Intended for healthcare professionals

Letters Tackling overprescribing

Some ways to tackle overprescribing

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2951 (Published 30 November 2021) Cite this as: BMJ 2021;375:n2951
  1. Peter Selley, retired GP,
  2. Roger Stephenson, retired GP, volunteer vaccinator
  1. Crediton, UK
  1. peterjselley{at}gmail.com

Mir and colleagues suggest that £2m is wasted annually on unnecessary and potentially harmful prescriptions.1 Recent studies show that a third of people over 80 in England take eight or more drugs2 and that 11.5 million adults in England were prescribed one or more addictive drugs in 2017-18.3 While prescribing increases, life expectancy in deprived areas falls.4

Twenty years ago we showed that our GP practice had prescribing costs consistently 40% below the local average, while adhering to guidelines.5

Five years later our practice was publicly criticised for our “poor” prescribing and chronic disease management. NHS data showed, however, that despite our low prescribing our patients had comparatively longer life expectancy, fewer hospital admissions, and better general health.

The time has come to study other high quality “low prescribers.”

Meanwhile:

  • Stick to the maxim that many acute illnesses are self-limiting and need no prescription

  • Understand the power of drug companies. Most published reports of drug trials—which influence guidelines—are ghostwritten by drug companies6

  • Demand transparency of drug trial studies. Support the BMJ campaign for release of statin trial data7

  • Avoid “therapeutic trials” of addictive drugs in individual patients; these are doomed to failure

  • Accept that hospital specialists are not best placed to reduce polypharmacy—this is the GP’s role

  • Realise that not prescribing saves more money than switching to cheaper drugs. GP “switching” software (such as Scriptswitch) diverts attention from stopping unnecessary prescriptions

  • Reward reduction of polypharmacy rather than incentivising often cursory drug reviews.

Fewer drugs equals fewer adverse effects equals fewer GP appointments equals fewer drugs, and so on.

Mir and colleagues are correct: achieving high quality individualised prescribing need not be a bitter pill to swallow. But at the moment there are too many spoonfuls of sugar helping the medicine go down.

Footnotes

References

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