Current economic circumstances put public services under stress. The UK National Health Service (NHS) is also subject to these pressures and generic prescribing is one of the ways to reduce cost without significantly harming patient care. In fact, the overall savings available in global terms are probably modest. About 10% of the total NHS spend is on medicines (that is, around £10 billion). Control of spending in secondary care is normally exercised by hospital formularies, so the focus for savings is in primary care. The UK Department of Health (DoH) estimates that in 2009 primary care spending on branded (non-generic) prescriptions was about £5.5 billion and £2 billion on generics. However, of this total, 83% of the volume of prescriptions was generic. Of the remaining 17%, only around 5% was available to be prescribed in a generic form.1 So although there appears to be a significant margin for potential savings on one measure, it is much less according to another.

The therapeutic value of medicines is not in dispute, and the savings in hospital admissions from effective treatment are obvious. Nevertheless, if medicines can be prescribed less expensively and with equal clinical benefit, it is sensible to realise the savings and put them to better use. Here, we consider the legal implications of doing so.

Reasonable care in prescribing

The principle of reasonable care requires doctors to adhere to proper standards of care, that is, standards that comply with the views of responsible practitioners and withstand logical scrutiny. The standard would normally be satisfied without difficulty for those who prescribe generics responsibly. If the generic is therapeutically identical to the original medicine, it is reasonable to suppose that its clinical impact will be the same. There may be cases, however, where the doctor reasonably believes that some aspect of the medicine will behave …