Spending money on primary care budgets is not a bad thing, as some people seem
to think, but the focus must be on promoting efficient, effective prescribing,
said Mr ALAN BURNS (chief executive, Cambridgeshire health authority).
Ways of successfully controlling a primary care budget included all areas of
medicines management, setting the budget through planning and agreement with
all parties and concentrating on making the best use of the budget. The main
ingredients for successful budgeting in primary care were:
The process of budgeting would be affected by the unified budget, clinical
governance, the development of primary care trusts and the national plan. Clinical
governance would have a major impact on patient care but it was important that
it concentrated on best treatment rather than finance. Mr Burns said that, in
his experience, the primary care groups that were most effective and controlled
their budgets best were those that had made the education of all members of
the health care team a top priority.
Information presented to general practitioners in order to change their prescribing
habits now had to take a different direction. Incentives did not seem to be
any better than education at producing changes. What was more effective was
to remove disincentives to good prescribing and to make the therapeutic area
a topic that everyone wanted to talk about.
Achieving these objectives required support that pharmaceutical companies and
skilled community pharmacists could provide. It was also important to invest
in the leadership of clinicians, as they understood the issues in prescribing
best and, unless they were persuaded to make changes, noone else would. The
role of pharmaceutical advisers had to change. They had to become “change
managers” who happened to be pharmacists because that was what was now
needed.
Other means of controlling the budget included formularies that were used by
both primary and secondary care. In addition, the drug budget needed to be integrated
between acute hospitals and their catchment area for certain drugs. This would
allow full use to be made of purchasing power in a bid to improve patient care.
Open, comparable prescribing data continued to be important as they allowed
both managers and general practitioners to see how they were performing. Not
all practices were the same; some needed more help than others. Some “sticks”
were needed in addition to the “carrots”, Mr Burns warned.