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Gold, incentives and meh

Government faces legal challenge on drug switching

The pharmaceutical industry is to take the Government to court in an attempt to halt the proliferation of drug switching schemes, Pulse has learned.

Lawyers for the Association of the British Pharmaceutical Industry have been granted a judicial review of drug switching, and will argue that patients are being put at risk and GPs illegally paid to participate.The Department of Health responded to legal moves from the industry by issuing urgent guidance to PCTs on how to operate schemes safely, insisting patients must be individually assessed and warning against inappropriate payments to GPs for switching patients to cheaper drugs en masse.But the ABPI told Pulse the guidance did not go far enough and that patients must give explicit consent before being moved to cheaper alternatives.News of the legal action came as PCTs across the country began extending mass switching beyond statins to ACE inhibitors, PPIs and anti-platelets (see story below).The ABPI said payments to doctors as a direct financial inducement to use certain medicines in substitution for other named medicines were illegal under European law.Prescribing experts admitted the timescales imposed by PCTs for switching patients meant GPs were sometimes forced to change scripts without assessing individual clinical circumstances or obtaining explicit consent. But they insisted that, far from being bribed, GPs were not receiving enough money for the huge amount of time and effort involved.Dr Peter Fellows, chair of the GPC prescribing sub-committee, said: 'Doing all this for very small short-term financial gains is really ridiculous. I will fight to the death to defend doctors' right to prescribe what they think is most clinically effective.'Medicolegal experts said GPs must choose treatment based on their assessment of an individual's needs and should obtain patient consent – or they could face legal problems.Dr Michael Devlin, a medicolegal adviser with the Medical Defence Union, said: 'It's always important to keep clear, contemporaneous records detailing the need for change, any information given to the patient, that consent was obtained and the new medication, its dose and any relevant cautions.'Professor Mike Kirby, a researcher on drug switching and professor of health and human sciences at the University of Hertfordshire, said careful evaluation was essential before switching.'You would only need to have one event and you would waste all the money you had saved by the patient going into hospital,' he warned.

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