Rising prescribing costs key challenge for NHS Borders

National medicines policies are pushing up prescribing costs without extra funding, says director of public health

Wednesday 13th March 2019

During an evidence session with the Scottish Parliament’s Health & Sport Committee, representatives of NHS Borders highlighted how tackling rising prescribing costs in both primary and secondary care is a “key priority”.

At present, the board is in special measures because of financial difficulties, currently at stage four of the Scottish Government’s escalation framework, and external support has been brought in to work with the board to help it reach a financially sustainable position over the next three to five years.

Among the myriad challenges the board faces, prescribing costs, agency staff costs and “extremely difficult” to achieve efficiency savings targets came to the fore during Tuesday’s evidence session. 

Joint director of public health at NHS Borders, Dr Tim Patterson, drew the Committee’s attention to the pressure exerted on finances by significant increases in prescribing costs in recent years.

Two main drivers behind rising costs in prescribing

Despite a 42% increase in secondary care prescribing costs, there hasn’t been a commensurate increase in prescribing funding”, Dr Patterson explained.

[In addressing financial sustainability] one of the key priorities will be prescribing costs; we currently spend about £25m in primary care prescribing and £10m in secondary care prescribing…which has gone up by 42% in the past four years.”

There are many causes for this out with our control; one of the big causes in particular for the secondary care prescribing has been the changes in policy for the Scottish Medicines Consortium (SMC)”, he stated.

The SMC is the body that decides whether drugs and medicines will be available publicly on the NHS.

So we’re looking at prescribing as one of our key priorities in order to get a financial grip, working very closely with primary and secondary care colleagues. We’re supporting them with additional pharmacy staff and have also agreed to locally enhanced services with GPs.

Local enhanced services are focusing on areas where we are outliers in prescribing and also where there may be medicines of limited value. In secondary care we are particularly looking at biosimilars, which are extremely expensive as well as increasingly effective, but not funded through the prescribing budget allocations.

Dr Patterson added that consultants within NHS Borders were looking closely at prescribing costs, particularly where there are shifts from proprietary drugs to generic drugs.

The Scottish Borders and its ageing population

NHS Borders serves the highest percentage population of elderly people in Scotland, and this, Dr Patterson explains, has been a significant factor in driving up prescribing costs.

If you look at primary care list sizes, even though they have only gone up by about 2%, the actual number of over 65s in the Borders on GPs’ lists has gone up by 26%. In the over 75 to 85 bracket, that has gone up by 12% and those aged over 85 has also gone up by 12%.

“That’s significant and most older people have not just one disease or morbidity, they have multiple morbidities. This has put a lot of pressure and work on our GPs; one of the concerns that has been shown in the Borders and elsewhere is that this is causing a huge amount of stress in General Practice.”