How to reduce NHS procurement costs with a Smartie & a click

Yesterday I suggested a comparatively easy approach to reducing NHS prescription costs through placing an electronic gateway, which required merely the click of a GPs mouse, to affirm that, in their opinion, the prescription being issued was not a waste of money. I also suggested a wider trial of embedding such an affirmation more widely into P2P workflows.

Today I have learnt of further research which suggest that sleeping tablets frequently are no more effective than a ‘Smartie’ (well a placebo – I’m sure you get the drift). That’s not to say that the issue of prescriptions for sleeping tablets should be replaced by ‘Smarties’ (or other equal and approved equivalent). No, what I would suggest is, given that sleeping problems are rarely serious, why not first explore the lower cost and lower adverse impact option, and only if the ‘Smarties’ (or other equal and approved equivalent) fail to be effective, progress to trying traditional sleeping tablets.

Surely GPs should be completing yesterday’s and today’s evaluations  anyway, even though the evidence of the two research reports casts some doubt. Therefore why not introduce the ‘affirmative  click’?

So I would extend my proposal from yesterday to include a further affirmative statement:

I confirm I have thoroughly considered and evaluated other potentially lower cost options.

Like yesterday, I think this additional affirmative statement could also be trialled in P2P workflows to see if it proved worthwhile in more general purchasing beyond the NHS.
   

How to reduce NHS procurement cost with a click

On Sunday my minister made an announcement that he recognised that high price of stamps, therefore he hoped the congregation would understand that he would not be posting Christmas Cards. He also said he would understand if the congregation took a similar position. The easy way to save money is not to spend it - common sense.

Now if you knew that one one category of your expenditure was on something which had no real benefit, the easy answer to reducing costs is not to buy it. However, like paying for a postage to send Christmas Cards to addresses which you pass on the way to the post box it needs to be easy to break the habit.

So I am going to take the bold step of offering a low cost option to the NHS on how to significantly reduce costs. I propose that the online pro forma prescriptions which GPs use should be amended to include the following statement with a requirement to confirm, with a click, before the prescription can be issued.

In my professional judgement, I confirm that this medication is fit for purpose, is appropriate for the illness and will deliver an anticipated medical benefit.

If such a statement were included it would put the onus on doctors to confirm that they are not wasting money on prescriptions which they know are likely to 'do no good' and quite possibly go against that medical mantra of 'do no harm'.  My suggestion is aimed at trying to move from a recognition of recent research that "[an antibiotic which accounts for a third of all antibiotic prescriptions] is useless for most people who are getting it at the moment' to a change in prescribing behaviour and the associated reduction in prescription costs.

Come to think of it, could a similar affirmative statement, suitably reworded, be embedded into the workflow of most P2P systems? That would be an interesting pilot to run and test its impact.