NHS Prescription Research Articles

Regulating the Prices and Costs of Medicines in the United Kingdom

Pharmaceutical price and overall cost controls in the UK (which represents 4% of the world medicines market) are aimed at containing NHS medicines spending, while also permitting the development of the research based pharmaceutical industry. The non-statutory Pharmaceutical Price Regulation Scheme (PPRS) allows free pricing of new patented medicines (generic medicine prices are controlled separately). But it limits profits from NHS sales, and the amounts spent on activities such as research and promotion. The ratio of industry R&D to promotion costs incurred within the NHS market is 3:1. Elsewhere in the world more is often spent on promotion than on research. On the demand side the NHS imposes direct and indirect budgetary restraints on prescribers. These have been coupled with positive incentives for economic medicines purchasing and prescribing. Some 80 per cent of all NHS prescriptions are now written generically. The National Institute of Clinical Excellence (NICE) works to clarify and ensure NHS patients' rights to access to medical and other treatments. Britain has arguably been successful in containing domestic medicines spending while permitting research based pharmaceutical companies to prosper, and contribute a £2 billion export surplus. The increasing sophistication of NHS medicines management and the demands of the single European market are in the future likely to lead to a reduced role for the PPRS. However, it will probably be preserved in a modified form after it is renegotiated in 2004/05. © 2003 by The Haworth Press, Inc. All rights reserved.

Survey of the use of transport by recipients of a regional Electric Indoor/Outdoor Powered (EPIOC) wheelchair service

Purpose: To determine the extent to which Electric Indoor/Outdoor Powered wheelchair (EPIOC) users travel in vehicles, their concerns about safety, any accidents occurring during transportation and difficulties with their equipment.Method: All 268 EPIOC users on the departmental database were sent a purpose-designed postal questionnaire asking whether the respondent:—used the chair during transportation and in what type of vehicle; understood clamping processes; had a ‘mishap’ or an ‘accident’; felt safe during transportation and wished to comment. Replies from two mailings resulted in 203 usable replies (76%). Responses and comments were entered into an Excel database.Results: Thirty-seven (18%) users did not use any transport. Of the 170 (82%) who did: 51% used Dial-a-Ride, 44% taxis, 41% ambulances, 37% local authority transport, 34% cars and others 17%. Twenty-one (12%) experienced ‘mishaps’—8 toppled out of their chairs and 6 reported clamping-related accidents. Headrests were only used by 69 (41%). Thirty-four (19%) of 182 expressing a view about ‘feeling safe’ felt unsafe sometimes. Wheelchair users often feel vulnerable when being transported by public providers.Discussion: Risks of vehicular travel by wheelchair users could be reduced with appropriate equipment and regular review of NHS prescriptions, education of users, wheelchair services and transport providers.

Effect of national guidelines on prescription of methadone: analysis of NHS prescription data, England 1990-2001

Though there is strong evidence to support the use of methadone maintenance for opiate addiction1 it is often delivered poorly. Evidence based guidelines were developed in 1996 and 1999 (see...

Wet combing to eradicate head lice

Dr Vander Stichele and his colleagues (July 2002 JRSM1) make a welcome contribution to the debate on the merits of wet combing for the detection and treatment of head lice. The comb they have tested is the Bug Buster comb2. This forms part of the kit now available in the UK on NHS prescription to assist parents who are encouraged to remedy head lice at home. However, the Belgian researchers do not seem to have tested the full Bug Busting method. In our experience, dry and damp lice move swiftly away from disturbance created by combing, thus evading detection. We find that it is important to shampoo and rinse the hair before applying conditioner. This takes moisture (which temporarily immobilizes lice) to the hair roots, their main habitat. The omission of shampooing in the Belgian study produces a protocol which is easier for school screening, but not the most effective.

Demand, appropriateness and prescribing of 'lifestyle drugs': a consultation survey in general practice.

The simultaneous launch of orlistat and sildenafil in 1998 provoked much media attention, particularly around the role of lifestyle drugs and their potential costs if controls were not established. Fears were also expressed that primary care would be overwhelmed by demand, and little information was available about the attitude of GPs to their new role as prescribers of lifestlye drugs. Partly in response to these concerns, tight prescribing guidelines and licensed indications, for sildenafil and orlistat, respectively, were issued. Our aim was to describe levels of demand for orlistat and sildenafil in general practice, whether this demand was translated into a prescription, adherence to prescribing guidelines/licensed indications and the GP perception of appropriateness of an NHS prescription for either of these drugs. We carried out an observational study in primary care conducted over a 6-week period during 1999. Twenty-seven GPs were recruited, each from a different practice. All GP consultations were recorded for the study period and the GP completed a structured questionnaire each time sildenafil or orlistat were discussed in a consultation. Sildenafil was discussed in 0.5% (68/13 394) of consultations and orlistat in 0.3% (42/13 394). GPs thought that a corresponding NHS prescription would be highly appropriate in 57 and 74% of cases, respectively, although for both lifestyle drugs, nearly 20% of GPs thought such prescriptions were inappropriate. An NHS prescription was issued in 43% of consultations in which sildenafil had been discussed and 33% in which orlistat had been discussed. Five out of 29 NHS sildenafil prescriptions were issued to patients failing to fulfil the requirements of prescribing guidelines; similarly, one out of 14 orlistat prescriptions fell outside licensed indications. There were four examples of NHS prescriptions for sildenafil which were given even when the GP thought the drug to be inappropriate, whereas orlistat was never given when the GP thought it inappropriate. Levels of demand for the two lifestyle drugs, sildenafil and orlistat, were modest when compared with earlier media predictions. Neither was there evidence that GP was pitted against patient in their negotiation concerning a lifestyle drug NHS prescription since most GPs agreed with their patients that such a prescription was appropriate. Prescribing guidelines and licensed indications were generally adhered to, but the modest level of demand raises questions about expanding the guidelines for sildenafil.

