The auditors have been into various Primary Care Trusts around the country, including ours, and found that they're overspent to the tune of millions of pounds. In some areas they've brought in external consultants, local NHS management being not quite top calibre, to advise on changes which could help to save money. The overspends are generally due to seriously bad management at a non-clinical level going back over years, which would result in anyone in the private sector having to leave their jobs the day before yesterday, but rather than deal with that painful issue, for quick gains GPs' prescribing budgets are being targeted for savings.
To make them, our area has bought us a piece of software called Scriptswitch. Scriptswitch integrates with clinical software and is pre-programmed by people at the Trust with a list of preferred cheaper options for common drugs. So if I usually prescribe Antacid A and start doing so, a message comes up telling me that I might like to change to Antacid B, gives me the cost saving and asks whether I want to accept it. It then it comes up with an equivalent dosage automatically.
It seemed like a great idea at first but we keep finding problems as we go along. For example. three 20mg capsules of an antidepressant are much cheaper than one 60mg one. Does that make sense? Would you rather take one pill or three?
Cheap inhaler X tastes so disgusting compared to inhaler Y that the patients, and especially children, come back within a week asking to have the original one back again. In some cases statin K's equivalent is twice the strength of statin L, so I deal with numerous calls from people querying the dose change, even though I attach a letter to each prescription explaining the change and the reasoning behind it.
For anyone who has to write a similar letter, "more cost effective" sounds so much better than "cheaper". We used to tell people things were cheaper, and they voted with their feet, because "cheaper" means second best. Now we use economyspeak, and everyone's happier that they're doing something to save the health of the nation and control the Chancellor's budget without him realising it.
Cost savings are denoted as positives, losses as negatives. Whoever programmed the software at the Trust entered several more expensive drugs in by error, and these come up as -£66 rather than £66. None of us expected such a stupid mistake, so for the first quarter of the year, we read it as a hyphen and cheerily prescribed away and managed to increase our spending, changes to the software apparently taking three months to be made.
Quite often the pharmacy suppliers can't and won't get hold of the new drug, since they're in a chain which has planned its buying based on historical prescribing. Some of them are honest and ring us to ask for a change, others are less so, and instead of losing their customers to another pharmacy by telling them to try elsewhere, they just tell them that the drug is no longer unavailable, which takes us quite a lot of ringing round to unpick and resolve.
In spite of all of these stupidities, we have still managed to reduce spending on drugs by a small amount, although at the expense of some anxiety for patients, so that some of the money will be spent on other things to improve patient services, such as new diagnostic equipment. The scheme is being used increasingly across the country, so for anyone who lives in GB & NI, don't be surprised if you pick up a prescription which looks as if it's meant to be for someone else, but remember to query it and nicely suggest to your surgery Practice Manager that there should at the very least have been a letter attached to it explaining what is going on and that you will be changed back to the original medicaton if for some reason you cannot tolerate the new one..
Would have been nice to have known more but in the great scheme of things completely unimportant. 
