GP prescribing incentive schemes face axe

By Lilian Anekwe

Exclusive: NHS managers have sounded the death knell of prescribing incentive schemes, with two-thirds of PCTs ready to scrap the schemes in response to changes to the new GP contract, Pulse can reveal.

Our investigation shows two-thirds of PCTs are set to bin their prescribing incentive schemes and the financial incentives offered, resulting in a massive loss of income for GP practices.

It comes after GPC negotiators and the Department of Health agreed to include quality and productivity indicators in the QOF for the first time, in a bid to meet the Government's primary care efficiency drive.

The new indicators were included as part of a contract deal that saw practices offered no new money for 2011/12 and only a 0.5% increase to cover rising practice expenses.

The loss of prescribing incentive money is likely to result in more cash being taken away from patient care, say GP leaders who urged PCTs to retain their existing schemes

The new contract allocates 28 points for GP practices to ‘conduct an internal review of their prescribing followed by an external peer review which will include an assessment of clinical and cost effectiveness', and agree three areas in which to make improvements in order to prescribe more cost-effectively.

PCTs have made widespread use of prescribing incentive schemes to encourage GPs to prescribe more cost-effectively, including drug switching and generic prescribing schemes. Of the 35 PCTs who responded to our inquiry, 21 currently have prescribing incentive schemes in place.

Of those, only seven said they planned to continue funding the scheme next year, while two-thirds said their schemes were either subject to review or would have their funding scrapped.

PCTs told Pulse that their decision to reassess the schemes had been taken as a direct result of the new quality and productivity indicators and concerns that GPs we effectively be paid twice - although the final wording of the indicators has yet to be released.

A spokesperson from NHS Hertfordshire said: ‘There was an optional prescribing element included in the PBC LES for 2010/11. There are plans to have a similar scheme in 2011/12 which will be reviewed in light of the QOF changes.'

A spokesperson from NHS Bury said: ‘NHS Bury has operated a prescribing incentive scheme during 2010/11. In light of the change to QOF we are now reviewing our plans for 2011/12.'

Others said prescribing incentive schemes would only continue if GPs could prove they were entitled to any additional payments.

NHS Oxfordshire said the trust would only continue the scheme ‘until such time as the details of the changes to the QOF are clear that the prescribing incentive scheme will not add anything to the revised QOF.'

NHS Dudley said it intended to run the prescribing incentive scheme next year, but added that ‘the associated targets will be in addition to those agreed as part of the new QOF additional allocation.'

The GPC said that trusts should retain any existing prescribing incentive schemes, as the new indicators reward improvements in cost efficiency, not quality.

Dr Bill Beeby, a GP in Middlesbrough and chair of the GPC clinical and prescribing sub-committee, said there was no guarantee the money in these schemes would be recycled for the benefit of patients.

‘QIPP does look at quality but the new indicators are intended to reduce costs and efficiencies. We have to be sure ultimately that this is in the best interest of patients. It's a risk.'

35 – Number of trusts surveyed

21 – Number of trusts that funded prescribing incentive schemes in 2010/11

14 – Number of trusts that have cancelled schemes for 2011/12 or placed them under review

7 – Number of trusts who have committed to retaining schemes in 2011/12

Source: Pulse investigation

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