Prescribing omeprazole would conflict with desire to control prescribing costs

EDITOR—Hatlebakk et al suggest that omeprazole 20 mg once daily should be considered as a first choice when patients with heartburn are being treated in primary care.1 With the formation of primary care groups all general practitioners are coming under increasing pressure to control prescribing costs. If costs are exceeded in one budget, budgets in other clinical areas (such as staff, including practice nurses) may be threatened. I and my colleagues in the practice have worked hard over two years to control our prescribing costs. Omeprazole was the largest single gastrointestinal drug cost, accounting for 7% of our total drug budget and just over half of our gastrointestinal drug costs.

Hatlebakk et al make no mention of lifestyle advice—such as advice on smoking, diet, and weight reduction—as a method of controlling symptoms. Recent recommendations from our primary care group (through the primary care investment plan) suggest that we should target the use of proton pump inhibitors, and this will be linked to an element of payment that we receive under the prescribing incentive scheme. Increasingly we are using histamine receptor antagonists both as first line treatment of symptomatic reflux and as intermittent maintenance treatment. We are going to find considerable conflict in following Hatlebakk et al's recommendations.