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The drive to make preventive medicine a key priority of primary care is forcing GPs into a 'scattergun' approach to prescribing, a new study warns.

GPs are under such pressure to meet targets they are prescribing 'indiscriminately' to achieve them, the researchers concluded.

There was no relationship between expenditure on prescribing and quality of care in five of the seven areas the study examined – including preventive measures such as flu vaccination, smoking cessation and use of statins.

But the GP lead researcher cautioned the results should not be seen as a rationale

for implementing cost-cutting prescribing incentive schemes, saying such schemes were 'not desirable'.

The University of East Anglia study analysed expenditure on prescribing in 71 practices in Waveney PCT and used McColl quality indicators to estimate the number of lives saved per 100,000 population.

It found up to an eight-fold variation in the expenditure per patient, but no relationship between cost and quality for hypertension, aspirin

and statin use, smoking cessation and flu vaccination.

There was, however, a significant correlation between cost and quality for prescribing of ACE inhibitors in heart failure and warfarin for atrial fibrillation.

Study author Dr Bob Fleetcroft, a GP with a special interest in clinical education for Great Yarmouth PCT, said GPs were more efficient at prescribing drugs like warfarin because of their narrow indications, but for preventive measures they often prescribed in low-risk patients.

He added: 'I'm not saying the interventions are not important or should not be done, but the effects are often overestimated.'

GPC prescribing sub-committee member Dr Chaand Nagpaul, a GP in Edgware, Middlesex, warned: 'Percentage targets don't encourage treating the highest risk patients. The current approach has a scattergun effect.'

The research was presented at last week's London School of Economics health economics conference and is to be submitted to the BMJ.

GPC deputy-chair Dr Laurence Buckman insisted that while the quality framework would push up prescribing costs, it would also make prescribing more efficient.

By Rob Finch

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