Prospects for the future

In future the need for the PPRS - which acts on the 'supply side' of the NHS medicine cost equation - may be reduced by further changes in the health service. 'Demand side' innovations have already increased the ability of the health service to purchase medicines in a cost-sensitive way.

Such developments have included:

• the emergence of a new NHS culture, sympathetic to concepts such as evidence based medicine (EBM), the use of well researched clinical guidelines, and the value of cost-utility and other forms of economic analysis in health care improvement;
• the provision in England and Wales of detailed, high quality PACT (prescribing analysis and cost trend) data to prescribers and health service managers. This has been accompanied by the supply of similar information by the Prescription Pricing Authority's counterparts in Scotland and Northern Ireland;
• institutional and locally agreed formularies, and the employment by Health Authorities and other bodies of medical and pharmaceutical advisers. Efforts to persuade prescribers to prescribe 'rationally' are increasingly supported by promotional and allied interventions;
• the PRODIGY experiment. This computer-based clinical decision support programme advises prescribers on lower cost treatment options;
• changes in the organisation of primary care and the introduction of prescribing incentive schemes. The latter offers practices financial rewards for curbing medicines costs. Although GP fundholding has been ended, the creation of bodies such as Primary Care Groups with unified, cash limited budgets is creating new financial pressures on prescribers to economise;
• generic prescribing targets. About two thirds of all NHS medicine prescriptions are now written generically, compared with about a fifth at the start of the 1980s;
• the National Institute for Clinical Excellence (NICE) to assess the value of medicines and determine best practice has introduced a further dimension into the NHS's medicine price and cost control arrangements. The activities of NICE, backed by the Commission for Health Improvement, may in future serve to discourage the use or availability of some medicines.