Prescribing costs
In 2100, a latter-day Charles Wilson or Brian Abel Smith will
write a definitive economic history of the National Health Service.
If, sadly, the work is also by way of an epitaph, it will no doubt
dwell at length on the impact of the transition from public to
private, or part private, funding, and the economic effect of so
great a change — mirrored only by the original, reverse,
transition of 1948.
Epitaph or not, however, the work will also contain an extensive
section devoted to the cost of prescribing, and its profound effect
on the overall costs of both primary and secondary care — if
indeed that distinction still exists at that time. There will, of
course, be nothing startling in such an observation. As early as
1956, the Guillebaud Committee1 reported that “since
the beginning of the National Health Service, the gross cost of
pharmaceutical services has increased substantially, and the annual
rate of expenditure is now more than double what it was in the first
few months of the Service”. To emphasise the point, and the
implicit note of alarm, it should be noted that while in 1949 the
total number of prescriptions dispensed by the general
pharmaceutical services was 202m, in 1954 it was 218.7m and in 2001
it was 578m. And that rise relates only to primary care. Hospital
care has seen not dissimilar rises both in prescriptions and in
costs over the same period.
Why this trip down Memory Lane? It is to make an obvious, if
rather vulgar, point: pharmacy costs, whether in primary or
secondary care, are high and have consistently exercised all those
charged with the management of the Service. If — and setting aside
the boring necessity of an extensive infrastructure — one was
called upon to design ICT systems for the Service that rapidly
increased both therapeutic and financial effectiveness, most
managers would opt for systems that tackled pharmaceutical costs.
However, one of the problems that beset those endeavouring to
persuade reluctant authorities to invest in ICT is the real
difficulty in demonstrating immediate cash savings.
Evidence of the savings that electronic prescribing, medicines
administration and medicines management can enable has been steadily
mounting over the past decade. There is a small, but persuasive,
body of definitive studies that show the different kinds of savings,
including both direct and indirect financial savings, that can be
derived from intelligent use of the opportunities released by
computerised prescribing. And this issue of the Journal
carries two articles from secondary care that demonstrate the point.
In primary care, it is only necessary to look at the volume of
prescription-handling traffic to see the potential benefit of
applying ICTs to processes: 538m prescriptions are dispensed on
behalf of more than 30 000 general practitioners; they are all
processed, analysed, and paid for through the Prescription Pricing
Authority. This is a large-scale data-transfer operation that cries
out to be automated from end to end — where the potential savings
in time and effort are, at the very least, considerable and where,
as one of the main pillars of the National Strategic Programme,
trials are already under way.
Another opportunity for extensive savings is available in the use
of computer-based prescribing protocols. If they can have so great
an effect in secondary care, consider what might be their potential
in primary care. Their promise dwarfs the impact of the limited list
or the successful drive to generic prescribing.
In short, for those doubters who cannot, or who choose not to,
accept the cost benefits and the proven organisational improvements
flowing from the drive to computerise the NHS, the field of
electronic prescribing is an absolute winner of a persuader.
In this issue of the Journal, we have articles covering a
number of vital aspects in progress towards full-scale electronic
prescribing. Sean Brennan and Alan Spours report from their recent
survey on the take up of electronic prescribing and medicines
administration (EPMA) in England, which shows that despite very
considerable therapeutic and financial benefits to be derived from
EPMA, there remain sizeable barriers — a major one being
resources. Dr Neal Maskrey, Medical Director of the National
Prescribing Centre, describes its work, which must play a
considerable role if there are ever to be effective national
prescribing protocols in primary care. Finally, Keith Farrar and his
colleagues from Wirral Hospital Trust explain how they significantly
reduced prescribing errors in paediatrics with new protocols — a
prize-winning development, recognised in this year’s Healthcare IT
Effectiveness Awards. His second article, with Ann Slee, reviews
some of the best-known published evidence of the beneficial impact
of computerised prescribing on medication-error rates and associated
costs.
There appears to be very little doubt that the potential
advantages of electronic prescribing are extensive. The Journal
understands that the precise form of the national initiative in this
area is currently under review: it is to be hoped that the review
will be speedy and positive.
Michael Fairey
Reference
1. Report of the Committee of Enquiry into the cost of
the National Health Service. Guillebaud Report. London. HMSO,
1956. Cmd.9663.
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