Action needed to cut prescription costs, meeting told

More work needs to be done improve prescription of medicines and cut down on waste, members of the integration joint board were told on Wednesday.

The meeting was told how the cost of medicines prescribed by GPs in Shetland continues to rise.

Health chief Simon Bokor-Ingram said as the population became older, the prevalence of long-term conditions increased, driving up costs.

He said a more “strategic” and “person-centred” approach was being taken to prescribing, however, he warned anecdotally and empirically “we’ve still got a local issue to do with medicine wastage”. And he said there were issues with non-usage and hoarding.

Better prescribing meant working with GPs, specialist nurses, hospital staff and other health workers, he explained.
Shetland prescribing was, generally of a high standard, members were told, though “there is significant variation between practices, and Shetland has some higher prescribing costs compared to similar populations elsewhere”.

“If prescribing costs continue to rise that’s going to put pressure on budgets,” Mr Bokor-Ingram warned, with less money from the government for health and care.

Director of pharmacy Chris Nicolson said there needed to be more effective prescribing and this financial year savings of £192,000 may be required from the GP prescribing budget alone.

Next to staffing costs, medicines are the biggest spend from NHS Shetland – worth about £6 million.

Mr Nicolson said pulling together health staff and patients to change the approach to prescriptions would help with the savings.

“If prescribing costs continue to rise that’s going to put pressure on budgets” SIMON BOKOR-INGRAM

There needed to be a move away from a dependency culture on medicines to solve issues and an honesty about medications being potentially harmful as well as helpful.

He said there was a hope “to grow our own pharmacists” and this year the health board had its first pre-registration pharmacist in hospital.

The Scottish government was also keen for pharmacists to be in GP practices. A pharmacist is already working at Lerwick Health Centre, the meeting was told.

Mr Nicolson admitted the health board was “a long way off” getting a pharmacist in every practice, though GPs and patients were beginning to see the benefits of having a pharmacist present.

A five-year prescribing action plan is also being drawn up, including the use of pharmacy technicians.

Mr Nicolson said the technicians could offer help in care homes, as well as going into people’s homes to help them order their prescriptions.

According to his report prescribing budgets were seen by some GPs as “largely irrelevant and simply indicative” and “perhaps unsurprisingly, many GPs seem not overly concerned by budget overspends, whether at practice or health board level.

“A view sometimes expressed is that ‘it’s up to the Scottish government [or] health board to provide an adequate budget to meet needs’. There is little evidence of any services which have been lost because of overspends, which adds credibility to this view.”

Shetland south councillor Billy Fox picked up on the observation, having been told at a previous meeting of the joint board that there needed to be a shift away from such a view.

“It’s a difficult one,” said Mr Nicolson.

“I understand where that’s coming from but we need to move towards a position where people take a wee bit more responsibility for budgets,” he said.