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.


Add Your Comment
  • Johan Adamson

    • September 8th, 2016 8:54

    I think there is a big issue in mental health where GPs are prescribing pills where mental health services are inadequate. They need to offer side by side counselling etc which would reduce long term drug use perhaps.

  • David Spence

    • September 8th, 2016 10:18

    It does not surprise me that the cost of medicine is going up. It is, I think, another nail in the coffin for the NHS, and for this Government (the Tories) to do further privatisation of the NHS as justification to reduce the funding the NHS gets.

    It also doesn’t surprise me that private health care and the pharmaceutical industries are in hand-in-hand when it comes to making vast profits.

    I once said to my GP, if the NHS is completely privatised, ‘ she will become nothing more than drug pusher/agent on behalf of the private pharmaceutical industries ‘.

    You only have to look at the USA, to see that it is nothing more than a pill popping country, where the people are nothing more than clients on behalf of the private medical and pharmaceutical services (said loosely).

    A system of where medical health care and the drugs industry live a symbiotic relationship.

  • Martine Hall

    • September 8th, 2016 11:15

    In my experience working closely with a Pharmacist, Pharmacy Technician & two local chemists in the borders while working in a very large GP practice I have seen the extent of the waste & it is overwhelming. There are many steps that can be taken to cut it down but you need the man power to implement it. Education of staff & patients is important but it needs to be driven by a dedicated team looking at things like existing repeat patient medication in primary care & without these specific resources savings get overlooked & fall by the wayside by over extended staff in the most part. I recently had a minor operation in the Gilbert Bain, I had the same operation a year previous in the borders. In the borders I left the hospital with 3 boxes of strong pain killers that I didn’t use, in fact still have, before I left the Gilbert Bain I was asked if I had my own pain medication which initially tool me aback but actually is very sensible & commendable proving there are some medicines management protocols already in place to make savings but they obviously need help Shetland wide.

  • Andrew Gibson

    • September 10th, 2016 20:33

    Johan is correct regarding side by side treatments.

    From personal experience I was on anti-depressants when I lived in Shetland and they basically kept me going. My GP wanted me to come off them, I knew I wasn’t ready, but it would have been hypocritcial of me to not do so. No other treatments were offered.

    Two months later I was struggling to cope with work and had to resign; I haven’t worked since. My mental health has improved, but unfortunately my physical health has deteriorated and I have been regular user of other NHS services in the last 2/3 years including having 2 heart attacks.

    Would the £10-15 per month on anti-depressants been a more economical way of keeping me healthy?


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