning generic drugs and with the increased use of drugs recommended in current clinical guidelines, our practice budget is well into negative balance, with a threat of reducing our services to balance the books. This, as you may imagine, is a source of considerable irritation, not helped by articles such as that by Avery et al, which contribute little to the debate, presumably take a lot of time and money, and are pretty pointless.


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