Last week the government released a report on overprescribing that suggested perhaps 10% of prescriptions issued by GPs were unneeded or harmful. The media headlines tended to frame this as another reason to attack GPs. The Telegraph, for example, had this headline: "GP's needless prescriptions push drugs bill to £9bn…"
This framing was wrong but also led to a huge story being missed and an important lesson being ignored.
While GP overprescribing is a problem that deserves to be tackled, it is a far smaller problem than hospital prescribing and is already being tackled (for example, the report highlights the campaign against antibiotic overprescribing in the mid 2010s that led to substantial reductions).
The GP prescribing budget is one of the few areas of NHS spending that has been under control. It has been between £8bn and £9bn for longer than a decade and has shown as many falls as rises year on year. Overprescribing by GPs is not driving spending up.
Hospital prescribing, on the other hand, has risen from £4.2bn in 2010/11 to £11.7bn in 2019/20 and is rising at a rate of between 8% and 16% every year (see the NHS Digital data here:https://digital.nhs.uk/data-and-information/publications/statistical/prescribing-costs-in-hospitals-and-the-community/2019-2020 ). See the chart:
(the numbers above the bar are the annual growth rates in the spending)
This is out of control and, unlike GP prescribing, is a big problem.
We have a good idea why one budget is under control and the other is not. Detailed data about what is happening in GP prescribing in England is available and has been public for more than a decade. Analysts like me can count the number of prescriptions for, to give an example, 20mg simvastatin pills, in every GP practice every month. This hugely rich dataset covering more than a billion annual prescriptions can be interrogated to reveal the differences among practices for every one of the 20 or 30 thousand items they can prescribe (Oxford's EBM Datalab even provides a free interactive tool allowing anyone to analyse the data: https://openprescribing.net/ ).
We don't yet have anything like that for hospital prescribing (the Datalab is working on one but it isn't complete). For many years the only source the NHS had was data bought from an external firm which had restrictive clauses preventing detailed use or dissemination of the numbers (that external firm's primary purpose for collecting it was to sell it on to the pharmaceutical industry for sales analysis, not to help the NHS get a grip on its spend). The NHS has no mandatory collection of data that would give it the same level of insight it already has for GP prescriptions.
Given how little we know about hospital prescribing, there is little mystery why the budget is out of control (and rapidly approaching 10% of the whole NHS budget). When the NHS has exquisitely detailed data about what is happening it can get a grip on both quality and spending; when it doesn't, the budget is out of control and the system has no idea about the quality. For all we know hospitals are wasting gargantuan amounts of money and overprescribing on a massive scale.
We should be praising GPs running one of the most well-managed areas of NHS spending. And we should be scandalised, instead, by the NHS's failure to collect the data necessary to get a grip on out of control prescribing by hospitals. That's what the headlines should have been last week.
