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CAMHS won't see you now

Prescribing freedom threat

The first signs have emerged of a PCO crackdown on soaring prescribing bills in the wake of the new contract.

GPs in Wales are furious

after changes to their prescribing incentive scheme left the average practice facing a loss of £7,000 in expected income.

News of the scheme came as figures from the Prescription Pricing Authority provided the first hard evidence of spiralling prescribing costs for drugs linked to quality targets.

Cardiff local health board has reacted to fears over its rising drugs bill by informing GPs they will only be eligible for lucrative incentives on prescribing quality if they first meet strict budget limits.

The board said: 'It is likely there will be an increase in prescribing of expensive drugs for GPs to reach the new GMS targets. The purpose is to continue to place a downward pressure on the prescribing budget to ensure ineffective prescribing is eliminated.'

But Dr Charles Allenby, Bro Taf LMC treasurer and GPC South Wales representative, said GPs would lose out on incentives in areas such as appropriate use of antibiotics and generics because the quality framework would push them over budget. 'Local GPs are very upset,' he said. 'If GPs try to achieve quality targets they're going to exceed their budgets. And if GPs become lackadaisical it will take a lot of future effort to encourage them to prescribe responsibly.'

The Prescription Pricing Authority found the overall drugs bill rose by 5.8 per cent in the year to June 2004, but that prescribing costs increased much faster for drugs in the framework.

The cost of antiplatelets rose by 34 per cent, smoking cessation drugs by 23 per cent, insulin by 18 per cent and statins by 15 per cent.

Dr Peter Fellows, chair of the GPC prescribing sub-committee, said: 'I do not like local schemes that ration prescribing. Incentives should be decided nationally in line with the quality framework.'

He said increases in prescribing bills were 'inevitable' and predicted rises of 10 per cent compared with the Prescribing Support Unit's prediction of a 5.6 per cent rise.

Further data showed national service frameworks had dramatically pushed up prescribing bills.

By Emma Wilkinson

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