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All is not lost in battle over prescribing curbs

From Dr Bill Hart, Everthorpe,

East Yorkshire

How right you are to highlight prescribing restrictions as a disturbing new development in the ever more intrusive attempts by PCTs to keep GPs in their places (News, 9 November).

What is happening here is the hijacking of annexe 8 to the revised GMS contract and manipulation of its wording in order to bring undue pressure to bear.

The annexe seems designed to prevent the more flagrant schemes being used

to make money out of prescribing, particularly by dispensing doctors. It cites examples of inappropriate practices,

such as different prescribing between dispensing and non-dispensing patients, drug switches for the purposes of profit and the prescribing of excessive amounts of high-cost products.

All responsible GPs would be more than happy to go along with such strictures, ever mindful that we live in hard times and that we have a duty to be careful with public money.

The trouble is that the heading of the annexe is 'excessive or inappropriate prescribing' and that within the text there is the rather vague assertion that 'switching' patients to less expensive drugs, usually within a therapeutic class, is 'generally appropriate'.

This gives carte blanche for a PCT to come down hard on any poor GP who dares to write a script for modified-release diclofenac, accusing them of prescribing in an excessive or inappropriate manner, because it's not in the local formulary.

All is not lost, however, as enshrined in the said document is also a commitment to upholding the freedom to switch patients to higher-priced, or alternative, drugs for clinical reasons. Therein may be grounds for legal challenge should a PCT become too threatening.

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