Value for Money Report on Prescribing Practices and the Development of General Practitioners Services
The Minister for Health and Children, today, laid before the Dail the Value for Money Report of the Comptroller and Auditor-General on Prescribing Practices and the Development of General Practitioners Services.
The Report covers the period 1993-6 and deals with the nature and cost of the General Medical Services Scheme. Its principal focus is on the measures being taken to promote more cost-effective prescribing (and whether there is potential for further savings) and the extent to which the improvements identified in the Department’s 1994 Strategy Document have been implemented.
The Department and the GMS (Payments) Board provided background information and considerable statistical data for the study. Consultancy assistance to the Comptroller and Auditor General on medical and prescribing aspects of the Report was provided by the Department of Community Health and General Practice, Trinity College, Dublin.
Minister Cowen said
“I would like to thank the Comptroller and Auditor-General, and his staff, for this valuable analysis. The Report is a timely review of development in the areas of general practice and prescribing practices in the period 1993-6. The overall tenure of the Report is that while much has been achieved, more progress can be made. I agree with that sentiment and my Department are studying the findings of the Report with a view to making continuing progress in these areas. Indeed, it is planned to hold a National Seminar for all Health Board General Practice Units and my Department in the near future which will provide a forum for action on several of the Report’s findings.”
While accepting the overall conclusions reached in the Report, the Minister felt it important to elaborate on certain specific findings.
Indicative Drugs Target Scheme
While accepting the accuracy of the figures cited by the Comptroller and Auditor-General about actual savings made by doctors under the Scheme the Minister remains satisfied with the success of the Scheme and believes that it has, and continues to have, a positive influence in achieving more rational and cost-effective prescribing. He would point out that it has contributed greatly to a significant containment of costs in recent years. The average annual rise in the GMS drugs cost has fallen to approximately 6% as compared to 10% prior to the inception of the IDTS.
Economy in Prescribing Practices
The Report recognised that progress has been made in substituting lower costs equivalent drugs but felt that there is still scope to achieve further significant savings and identified substitution of generic for proprietary drugs and a switch to certain (more economic) alternative therapies for patient care in certain areas. The Minister would have concerns that the strong economic emphasis in Chapter 4 of the Report (dealing with economy in prescribing practices) could give the impression that potential savings that could be achieved by way of full substitution are, in fact, capable of being fully realised. He acknowledges that this point is, in fact, accepted by the Comptroller and Auditor-General in the Report which states that substitution is not feasible in all cases and that its estimates of savings must be viewed as being at the upper limit of potential savings.
The Minister would point out that prescribing remains at the absolute discretion of individual GPs in the exercise of their clinical judgement and it would be wholly unrealistic, and indeed contrary to best prescribing practice, to expect that a full switch to the cheapest therapies could take place. For example, the newer anti-depressants (SSRIs) have advantages over older ones (tricyclics) in that they cause less sedation, less anti-chloinergic effects, less cardiotoxicity and less weight gain. They are also very helpful to those patients who are unable to tolerate tricyclics and to those whose depression is accompanied by obesity or heart disease.
The Minister would further point out that a comparison with EU Member States shows that that our per capita consumption of medicines is below the European average. This supports the conclusion that Irish doctors’ prescribing habits are very prudent.
Finally, in this area of economy in prescribing, the Minister would draw attention to the recent establishment of the Centre for Pharmacoeconomics at Trinity College / St James’ Hospital which will facilitate further the type of analysis envisaged in the Report.
Improvements in General Practitioner Services
The Minister accepts that the Report was rightly concerned with evaluation of monies spent under the IDTS and GP Development Fund on the development of general practice. He accepts that greater evaluation is desirable but would point out that since March 1996 all new projects are required to have in-built evaluation mechanisms. Indeed, the existence of this evaluative process is acknowledged in the Report. It is intended that the issue of project evaluation will be one of the issues directly addressed at the forthcoming National Seminar.
The Report also referred to the target figure of 80% for GP computerisation by 1997 and indicated that the figure has not yet reached that level. More recently available figures from a national study show that the level of GP computerisation continues to climb and there are several initiatives taking place, at present, such as Healthlink, which electronically links GPs with hospitals. Moreover, a National GP Information Technology Group has recently been established by the Department to co-ordinate and promote GP computerisation and the appointment of a contract based resources person for that Group is provided for.