Introduction

Despite the availability of many drugs without a prescription, GPs continue to prescribe a significant number of non-prescription drugs for patients¹. This may be due to the fact that the patient is exempt from prescription charges, the prescription charge may be cheaper than the product price, and some GPs may be reluctant to recommend the purchase of a non-prescription item to a patient². As part of ongoing work on the influence of deprivation on medication use, the association between prescribing trends of non-prescription drugs and deprivation indicators for GP practices have been explored for one of the four health regions in N. Ireland.

Method

The study employed prescribing data relating to the Southern Health and Social Services Board (population = 300,000; 75 GP practices) compiled as a database by the N. Ireland Central Services Agency (CSA). Data over a two-year period were analysed for numbers and costs of items prescribed. The number of non-prescription items expressed as a percentage of the total number of prescribed items was recorded for each GP practice. These data were then analysed with reference to the age / sex and needs assessment weighting indices used in the N. Ireland prescribing capitation formula.

Results

The investigation has revealed that in 1999-2000, 30.3% (n=1.4m) of all prescribed medicines (n=4.6m) were for pharmacy (P) medicines and general sales list (GSL) medicines. These items accounted for 12% (£5.7m) of total prescribing costs (£47.7m). In 2000-2001 the amount of prescribed P and GSL medicines rose to 31.6 % (n=1.5m) of all medicines prescribed (n=4.7m). This accounted for a 4.2% increase in non-prescription medicine prescribing. The biggest contribution to this increase was from P medicines (5% increase in prescribing over the previous year). There was no significant correlation between practice deprivation index and the extent of prescribing of non-prescription drugs, however, there was a slight trend of decreased prescribing of P and GSL medicines with increased capitation factor score (needs).

Discussion

An upward trend would have been expected if NHS prescribing of non-prescription drugs was higher in practices with a higher needs score (an older practice population and/or those with additional needs due to morbidity or socio-economic considerations), since such populations are more likely to qualify for prescription charge exemption. Further analysis of the data is ongoing to examine the influence of other practice variables on non-prescription drug prescribing i.e. training practices, fund holding practices, those practices which encourage cost-effective prescribing, single-handed practices and dispensing practices. It is clear, however, from the results to date that there is considerable scope for community pharmacist prescribing within the NHS under patient group directions in this health board.

References

1. Ferner RE (1994) Dispensing with prescriptions. BMJ; 308: 1316.
2. Huw D, Thomas V and Noyce P (1996) Over the Counter Drugs: The interface between self medication and the NHS. BMJ; 312: 688-691.