Intended for healthcare professionals


NHS England’s plan to reduce wasteful and ineffective drug prescriptions

BMJ 2017; 358 doi: (Published 01 August 2017) Cite this as: BMJ 2017;358:j3679
  1. Azeem Majeed, professor of primary care
  1. Imperial College London, UK
  1. a.majeed{at}

National rules on prescribing are a better approach than variable local policies

The NHS in England must make around £22bn (€25bn; $29bn) of efficiency savings by 2020. Prescribing costs in primary care, currently around £9.2bn annually, are a key component of the NHS budget in England. Inevitably, the NHS has begun to look at the drugs prescribed by general practitioners to identify areas in which savings could be made, ideally without compromising patient care or worsening health inequalities. This process was initially led by clinical commissioning groups (CCGs), focusing on drugs that are either of limited clinical value or which patients can buy from retailers without a prescription (“over the counter” drugs).1

Flawed approach

However, this locally based approach is flawed.2 Firstly, CCGs have no legal power to limit the prescribing of drugs by GPs. As CCG policies on restricting prescriptions are not backed by statutory guidance, the inevitable result will be variation between GPs in the use of the drugs that CCGs are proposing to restrict—thereby leading to “postcode prescribing.”

It also raises legal …

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