Public Accounts Committee identifies room for big savings in prescribing expenditure

4 Mar 2015 03:57 PM

The Health Service could make significant savings if doctors consistently prescribed lower cost medicines which are as effective as ones that are more expensive. This is the stark message from the Assembly's Public Accounts Committee which has yesterday published its report on Primary Care Prescribing.

The report investigates why local prescribing costs appear to be relatively more expensive than in England, Scotland and Wales, and concludes that there are opportunities for significant savings to be made.

Committee Chairperson Michaela Boyle MLA said: "The Committee acknowledges that the health service has made savings as it has encouraged the prescribing of lower cost generic drugs. However, we believe that significant further saving could be made if the lowest cost versions of generic drugs were prescribed."

Primary care prescribing costs £460million each year – around 10% of all health and social care expenditure. The volume of items being prescribed has been increasing over the last seven years, with the local cost per head of population increasing slightly while the cost per head of population fell in the same period in England, Scotland and Wales.

Chairperson Michaela Boyle said: "It is clear that prescribing costs per head of population here are not in line with our counterparts. Given that we are the only jurisdiction that has incurred higher costs per head of population in 2013 than 2007, the Committee has concluded that we have been much slower in achieving savings. This money could have been better used elsewhere within the health service at a time of great budgetary pressure."

"My Committee was surprised to learn that, for a number of common diseases, GPs here tend to prescribe more expensive generic versions of drugs compared to their counterparts in England, Scotland and Wales. If the most effective and least costly drugs had been prescribed, it would have saved £8.9 million in 2012 and £5.1 million in 2013.

"In addition, the Department needs to work immediately on finding a suitable solution with community pharmacists on a way forward. Had agreement been reached in 2006 (as in other parts of the UK) the Department would have saved £550,000 in legal costs and £46million would have been released to provide additional, community-based pharmacy services here.

"This is a situation that must change and we will be challenging the Department of Health to ensure that all possible savings are realised."

Notes to Editors:

• The Health and Social Care Board has achieved savings in the four years since the General Pharmaceutical Budget was devolved from the Department. Between 2006 and 2013 the cost of prescribing in NI has reduced by 18% in real termsThe Committee also notes that the Comptroller and Auditor General in his 2014 report calculated that by reducing the average cost per 1,000 NIPU (Northern Ireland Prescribing Unit) by 10 per cent over a three year period, savings of £54 million could be generated.
• The Committee found that if local GPs reduced their prescribing of Pregabalin, which is used to treat epilepsy, neuropathic pain, and generalised anxiety disorder to the level prescribed in other jurisdictions, the health service would have saved over £8.5 million in 2012 and £9.7 million in 2013.
• In respect of the issues around community pharmacy, the Committee found that, seven years after a revised contract became effective in England and Wales, the Department and community pharmacists have failed to reach agreement on the terms of a revised reimbursement contract. Elsewhere in the UK, the revised arrangements introduced a new UK Drug Tariff category (Category M) covering almost half all items reimbursed each year. Under the revised contractual arrangements this has released funding which is made available if it can be demonstrated that community pharmacists are providing additional patient-focussed pharmaceutical services in community settings.
• Community pharmacists in NI refused to provide information to allow the Department to set the terms of the revised contract. Despite failing to reach agreement with community pharmacists in NI, the Department nevertheless effectively introduced the revised contractual arrangements in NI by using the Scottish Drug Tariff (agreed as part of the revised reimbursed contract with pharmacists in Scotland). However in 2010, a judicial review concluded that by continuing to apply the Scottish Drug Tariff in NI, in the absence of an agreed contract, the Department had failed to meet its statutory duty to provide fair and reasonable remuneration to community pharmacists. A subsequent judicial review also found in favour of community pharmacists. The Judicial Review process cost the Department £550,000. As a result of the Department's failure to agree the new pharmaceutical contract, £46 million (which could have been released to provide additional, patient-focused pharmaceutical services in the community – similar to other parts of the UK) had to be repaid to pharmacists.