Dr John Chisholm on the prescription problem

The figures have been released by Social Audit, a group campaigning for reform of the drug licensing laws, which has called on Health Secretary Frank Dobson to intervene.

The "unsuitable" drugs have been highlighted for the first time in the new edition of the British National Formulary, which lists every drug on the market, its uses, side effects and recommended dosages.

In total, approximately 100 medicines have been described as "less suitable for prescribing".

The book says these drugs may not work for some patients, may have undesirable side effects, or there may be better alternatives available.

Pain killers

Pain killers and other central nervous system drugs made up about two-thirds of the total. Drugs for the heart and circulatory system, and for respiratory disease, account for most of the rest.

Drugs on the list include the nasal decongestant Sudafed - a version of which is available over the counter.

It is rated as being of "doubtful value" by the BNF, despite the fact that GPs wrote 726,000 prescriptions for the drug last year at a cost to the NHS of £1.43m.

Other drugs on the list include:

• Tylex, a painkiller which combines paracetamol and codeine, and which can cause nausea, drowsiness and even dependence. Doctors wrote 1,224,000 prescriptions at a cost of £10.23m.
• Combivent, a treatment for asthma. Some 515,000 prescriptions were written at a cost of £9.68m.
• Cerumol, which softens ear wax. Better alternatives include olive or almond oil. Some 260,000 prescriptions were written at a cost of £337,000.

In a letter to Mr Dobson, Charles Medawar, who runs Social Audit, said GPs should be given more advice on effective use of drugs by the Prescription Pricing Authority.

Mr Medawar writes: "Perhaps you could encourage the Prescription Pricing Authority to modify the PACT (prescribing and cost) printouts it regularly sends to doctors, to advise about the numbers and cost of the 'less suitable' drugs they are prescribing, with an indication of how their performance compares with the average.

"The point about these products is not that they are always going to be wrong for every patient, but that doctors should be especially ready to justify such prescribing when there may well be better alternatives - and that the NHS should positively encourage this."

GPs need guidance

Dr John Chisholm: 'Doctors need practical help'

Dr John Chisholm, chairman of the British Medical Association's GP committee, admitted that it was tough for GPs to keep up-to-date with best clinical practice.

He said new systems were needed to allow GPs to access the most up-to-date data as swiftly as possible as they were under immense pressure of work. A computer prescribing programme, known as Prodigy is currently being developed.

However, Dr Chisholm said: "We must not rely on cook book medicine which fails to respect the differences of individual patients. A GP's decision to prescribe a certain drug is often not based on one consultation, but on a series of consultations.

"A GP may start off with a specific drug which will not work for a patient, and they may then have tried an alternative which works for that particular individual."

Dr Chishom added that even if GPs had not prescribed the drugs on the list, the NHS might not have saved any money as alternatives would still have been needed.

He said GPs also regularly dealt with patients who had been prescribed the "unsuitable" drugs by hospital physicians, and had little option but to continue with the same regime.

Alan Milburn: 'We must get maximum value for money'

Health minister Alan Milburn said the National Institute for Clinical Excellence, planned for launch next April, was designed to give doctors expert advice on best practice.