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Medicines use and pharmacist workload “cannot continue to increase”

By News Team

The number of prescription items dispensed in the community in England has soared by nearly 70 per cent in a decade, according to a new NHS Information Centre report “Prescriptions dispensed in the community; England, statistics for 2000 to 2010”, prompting pharmacy organisations to call for fundamental changes in the way medicines are prescribed and dispensed.

The report – which covers all prescriptions dispensed to patients in England by community pharmacists, appliance contractors and dispensing doctors – shows that between 2000 and 2010, the average number of prescription items dispensed per head of the population rose from 11.2 to 17.8, while the average net ingredient cost per head of the population rose from £113 to £169.

High blood pressure and heart failure drugs accounted for a high number of prescriptions, although drugs to treat diabetes were among the most costly. However, the average net ingredient cost of an individual prescription item has fallen during the 10-year period from £10.12 in 2000, to £9.53 in 2010.

In addition, 67.4 per cent of all prescription items were dispensed as generic formulations, representing 29.6 per cent of the total cost, compared with 51.8 per cent and 21.6 per cent respectively in 2000.

Increase in workload cannot continue at this rate

Howard Duff, Royal Pharmaceutical Society director for England, commented: “It’s hard to imagine other areas of healthcare having coped so well with a 70 per cent increase in workload alongside the provision of many new services. However, we can’t continue to increase at this rate and something has to change. Solutions lie with putting substantial resources into developing the skill mix of pharmacy staff and the appropriate use of new technology to empower pharmacists to take control of their day-to-day working lives. Greater involvement of pharmacists in the effective use of medicines use would undoubtedly mean far better value for the NHS through waste reduction and improved patient outcomes.”

Keeping up with demand will not be enough to sustain pharmacy

Ian Facer, chairman of Pharmacy Voice, expressed concerned that merely keeping up with demand will not be enough to sustain the sector into the future. He said: “Something fundamental has to change culturally and in the contractual framework to get pharmacists off this script treadmill and into the arena of value-adding optimisation. This transformation must be done in a way that engages the profession, indeed the whole pharmacy team, and protects front line services.”

With the NHS relying on community pharmacy to ensure patients receive their medicines safely and reliably, Alastair Buxton, head of NHS services at the Pharmaceutical Services Negotiating Committee, said: “The good news is that October’s launch of the New Medicine Service – a free NHS service from community pharmacies for patients newly diagnosed with a long-term condition – is a positive step in that direction.”

Growing and ageing population

Care services minister Paul Burstow explained the increase: “The big rise in prescribing largely reflects the impact of a growing and ageing population, as well as an increase in the prescribing of preventative medicines, such as low cost statins. . . . The NHS must adapt and innovate to ensure it is able to meet these demands. We are increasing investment in the NHS by £12.5bn but the NHS needs to be smarter with its resources. That is why we are continuing to encourage the prescribing of preventive medicines, which help to prevent illness and improve patient outcomes.”

Key findings from “Prescriptions dispensed in the community; England, statistics for 2000 to 2010”

Nearly 927 million prescription items were dispensed in 2010; a 4.6 per cent rise on 2009 and a 68 per cent rise on 2000.

Total net ingredient cost in 2010 was £8,834m; a 3.5 per cent rise on 2009 and a 58.2 per cent rise on 2000.

Net ingredient cost per patient in 2010 was £169, compared to £165 in 2009 and £113 in 2000.

The BNF chapter with the greatest number of prescription items dispensed is “Cardiovascular system” and the chapter with the highest net ingredient cost is “Central nervous system”.

The BNF section with the greatest number of prescription items dispensed is “Hypertension and heart failure” and the section with the highest net ingredient cost is “Drugs used in diabetes”.

In the top 10 drugs by cost, four are for the treatment of respiratory disease. These are inhaled medicines (fluticasone, beclometasone, budesonide and tiotropium) used in the treatment of chronic obstructive pulmonary disease and asthma.

Respiratory disease has the second highest cost per prescription item (£17.16) after malignant disease and immunosuppression. More was spent on inhaled fluticasone formulations than any other medicine during the year (£380.6m).

BNF section 6.1, “Drugs used in diabetes”, had the greatest overall cost in 2010 (£713.2m) and had the greatest increase in cost (£78.4m) over the past year. This was the major contributor to the overall cost increase, accounting for over a quarter on the additional cost in 2010 over 2009.

BNF section 4.7 “Analgesics” had the second largest increase in cost in 2010 (8.2 per cent, £37.0m). Use of these medicines increased (by 4.6 per cent) to 60.1 million items. There was increased use of paracetamol, co-codamol and sumatriptan succinate. Under the category M scheme costs rose for paracetamol and co-codamol by £15.3m and fell by £6.3m for sumatriptan succinate.

There was increased use of:

  • oxycodone hydrochloride, mainly the modified-release products, with costs increasing by £7.9m between 2009 and 2010 to reach £44.2m.
  • buprenorphine, mainly low dose transdermal patches (5, 10 and 20micrograms/h), with costs increasing by £5.9m between 2009 and 2010 to reach £36.7m.

BNF section 4.8 “Antiepileptics” had the third largest increase in cost in 2010 (£36.1m) with the number of items dispensed increasing by 10.2 per cent. The following chemicals have seen costs rise in line with increased use: pregabalin, levetiracetam, midazolam and lacosamide. Use of topiramate and gabapentin rose but costs fell by under the category M scheme.

The number of special order products dispensed in 2010 was 0.7 million items at a cost of £138.7m. The average cost per item was £194, in comparison with the overall average cost per item of £9.53. The leading chemicals dispensed as specials were melatonin and midazolam.

The majority of Category M formulations have fallen in price, although some formulations have increased in price.

Citation: The Pharmaceutical Journal URI: 11081381

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