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Prescribing cash rewards focus on cost not quality

Cash-strapped primary care trusts are hampering GPs' efforts to improve the quality of their prescribing with unfair incentive schemes, Government-funded researchers are warning, writes Brian Kelly.

In 52 per cent of PCTs, any practice that stays within its prescribing budget gets an automatic cash reward even if no quality targets have been met.

In contrast, 14 per cent refuse to pay GPs who overspend, however good the quality of their prescribing.

The study scrutinised incentive schemes in 130 PCOs between 1999 and 2001.

Most schemes focused on indicators designed to control drug costs ­ 75 per cent of PCTs had an indicator for generic prescribing and 77 per cent for gastrointestinal drugs.

Indicators for statin prescribing leapt from 17 per cent of PCTs in 1999 to 55 per cent two years later. But four PCTs rewarded GPs for cutting ­ rather than increasing ­ their statin prescribing, said a report in the British Journal of General Practice (June).

Study leader Dr Mark Ashworth, research fellow in general practice at Guy's, King's and St Thomas' school of medicine and a GP in south London, said PCTs were hampering efforts to improve GP prescribing by 'rewarding underspent practices regardless of quality and withholding rewards to high-quality prescribers who overspent'.

Dr Peter Fellows, chair of the GPC prescribing sub-committee, said early results from its UK-wide survey showed the aim of most incentive schemes was to cut costs.

RCGP prescribing spokes-man Dr Jim Kennedy said: 'It's probably in breach of clinical governance to have schemes where the big issue is the money and not a balance between money and quality.'

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