New research published by the Journal of the Royal Society of Medicine finds that general practices in England with the worst prescribing quality scores are 2.1 times more likely to prescribe homeopathy than practices with the best quality scores.

Prescribing of homeopathy still occurs in a small minority of English general practices. The researchers hypothesised that the practices which prescribe any homeopathic preparations might differ in their prescribing of other drugs.

Even infrequent homeopathy prescribing is strongly associated with poor performance on a range of prescribing quality measures, but not with overall patient recommendation or quality outcomes framework score.

The association has been unlikely to be a direct causal relationship but might reflect underlying practice features, such as the extent of respect for evidence-based practice, or poorer stewardship of the prescribing budget.

Researchers from the University of Oxford and Exeter University looked at practices that prescribe homeopathy to see if they differ in their prescribing of other drugs.

They found that even infrequent homeopathy prescribing was strongly associated with poor performance on a range of prescribing quality measures, but not with overall patient recommendation or quality outcomes framework score.

Lead researcher Dr Ben Goldacre, Senior Clinical Research Fellow at the Nuffield Department of Primary Care Health Sciences, University of Oxford, said: "Despite the lack of evidence for homeopathy, and its lack of a plausible mechanism, some NHS doctors still prescribe it."

"We set out to explore whether general practices prescribing homeopathic remedies also behave differently on other measures of general practitioner behaviour," said Goldacre.

The researchers identified 644 practices that had issued at least one homeopathy prescription in a six-month period (December 2016 to May 2017). There were 2,720 homeopathy prescriptions in total costing £36,532 (mean £13,43 per item).

They found that prescribing any homeopathy was associated with poorer performance at practice level on a range of standard prescribing measures. The association was unlikely to be a direct causal relationship, say the researchers, but might reflect deeper underlying practice features, such as the extent of respect for evidence-based practice, or poorer stewardship of the prescribing budget.

Dr Goldacre said: "Although NHS expenditure on homeopathy is low, we believe the strong association between homeopathy use and poorer prescribing, in general, is more important than cost. It should raise concerns and may be of interest to those seeking to understand variation in clinical styles and the use of alternative medicine by clinicians."