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NAO report: Prescribing Savings in 2008

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Introduction
The National Audit Office (NAO) has recently published calculations of savings in four therapeutic areas, due to changes in prescribing patterns (rather than changing prices for medicines) 1.  This work was commissioned by the NAO from the Department of Medicines Management at Keele University. Based on their figures, it was calculated that approximately £394 million was saved across all Primary Care Trusts (PCTs) across England in 2008 for drugs related to the following areas: statins, proton pump inhibitors (PPIs), renin angiotensin drugs (ACE and ARB), and clopidogrel .  Details of how the resulting figures were calculated are available on the NAO website1.

Background
In May 2007, the NAO published ‘Prescribing costs in primary care’2, a report that looked at supporting primary care prescribers in their decision making. This focused on the scope for improving prescribing efficiencies, assessing prescribing effectiveness, influencing prescribing behaviour, and reducing the number of medicines that are wasted.

To accompany that report, the NAO also published ‘Influencing prescribing cost and quality in primary care’3, a document that offered a blueprint for prescribing advisers on how to plan communication and target clinicians in order to effectively drive clinical and cost-effective prescribing initiatives.  In this document, prescribing advisers were given suggestions on how to increase the impact of their communication with prescribers using techniques such as defining territory, targeting effort, segmenting practices, and making the most of face-to-face visits to clinicians.

Summary

Clearly, the calculated savings during 2008 are a testimony to the work that prescribing advisers across the country have put in to drive change and influence prescribing habits in the areas covered by the report.  However, taking into account the fact that each PCT started from a different baseline, there has still been a wide range of achievements across the country, thereby indicating that there are opportunities for further improvements to be made and for learning on successful activities to be shared. The NPC’s National Support Materials may also help achieve some of these goals. Advisers may also like to share their successes (or glorious failures) in the NPC discussion room.

What does this mean to medicines management?
Good medicines management depends on clinical and cost-effective prescribing and is supported through the implementation of effective communication and behaviour changing strategies.  During 2009 the National Prescribing Centre, through its Associate programme4, will be focusing on ensuring that NPC Associates are fully aware of the suggestions included in ‘Influencing prescribing cost and quality in primary care’, and that they are supported to develop their influencing strategies and techniques.

Action
If you are a prescribing adviser, or if you work within, or for, a PCT medicines management team, and you haven’t already seen this report you should access it immediately from the link below and review it with the rest of your team, paying particular attention to the calculations made for your PCT, and the influencing activities you have undertaken.  Similarly, if by any chance you haven’t seen the two 2007 NAO reports referred to below you should do so as soon as possible and ensure that you are targeting your efforts effectively.

References
1 www.nao.org.uk/publications/0809/prescribing_savings_in_2008.aspx accessed 26th May 2009
2 National Audit Office. Prescribing costs in primary care. London: The Stationery Office. May 2007
3 National Audit Office. Influencing prescribing cost and quality in primary care. NAO Marketing & Communications Team. May 2007
4 www.npc.nhs.uk/associate_programme accessed 26th May 2009

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