You & Your Health: Prescription changes over the years

With Andrew Watson of Goodmeasure Pharmacy, Rotherham

If you’d have been given a prescription thirty years ago, chances are it would have been for antibiotics, pain killers, or an inhaler.

But over the last ten years, the most commonly prescribed medicines have been those used to treat high cholesterol, blood pressure, and indigestion or stomach ulcers.

So, let’s look at the changes in volume and variety of medication prescribed over the last few decades.

Patients depend on medicine to maintain health, prevent illness, manage chronic conditions, and treat disease. Prescribing medication is the most common intervention provided to patients by the NHS, and the second highest area of spending after staffing costs.

Changes to annual spend and volume

In 2022/23, the cost of prescription items was £10.43bn. Back in 2012/13, the total cost was £8.52bn, and in 2002 it was £6.84bn.

In terms of volume, the number of items dispensed by community pharmacies in 2022/23 was 1.18bn. Ten years ago (2012/13) this figure was 914.3m, and twenty years ago (2002/03) it was 650m.

The national average of items per capita (or per person) is 21; at the turn of the century, it was 11. Here in South Yorkshire, our average is 25. West Yorkshire has the highest average with 29 items per person.

Around 90 per cent of prescriptions are dispensed free of charge, mainly to patients over the age of 60 who are exempt from prescription charges.

The amount of medication being prescribed has more than doubled over the last two decades. This could be down to either an increased number of distinct medicines available, or increased utilisation of previously available medicines.

Top three medical areas requiring medication

In 2022/23, the cardiovascular system accounted for the highest proportion of medicines dispensed, with 344m items, or around 29 percent of all items. Four of the top ten items were those needed to treat heart disease or high cholesterol, such as statins and other lipid regulators.

There has been a rising prevalence of cardiovascular disease in recent years, doubling from 271m cases in 1990 to 523m in 2019. In England, there are about 11.8m adults with hypertension, aka high blood pressure.

When they were introduced in the 1990s, statins were only given to patients with very high cholesterol. Whereas now they are usually started in patients with much lower cholesterol levels and have become the standard treatment for anyone who has had a heart attack.

The second highest area was the nervous system with 227m items (19 percent). These are medicines for pain, seizures, dementia, depression and other mental health conditions.

The third highest area was the endocrine system with 127m items (11 percent). These are medicines for diabetes, menopause, osteoporosis, and thyroid problems.

Top three chemical substances prescribed

2022/23                                      2012                              2000

Atorvastatin – 58.7m                   Simvastatin – 42.6m                     Salbutamol – 15.8m

Omeprazole – 35.6m                   Aspirin – 31.2m                            Aspirin – 15.4m

Amlodipine – 35m                       Levothyroxine – 26.6m                Amoxicillin – 12.8m

All top three drugs have seen a huge increase in usage in recent years. Back in 2000, Atorvastatin was the 45th most prescribed medicine, omeprazole was 20th and amlodipine was 16th.

At the other end of the top ten, the chemical substances are Colecalciferol (Vitamin D3) with 25.9m items, Metformin for type 2 diabetes at 24.4m, and the antidepressant Sertraline at 22.1m.

Antibiotics like amoxicillin used to be at the top of the table, but the government brought in a five-year strategy in 2013 to slow the development and spread of anti-microbial resistance.