Repeat prescriptions are one of the most common ways people interact with the NHS. But in England, there’s no national guidance on how long those prescriptions should be issued for - and until now, very little data on how often people are getting them from their pharmacy for long-term conditions.
Researchers from the Bennett Institute for Applied Data Science in the Nuffield Department of Primary Care Health Sciences have analysed prescribing data for five common medications used to treat long-term conditions such as high blood pressure, high cholesterol and thyroid problems. The study, published in the British Journal of General Practice, found big differences in prescription durations - both nationally and regionally - which may have implications for patients, practices and NHS policy.
What the study found:
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48.5% of prescriptions were for 28 days
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43.6% were for 56 days (around two months)
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Just 8% were for 84 days (around three months)
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In some parts of England, just 7% of prescriptions were for 28 days – in others, it was as high as 95%
The study used data from OpenPrescribing (OpenPrescribing.net), a publicly available tool developed by the team in the Bennett Institute, which draws on NHS England prescription records. The researchers looked at more than 160 million prescriptions issued between December 2018 and November 2019 for five commonly used medicines: ramipril, atorvastatin, simvastatin, levothyroxine and amlodipine. All are typically taken once daily and used to treat long-term health conditions.
Why this matters
Repeat prescriptions are a major contact point between patients, GPs and pharmacies. 1.1 billion prescriptions are issued every year, two-thirds of which are estimated to be repeat prescriptions, most-commonly for long-term conditions. This means a large amount of time and NHS resource is spent issuing, processing and collecting prescriptions. So, issuing longer prescriptions where appropriate could reduce inconvenience for patients and save time for healthcare staff.
Importantly, approaches to prescription duration are already beginning to change in parts of the UK. Since 2022, the NHS in Wales has recommended two-month rather than one-month prescriptions where appropriate, as part of efforts to improve efficiency and reduce unnecessary workload.
What’s driving the variation?
The research found that the type of GP practice and the electronic health record (EHR) software used were linked to prescription length. In particular:
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Dispensing practices (those that both prescribe and dispense medicines, often in rural areas) were much more likely to issue one-month prescriptions.
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The proportion of patients with long-term conditions in a practice also made a difference - practices with more patients living with long-term conditions were more likely to issue shorter prescriptions.
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EHR systems influenced prescribing patterns too. Some software systems default to 28-day prescriptions, although these settings can be changed locally.
What this means
Dr Helen Curtis, a Senior Researcher in the Bennett Institute and senior author on the paper, explained: ‘This research shows that there is no consistent approach to how long repeat prescriptions last in England, even for the same medicines and conditions. While some variation may be clinically appropriate, the scale of the differences suggests that local policy, payment structures, and system design are also playing a role.
‘The findings of our study raise important questions about prescription length for long-term conditions. Longer prescriptions could save time for patients and the NHS, but financial and practical factors may be discouraging their use. By highlighting these patterns, the study provides a starting point for more joined-up and evidence-based approaches to repeat prescribing that better balance safety, convenience, cost and patient experience.’
The study, the researchers explain, provides the first detailed national picture of how long repeat prescriptions last in England. The next step is to build on these findings by using more detailed patient-level data to explore the impact of different prescription durations on health outcomes, NHS resources and patient experience, which could ultimately help inform future NHS policy on repeat prescribing.
Read the full paper, ‘Variation in prescription duration for long term conditions: a cohort study in English NHS primary care using OpenPrescribing’, in the BJGP.