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GPs given script initiation job

By Lilian Anekwe

GPs will be expected to take responsibility for initiating drugs to patients attending hospital outpatient clinics, as part of a major Department of Health crackdown on prescribing costs.

Ministers have told NHS managers to minimise outpatient prescribing, moving instead to a system in which clinics provide GPs with advice on initiating therapy, ‘moving costs to primary care but allowing secondary care to focus on other issues'.

The controversial move is one of 50 ‘top tip' efficiency measures set out by the DH as it ramps up its push for more cost-effective prescribing under its quality, innovation, productivity and prevention (QIPP) policy drive.

Tip 8 advises SHAs and PCTs that ‘outpatient prescribing should be minimised' in favour of ‘moving to an advice to GP system' that puts GP in control of initiating therapy once patients are discharged from hospital.

An impact assessment claims the initiative will result in ‘significant reductions in volume of outpatient dispensing' – and shunt the costs of prescribing costly hospital drugs that GPs are not familiar with onto primary care.

In the document the DH admits the schemes will be difficult to implement but insists they will have a ‘marginal impact' on patient outcomes.

SHAs and PCTs are told to push for greater than 80% use of simvastatin in GP statin prescribing and to reduce use of angiotensin receptor blockers with advice that a ‘crude ratio of ARBs to ACE inhibitors may be a useful diagnostic'.

PCTs will also be expected to audit GP prescribing to identify low users of cheaper PPIs and to draft guidelines supporting use of drugs with the lowest acquisition cost for atypical antipsychotics and antidepressants.

And prescribing advisers are expected to discourage GP prescribing of unlicensed products, by ‘managing use of specials to support cost-effective use in primary care, minimising their use or choosing those of known low acquisition cost'.

Dr Bill Beeby, a GP in Middlesborough and chair of the GPC clinical and prescribing subcommittee, said: 'We already have an enormous problems with people recommending drugs that we should not be initiating.

'This doesn't seem very sensible to me and it's patients who end up getting really hacked off.'

PCTs will be expected to audit GP prescribing of PPIs What the QIPP document recommends

• Outpatient prescribing minimised – moving to an ‘advice to GP system'-
• Looking for 80% of statin prescribing to be simvastatin
• Reduced use of ARBs and use of lowest cost choice if unavoidable
• Cutting PPI cost
• Lowest acquisition cost of atypical antipsychotics and antidepressants
• Managing use of specials

Source: Top tips– efficiency schemes in provider settings, DH 30 Sept 2010

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