Prescriptions raise complex questions

In your editorial, “Prescription charges are not a tax on ill-health” (1 April), you express great concern that free prescriptions for all has contributed to a rise in the NHS Scotland cost of prescribing by £30 million in a recent nine-month period.

You describe “a surge in the take-up of prescribed medicines”. Such costs have risen by 22 per cent over the past ten years, some of that increase due to new drugs approved for use which are more expensive than the 
existing range.

That is the case, for instance, in conditions such as diabetes, urinary function, chronic pain and heart failure.

In addition, GPs and practice nurses have tended to follow single-disease guidelines sometimes more assiduously than was best for patients with several chronic conditions. That too has generated polypharmacy and expense.

Counterbalancing that is reduced costs for drugs which go off-patent and which quite quickly become much cheaper.

In 2012/13, atorvastatin (Lipitor) came off-patent and total costs in Scotland fell by 5 per cent in large part due to that change. The average cost per patient in health boards varies greatly, not all due to differences in chronic disease prevalence.

Working together, practice-linked primary care pharmacists and GPs have improved quality, safety and cost-effectiveness of prescribing, more effectively in some health board areas than others over the past few years. Clearly this takes time and resource but it should be time well spent.

The range in health board annual cost per patient (net ingredient cost) in 2013/14 was between £153 and £195.

Save even a third of that difference annually and we have a sum of £73m to use in other directions. Make that sustainable and the year-on- year savings are impressive.

To assist that, we are entering an era of de-prescribing in primary care when those taking many prescription medicines will find they are recommended to reduce the number of tablets taken and reduce potential interactions and side effects. For those likely to be in their last year of life, medication which is taken to add years to life becomes unnecessary and can be safely stopped.

The challenge in front of us is to generate further safety and cost-effective changes with less GP input and more pharmacist time.

The acute shortage of GPs threatens this aspect of modern general practice and the financial cost could be considerable. Time spent face-to-face with patients to explain and reassure rather than prescribe and time to review the repeat prescription list of many is time well spent.

I hope pharmacist colleagues will want to get even more involved and when community pharmacies involved and commercial considerations have influence, these are discussed and a way forward in favour of patients, carers and NHS agreed.

Philip Gaskell

General practitioner

Allan Park Medical 
Practice

Stirling

Parkinson’s UK is very concerned that people in Scotland are not getting the full facts about free prescriptions.

Your article, “£30m surge in cost of free prescriptions” (1 April) said that the cost of free prescriptions had risen by more than £30 million in the first nine months of 2014. In fact, that figure related to the total prescribing budget in Scotland of £739m.

The reality is that the free prescriptions policy costs a small fraction of the figures quoted in your article.

Before free prescriptions were introduced, only about 8 per cent of prescriptions were paid for.

The system was also arbitrary and unfair with people, with some long-term conditions, receiving their essential medicines for free when others with serious conditions – including Parkinson’s – had to pay.

People with Parkinson’s are often prescribed multiple medicines, and prescription charges prevented some people from taking all the medicines they needed.

We believe reintroducing prescription charges would be a false economy as we know they prevent people managing their long-term condition effectively. This puts huge pressure on health and care services, and makes it much harder for people with long-term conditions like Parkinson’s to stay in work.

Unless people with all long-term conditions remain exempt from charges, individuals, the NHS and employers will all pay the price.

Katherine Crawford

Parkinson’s UK in 
Scotland