Compression hosiery in venous insufficiency: a natural nurse-led field.

The use of compression hosiery for the treatment and prevention of venous ulceration caused by venous insufficiency is commonplace in community practice. In recent years the role of the nurse in the management of these patients has grown supported by increasing levels of knowledge, nurse specialists and the implementation of nurse prescribing. The full list of compression hosiery items available on NHS prescription are included in the list of nurse prescribing items in the Nurse Prescribers' Formulary and the Drug Tariff. Central to a successful treatment outcome is the patient assessment. This forms the base of a partnership approach to care upon which product choices and advice can be tailored to meet the individual needs of that patient. An understanding of venous physiology, limb measurement skills and hosiery care place the nurse in an ideal position to lead in this area of nursing practice.

Cardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England

Sildenafil is used to treat erectile dysfunction, and prescription on the NHS is restricted. We are conducting a study of prescription event monitoring for sildenafil in England, the first phase...

Briefing paper – Zyban

Zyban is a drug, newly available on NHS prescription, to aid smoking cessation. Two clinical trials suggest superior efficacy to nicotine patches, however side-effects include xerostomia and its use may have an impact on oral health.

Briefing paper – Zyban

Zyban is a drug, newly available on NHS prescription, to aid smoking cessation. Two clinical trials suggest superior efficacy to nicotine patches, however side-effects include xerostomia and its use may have an impact on oral health.

PCG attacked for ban on nursing home supplies

West Sussex group makes U-turn on NHS prescriptions for cases of clinical need

Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness

The 1998 UK government White Paper Smoking Kills emphasises that normal practice should be for general practitioners (GPs), practice nurses, and others to offer advice and support to smokers in their efforts to stop. However, GPs are not allowed to write NHS prescriptions for nicotine-replacement therapy, even though this is the only effective pharmaceutical treatment available in the UK. We estimated the cost-effectiveness, for the NHS, of allowing GPs to prescribe transdermal nicotine patches for up to 12 weeks. We used data from a randomised, placebo-controlled efficacy trial of nicotine patches and a survey of associated resource use in 30 GP surgeries in 15 English counties. We calculated the health benefit of nicotine-patch treatment in number of life years that would be saved by stopping smoking at various ages, and used an abstinence-contingent treatment model to calculate the incremental cost per life year saved by GP counselling with nicotine-patch treatment over GP counselling alone. Cost effectiveness was assessed on the basis that GPs would provide repeat NHS prescriptions for up to 12 weeks if the treatment was proving successful. If GPs were allowed to prescribe transdermal nicotine patches on the NHS, for up to 12 weeks, the incremental cost per life year saved would be: Pound Sterling 398 per person younger than 35 years; Pound Sterling 345 for those aged 35-44 years; Pound Sterling 432 for those aged 45-54 years; and Pound Sterling 785 for those aged 55-65 years. The low cost per life year saved would make GP intervention against smoking a cost-effective life-saving treatment. The priniciples of the government White Paper could be cost-effectively extended into general practice to reduce smoking and smoking-related illnesses.

Bandages: indications for use and Drug Tariff status.

Community nurses need to have an up-to-date knowledge of which bandages are available on NHS prescription (i.e. on Drug Tariff) so that they can select the most appropriate bandage for their patient from those currently available. It seems that, for many years, both doctors and nurses have selected bandages for their patients without any clear knowledge of how the materials in the bandage will perform or what effect they will have (McCollum, 1992). Ideally, the nurse would first carry out an accurate assessment of the wound and then use this information to select an appropriate bandage, based on a full knowledge of its components, indications for use, and correct application technique. A bandage that is applied incorrectly can cause serious tissue damage. This article presents an up-to-date guide to the bandages currently available on Drug Tariff. However, since the Drug Tariff status of wound care products is constantly changing, community nurses need to keep up to date with the changes if they are to provide optimum care for their patients.

Utilization of appetite suppressants in England: a putative indicator of poor prescribing practice.

