Prescribing in primary care

Understanding what shapes GPs' prescribing choices and how might these be improved

by Amanda Watt, Jan Tiessen, Tom Ling, Lila Rabinovich

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The National Audit Office (NAO) asked RAND Europe to conduct a qualitative study into general practitioners’ (GPs) prescribing behaviors. This study aims to understand what shapes GPs’ prescribing decisions, and how the cost efficiency of prescribing might be improved in the future. This qualitative study contributes to the NAO’s larger investigation into primary care prescribing in England, and more specifically how financial savings can be delivered by helping GPs deliver better value to patients. The approach used in RAND Europe’s study consisted of initial desk-based research and selection of two primary care trusts (PCTs), each representing cases with relatively low and high adherence to the National Institute of Health and Clinical Excellence (NICE) guidance on the prescribing of statins, which was taken as a proxy for prescribing efficiency. Within each PCT we conducted interviews with PCT managers, GP focus groups, and a workshop with GPs and other knowledgeable individuals. These forums were used to examine the current practice of GP prescribing, influences on GP prescribing decisions, and practical steps that could be taken to improve the cost efficiency of prescribing at the GP and PCT levels. RAND Europe’s work identified three areas for improvement: (1) the local level of the GP practice is important to foster a culture of inquiry and interest in new treatments alongside readily available cost information at the point of prescribing; (2) the regional level is important as a vehicle for translating scientific and cost information from general, possibly abstract, guidelines into information that is directly relevant to patients at the local level; and (3) experimental medicine conducted at national and international levels continues to be important to generate clear findings for possible use in developing guidelines.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Approach

  • Chapter Three

    Key observations

  • Chapter Four

    Improving the cost-efficiency of GP prescribing

  • Appendix A

    Interview protocol

  • Appendix B

    Focus group protocol

  • Appendix C

    Workshop protocol

Research conducted by

The research described in this report was prepared for the National Audit Office and was conducted by RAND Europe.

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