Issuing prescriptions for longer than 28 days may result in better compliance as well as considerable savings for the NHS, but what about the impact on pharmacy remuneration?

Issuing 28-day rather than longer duration prescriptions for people with long-term conditions lacks a robust evidence base and should be reconsidered, according to a study published in the British Journal of General Practice.

Related research shows that “considerable savings” could be made by the NHS switching to longer prescriptions but this would have “undesirable consequences” for pharmacy remuneration and might lead to a loss of pharmacy services, researchers warn.

Local guidance by clinical commissioning groups in many parts of the country encourages GPs to issue shorter supplies of repeat medications, partly to reduce wastage. Prescriptions are often 28 days in length, but this policy has been questioned before, the paper notes.

The study, led by RAND Europe in Cambridge and funded by the National Institute for Health Research, examined previously published studies dating back as far as 1993. The researchers found nine studies that suggested longer duration prescriptions are associated with better adherence.

They also found six studies that suggested shorter prescriptions might be associated with less wastage, although these studies were considered to be low quality.

In related work published in BMJ Open, the researchers undertook an analysis of 11 years of UK GP prescribing data. This found that any savings due to reduced waste resulting from issuing shorter prescriptions were more than offset by greater costs due to the additional work required by GPs and pharmacists.

Longer prescriptions could save GPs’ time, which could in turn be used to increase time spent with patients, the research suggests. Savings to the NHS from lengthening all prescriptions for statin drugs alone were estimated at £62 million a year.

In a further economic modelling study, published in Applied Health Economics and Health Policy, researchers show that if longer prescriptions result in better medication adherence, this could lead to improved health outcomes and, as a result, reduced costs for the health service.

Dr Rupert Payne, from the University of Bristol’s Centre for Academic Primary Care,
and one of the study’s authors, says: “This has been a contentious issue for many years. Our research shows that the current recommendations to issue shorter prescriptions have been based on a lack of sound scientific evidence.

“There is the potential for longer prescriptions to lead to important benefits by improving patients’ adherence and thus the effectiveness of the drugs, lessening workload for healthcare professionals, and reducing inconvenience and costs to patients.”

Consequences

However, Dr Payne also cautions that lengthening prescriptions could have undesirable consequences for pharmacists.

“Community pharmacies receive a fee for every [item] they dispense. So simply switching every repeat prescription item from, for example, one month to three months, could result in a large reduction in pharmacy income. Therefore, although the NHS may save money, it could lead to a loss of pharmacy services.

“Changes to policy around the length of repeat prescriptions should also consider how pharmacies are reimbursed.”

PSNC chief executive, Sue Sharpe, commented: “We will be reading this report very carefully. Pharmacists will already know that for some patients with well managed long-term conditions, who are adherent to their medicines, longer periods of treatment may be appropriate.

“Other patients with more complex conditions may need more regular review, along with extra support to manage their medicines and conditions. We would like to see them being able to access that support from community pharmacies.”

Leyla Hannbeck, chief pharmacist at the NPA, added: “The authors of the study concede that the evidence base is imperfect and urge caution in respect of making any changes in policy.

“The biggest cost in terms of repeat prescribing is GP time. It makes sense in the light of this study to adopt electronic repeat dispensing more widely, both to remove that time burden from GPs and to allow patients to agree with their pharmacist the most convenient interval.

“Our long-term aspiration should be that community pharmacy should take on in its entirety the routine management of medicines for stable long-term conditions. Patients should be fully supported in their local pharmacy to obtain, understand, monitor and review, and if necessary modify, their medicines.  Such an approach would be more efficient for the system and more convenient for patients, as well as reducing waste and ensuring regular opportunities for lifestyle interventions.”