The use of appetite suppressants, a putative inverse marker of prescribing quality, was analysed in the former Northern Regional Health Authority (RHA) and in England using National Health Service prescribing data and sales and patient-linked prescribing data supplied by Intercontinental Medical Statistics (IMS). The number (in thousands) of National Health Service prescriptions for appetite suppressants dispensed fell from 393 in 1991 to 235 in 1994. Per capita prescribing frequency varied threefold between different RHA and between individual Family Health Service Authorities (FHSA) within the former Northern RHA (NRHA). Prescribing frequency was higher in the spring and summer quarters and reduced in the winter quarter. Of 532 general practices in the NRHA, 82 (15%) prescribed no appetite suppressants between April 1993 and March 1994, while 70 (13%) prescribed more than 500 defined daily doses (DDDs) per 1000 patients, accounting for 47% of all prescribing. Only 53% of pharmacy purchases of appetite suppressants were accounted for by NHS prescribing and as little as 21% for phentermine, indicating substantial prescribing outwith the NHS. In 1991, 73,759 DDDs were supplied to pharmacies each day, the majority being diethylpropion (31,226) and phentermine (24,349). The fall in NHS prescribing is welcome as these drugs are of dubious clinical value and may be associated with serious adverse effects. Because of substantial non-NHS prescribing, routinely available prescribing data does not accurately quantify total prescribing of these agents.

Recent trends in the incidence of multiple births and associated mortality in England and Wales.

To review trends in multiple births and associated mortality in England and Wales since 1975, in the light of trends for earlier years; to assess, within the limitations of the available data, the extent of any association between multiple birth rates and assisted conception and drugs used for subfertility. Data collected routinely in England and Wales, between 1975 and 1994, were retrospectively reviewed. These comprised Office of Population Censuses and Surveys (OPCS) data collected at the registration of live and stillbirths and deaths occurring under the age of 1 year in England and Wales from 1975 onwards. Department of Health data about NHS prescriptions dispensed outside hospitals within England for drugs which could be used in the medical management of subfertility were also included. The proportion of pregnancies that resulted in a registered multiple birth increased from a low of 9.9 per thousand in 1975 to 13.6 per thousand in 1994. Up to 1992, the increase was seen in all age groups except for women under 20, with the most substantial increase being in women aged 35 to 39. The rise in the rate of triplet and other higher order births was much steeper than that for all multiple births, increasing from 0.13 sets of triplets per thousand maternities in 1975, to 0.41 in 1994. Prescriptions dispensed for selected drugs that may be used for the medical management of subfertility and assisted conception became more common over this period. The fragmented nature of the data precluded direct comparison with changes in multiple birth rates, however. Although the causes of the rise since 1980 in multiple birth rates in general, and the dramatic rise in the triplet rate in particular, cannot be ascertained or quantified directly from routinely collected data, drugs used for subfertility and more recently, assisted conception, probably had a major role.

The interface between self medication and the NHS.

Cost and convenience seem to be major factors in determining whether, given the choice, patients purchase a medicine over the counter or obtain it on prescription. With current arrangements, exemption from prescription charges provides an incentive to continue to obtain products on NHS prescription even when they are available over the counter. There is therefore no simple relation between the availability of over the counter medicines and the level of prescribing of deregulated products. The appropriate use of over the counter medicines--particularly those that have only recently been deregulated--places a burden of care on community pharmacists and calls for closer working relationships with general practitioners. In particular, systems for referral and for recording details of both prescribed and over the counter medicines need to be developed, and a direct route needs to be established for community pharmacists to report adverse drug reactions to over the counter products.

Impact of OTC drug use on NHS prescribing and costs

Impact of OTC drug use on NHS prescribing and costs

Dental prescribing: minimising the cost to the patient and the NHS.

The high cost of prescription charges, changes in drug availability and the increase in private and independent dental practice means that NHS prescriptions may not be the cheapest or most appropriate way of providing drugs to patients. This article examines this complex area and provides some practical advice.

Privatizing medicines in the National Health Service

There is generally a political outcry when the Government announces that, yet again, it is raising the NHS prescription charge. The debate is usually the same: on the one hand those that can afford drugs should make a contribution to their cost; on the other hand, the prescription charge undermines the principles of the NHS. But the debate should be widened to include access, equity, use, exemptions, government income from the charge, and privatization. This article looks at these issues with the aim of informing the wider debate.

Pharmacist fined for cheap drug charges

A pharmacist in Gwent who was fined £550 last week for refusing to levy NHS prescription charges on cheap drugs will take his case to Europe if the Welsh Office does not overturn the ruling against him. Allan Sharpe, owner of Sharpe the Chemist in Newbridge on Usk, has been treating NHS prescriptions for paying patients as private prescriptions if the drug costs less than the standard £5.25 charge. Mid-Glamorgan Family Health Services Authority and Gwent Health Commission, which launched the original complaint against Mr Sharpe, have refused to comment to the press. The disciplinary tribunal told him that his …

UK government to examine NHS prescribing

UK government to examine NHS prescribing