'Better support for patients needed' to reduce £300 million NHS medicines waste
Posted on 23 November 2010
This annual waste figure compares with a gross primary and community care medicines bill of nearly £8 billion, and total English NHS costs of £100 billion a year. It includes £90 million worth of unused prescription medicines stored in individuals' homes at any one time, £110 million returned to community pharmacies over the course of a year, and up to £50 million worth of NHS supplied medicines that are disposed of annually by care homes.
Many health professionals and members of the public believe that the physical waste of NHS medicines is a major issue
Professor Paul Trueman
The waste figure is valued in terms of the purchase prices of medicines discarded rather than taken by the patients for whom they were prescribed.
However, the new evaluation also reports that the NHS is managing the problem of drug wastage more robustly than ever before, and that the net savings possible from investing further resources in reducing NHS waste are likely to be less than half the full figure of £300 million.
This is in part because much of the waste identified was not caused by failures on the part of either patients or professionals, but by factors such as illnesses progressing and treatment changes being required.
Savings opportunities are also limited by the extra costs of interventions intended to further reduce waste. These could, if not carefully controlled, exceed the gains generated. The average primary care prescription medicine today costs the health service £10 for a full month's supply. Yet medical, pharmaceutical and other professional labour typically costs the NHS from £25 to up to £100 an hour, including overheads.
Report co-author Professor Paul Trueman said: "Many health professionals and members of the public believe that the physical waste of NHS medicines is a major issue. We should do everything we can cost effectively to reduce it. But we have not found that the NHS has a systemic problem with drug wastage which marks it out from other health services.
"In value terms there is more to be gained from helping people to take their medicines more effectively, even though this may increase the overall volume of drugs paid for."
The new research finds that up to £500 million of extra value could be generated in just five therapeutic areas (asthma, diabetes, raised blood pressure, vascular disease and the care of people with schizophrenia) if medicines were used in an optimal manner.
Professor David Taylor of The School of Pharmacy, University of London, warned:
"Reducing waste is everyone's business. Our evidence indicates that most NHS users are already highly responsible. Unfairly blaming patients or professionals is counterproductive, as are suggestions that multi-faceted social and clinical problems like medicines wastage could simply be solved by measures like charging NHS patients more for their treatments.
"Increased charges can reduce medicines taking adherence by discouraging people from obtaining treatments that will protect their health, and so reduce pressures on NHS resources."
The York and London University team also looked at medicines wastage in care homes. In this setting, the over-supply of PRN (take as the patient requires) medicines was identified as one area where savings might be made. In the community there are similar waste problems associated with repeat prescriptions and 'take as required' drugs, although in general medicines prescribed for acute conditions are more likely to be left unused than those given for long term illnesses.
Some survey respondents were concerned that current dispensing payments may not adequately incentivise the prevention of excess medicines supply.
The evidence gathered shows that other opportunities for savings include:
- providing targeted medicines taking adherence support for patients starting new therapies, and those on unusually costly and/or difficult to take treatments;
- encouraging the flexible and informed use of 28 day and – where it benefits patients – other longer or shorter prescribing periods
- targeting Medicines Use Reviews conducted by pharmacists more towards groups and individuals at special risk of having difficulties with their medicines taking, and of developing problems like 'treatment hoarding'. This includes providing better quality home care for isolated people and individuals developing memory problems
- caring better for groups such as 'treatment resistant patients', who may not be taking their medicines correctly;
- auditing the use of MDS (monitored dosage system) medicines taking aids, which help some patients but in other instances cause avoidable waste;
- further enhancing hospital and primary care liaison in contexts such as improving the quality of medicines management at around the time of hospital admission and discharge.
Notes to editors:
- The YHEC/School of Pharmacy research reported here was commissioned and funded by the Policy Research Programme in the Department of Health. The views expressed in this release and the Report to which it refers are not necessarily those of the Department.
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