Scottish GPs prescribe more now but spend less

BMJ 2013; 346 doi: (Published 24 January 2013) Cite this as: BMJ 2013;346:f539
  1. Bryan Christie
  1. 1Edinburgh

Family doctors in Scotland have cut the cost of prescribing by 11% at a time when the number of prescriptions issued has risen by a third.

The savings have been achieved by improving the management of GPs’ prescribing, including GPs getting regular feedback on their prescribing and most having support from pharmacists. From 2004 to 2012 the quantity of drugs prescribed rose by 33% to 3.2 billion defined daily doses per year (equivalent to 1.7 doses per day for every person in Scotland), but costs fell by 11% to £974m (€1.2bn; $1.5bn) in 2011-12.

A report from Audit Scotland welcomes this improvement but says that more could be done.1 It estimates that a further £26m could be saved by cutting wastage of drugs, reducing the use of drugs deemed “less suitable for prescribing” where clinical evidence of effectiveness was lacking, and increasing prescribing of generic equivalents.

Scotland’s auditor general, Caroline Gardner, said, “Since we last looked at GP prescribing the volume of drugs prescribed has continued to rise, but the NHS has significantly improved how it manages spending. This was during a period when there have been considerable pressures and constraints on the health service. Demand for prescriptions is likely to increase further, and it’s important that the NHS continues to work with GPs to make sure patients get the drugs they need and spending is well managed.”

Alan McDevitt, chairman of the BMA’s Scottish General Practitioners Committee, said, “Prescribing costs in the NHS are second only to workforce costs in the health budget, and therefore opportunities to make savings here can have a significant impact on health spending. The Quality Framework of the GP contract and the introduction of clinical guidelines for GPs have led to improved management of patients.”

McDevitt welcomed the recommendation in the report to increase the number of prescribing support staff. “The BMA supports the use of pharmacy advisers attached to practices to provide advice to GPs on prescribing, and we would welcome the roll out of this service across Scotland to all GP practices,” he said.


Cite this as: BMJ 2013;346:f539