Tuesday, October 27, 1998 Published at 11:57 GMT
Millions spent on 'ineffective drugs'
'Patients may not get the most appropriate drugs'
GPs write 30 million prescriptions a year for drugs that may not be suitable for patients, at a cost of more than £100m to the NHS, it has been claimed.
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 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:
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
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.
He said: "This is a terribly important issue. Of course, the government is committed to putting more money into the NHS, but we also want to make sure that every last pound of that money is spent wisely and that we get maximum value for money."