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Independents' Day

Prescribing freedom put in jeopardy

GPs' freedom to choose the best drugs for their patients is threatened by a controversial clause buried in the new contract, according to prescribing experts and health law academics, writes Brian Kelly.

They fear the 'excessive prescribing' clause in the model contract agreed by GP negotiators and the NHS Confederation opens the door for primary care organisations to crack down on practices with high prescribing bills.

GPC prescribing chair Dr Peter Fellows said PCTs were 'cock-a-hoop at the scope for prescribing pressure concealed here'.

He fears the decision to move the clause out of GPs' disciplinary regulations and into their contract will give PCOs much greater powers to force GPs to choose the cheapest drug option.

'Under the old regulations, if a GP was accused of excessive prescribing the LMC would be involved from the start. This clause does away with any LMC involvement and could give PCTs licence to clamp down on non-generic drugs and 28-day prescriptions,' said Dr Fellows.

RCGP prescribing spokes-man Dr Jim Kennedy, a GP in Hayes, Middlesex, said he feared PCTs may 'come down hard' on high-spending GPs. 'The clause is way too loose,' he said. 'There needs to be an agreement about who polices this ­ and GPs must have the right to present extenuating circumstances.'

The clause bans GPs from prescribing drugs and appliances 'whose cost or quantity is in excess of that which was reasonably necessary for the proper treatment of that patient'.

Christopher Newdick, a barrister and reader in health law at the University of Reading, said: 'This is effectively a disciplinary regulation that has been inserted into GPs' terms of service for the first time.

'The disciplinary guidance was very much to do with excessive and downright dangerous prescribing. You have to wonder whether this regulation may now be used in a different way.'

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