In a community pharmacy session on September 11 that was chaired by Mr Marshall
Davies (Vice-President of the Royal Pharmaceutical Society), speakers discussed
ways of controlling the drug budget in primary care. They concluded that budgets
should be agreed rather than imposed and that different ways of encouraging
change in prescribing habits worked with different types of prescriber
There are three types of prescriber and the approach used when persuading them
to change their habits should vary depending on which type they are, said Dr
CHRIS JAMES (chairman, Southampton Central primary care group). Three distinct
groups of prescribers could be identified. They comprised those who were:
The first group would be keen to improve or change their prescribing and would
respond best to general prescribing advice and assistance with audit and formulary
development. The second would probably need help with computerisation, medication
reviews and repeat prescribing systems review. With the third group, it was
best to assess any risk before leaving them to their own devices. There was
little, other than peer pressure, that would change this group and time would
be better spent elsewhere.
Primary care groups (PCGs) had to stay within budget, as there were no reserves.
In addition to controlling costs, PCGs were trying to provide better, more consistent
care for patients. To achieve this, they needed advice and systematic support,
good current prescribing data, high quality prescribing advice, incentives and
a strong corporate view. In addition, there had to be tangible benefits to changing
practice.
Advice came to PCGs from three sources: locally (in-house resources and the
local health authority); externally (the pharmaceutical industry) and nationally
(the National Institute for Clinical Excellence and other bodies). It was important
that this advice was not dictatorial. It had to be encouraging and supportive
of change.
It was essential to take a practice-wide view of services and to have a prescribing
task force. Meetings at Southampton were chaired by a GP with the support of
the prescribing adviser, and all parties in the PCG agreed a prescribing budget.
The prescribing adviser led formulary discussions at Southampton and the PCG
was hoping to influence the formulary used by local hospitals. Prescribing trends
were used to determine the services offered by the PCG. For example, proton-pump
inhibitors were the biggest drug cost to the PCG, so a lifestyle clinic had
been set up to counsel patients with gastrointestinal disorders. More information
about the PCG and its formulary was available on the internet at www.cspcg.co.uk.
Incentives were an important mediator of change. There had to be a mixture of
personal and corporate incentives to ensure that practices as a whole reached
their targets. These might include incentives for spending within the budget,
for conducting an audit or for individuals who achieved five personal objectives.