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GPs may boycott shared-care drugs

By Cato Pedder

GPs are threatening to boycott prescribing of drugs initiated by specialists unless they are paid for the service.

Several LMCs are embroil-ed in negotiations with primary care trusts over GPs' demand for a local enhanced service to cover ongoing prescribing of drugs under shared-care protocols.

The GPC has expressed support for the stand, making clear it is not part of GPs' 'core work' under the new contract.

GPC prescribing chair Dr Peter Fellows said the prescription of such drugs required extra work for GPs in monitoring patients. 'This is not bread and butter work.'

He believes GPs should be paid under a local enhanced service for prescribing any drugs classified 'amber' under the GPC's traffic light system. Amber drugs are those that GPs should only be expected to prescribe with specialist support under a formal shared- care arrangement (see right).

Gloucestershire LMC is in talks with local PCTs and has advised members not to prescribe any 'amber' drugs unless they are paid for it.

LMC secretary Dr John Peniket said: 'We are suggesting PCTs consider offering GPs an enhanced service for this. If they don't want to do that we are quite happy – we won't prescribe them.'

Paul Edwards, director of service provision and primary care development at Cheltenham and Tewkesbury PCT – one of those involved – said the trust had been working with the LMC to resolve issues around core and enhanced services but the issue of amber drugs had not been agreed.

Dr Peniket said GPs would continue prescribing amber drugs to patients who were already receiving them but would refuse for new patients.

Dr Fellows said: 'It would be difficult to turn round to patients already taking the drugs and tell them "Sorry, you have got to go to the PCT and ask if anyone else can prescribe this for you".'

Dr Simon Fradd, joint-deputy chair of the GPC, said prescribing drugs under shared- care protocols was 'definitely an enhanced service'. But he added: 'When drawing the dividing line between services the best way forward locally is to have some give and take.'

'Amber' drugs at

centre of pay row

Gloucestershire LMC's list of amber drugs covers 57 drugs, including:

lmethylphenidate for ADHD

lciclosporin for rheumatoid arthritis/ psoriasis

lleflunomide for active rheumatoid arthritis

lmethotrexate (oral or intramuscular) for rheumatoid arthritis

lgalantamine for Alzheimer's disease

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