DRUGS have been very much in the news lately. Not the drugs of misuse that plague our society, but those "magic bullets" that can really make a difference to the quality of patients' lives. Some can indeed be life-saving.
However, these drugs come at a cost, a major cost, and it is the responsibility of all prescribers of medicines to ensure that patients receive the best treatment at the lowest cost. After all, as taxpayers we all fund these drugs.
Health boards
are quite rightly very conscious of costs and each year "cash-releasing efficiency savings" are looked for, ensuring that, if we can, we should supply a treatment at a lower cost to release resources to fund new or additional services. Both treatments must be as effective.
This month a number of measures from health boards have been proposed to try to reduce costs. Many initiatives are sensible. If two drugs are identical in their effect then it is appropriate that the cheaper version is used.
However, we must remember that the development of medicines is a business that, like others, is there to make a profit for its shareholders. If a firm can capture a significant chunk of the market by clever pricing, this would be an advantage for the company.
There is, though, a balance needed for patients. If health boards forever chase the cheapest, and the cheapest keeps changing, patients could get a blue round pill one month and a yellow oval pill the next. Possibly confusing? I think so.
Some recommendations are helpful. One example is to prescribe tablet painkillers where possible. This is not only cheaper but because some dissolvable painkillers can contain a high level of salt, it is preferable for patients with certain conditions . Many doctors and pharmacists now have a small salt cellar on their desks, representing the amount of salt in a day's supply of dissolving pain-killers reminding them of the potential danger. For instance, the amount of salt in eight tablets of soluble effervescent paracetamol is one and a half times the recommended daily allowance. This could have a significant impact on the health of vulnerable patients.
Another health board proposal likely to cause doctors considerable work in explaining the rationale for change to patients is one regarding cancer. There are a number of equally effective drugs available in the treatment of prostate cancer, and most patients are on a drug that is inserted every three months as a pellet into the tummy wall. This costs £267.48 every three months.
Another similar drug costs only £207but is a liquid and has to be injected into the patient's bottom. While both drugs are equally efficacious, it will require a considerable amount of explanation to reassure patients that the change will make no difference to their treatment. I question whether the additional time, effort and anxiety justifies the £20-a-month saving. The cynic in me also wonders whether, once a large chunk of the market is captured by the new firm, if the price will remain the same for long.
There are areas in which we can all help to make savings – much medicine is wasted, sits on shelves and is unused. Recycling is, unfortunately, not possible because when medicines become a patient's property we cannot guarantee that they have been kept in appropriate conditions to ensure that they work properly. Patients and doctors, therefore, need to ensure that quantities requested, and prescribed, are reasonable.
A final factor that will in-fluence NHS drug costs is the reduction and abolition of prescription charges. Currently, a number of medicines are cheaper to buy from the pharmacist in comparison to paying a prescription charge.
When prescriptions are free, there will be a surge in requests for moisturising creams, simple painkillers and anti-inflammatory drugs that cost less than the current £5 charge. Is the NHS ready for this hike in drug costs?
Should we concentrate on how to remind people that just because this charge will be removed, prescriptions are certainly not free?
• Dr John Garner is a member of the BMA's Scottish Council and a practising GP.
